Pathways of front-line healthcare professionals’ information anxiety during the COVID-19 pandemic: A qualitative study in China

Abstract

Exploring information anxiety is critical to protecting the mental health of front-line healthcare professionals. Their information anxiety is impacted by interrelated conditions during public health emergencies, but existing studies have not confirmed the impact of the combination of conditions and clarified the pathways of information anxiety. Twenty-four healthcare professionals were recruited for semi-structured interviews. Qualitative Comparative Analysis was used to analyze necessary conditions and pathways of information anxiety. The results showed that information, environment, personal, and content were identified as antecedent conditions, and information quantity anxiety, information quality anxiety, and information content anxiety were identified as outcome conditions. Furthermore, information quality and social environment were necessary conditions. Spontaneous and extrinsic information anxiety were found based on pathways. Identifying conditions and pathways was essential for understanding the information anxiety of front-line healthcare professionals and providing evidence for medical institutions to take target measures in future public health emergencies.

Keywords

information anxiety healthcare professionals pathways qualitative comparative analysis pandemic

1. Introduction

The novel coronavirus epidemic was listed as a Public Health Emergency of International Concern in 2020 (Zhao et al., 2020). The negative impacts of COVID-19 are comprehensive, including severe blows to human health, socio-economic conditions, global order, and people's way of life. Healthcare professionals are the backbone of the fight against the pandemic, and their selfless dedication and professional treatment have made significant contributions to global COVID-19 prevention and control efforts. They were exposed to physical and mental exhaustion (Leo et al., 2021), causing emotional burnout during the COVID-19 pandemic. Different from the information needs of ordinary people, front-line healthcare professionals had to not only obtain, judge, and use necessary information related to their own medical work and daily life but also respond to extensive information demands from patients, relatives, friends, and colleagues as important information providers. The suddenness, complexity, harmfulness, and contagiousness of public health emergencies have caused widespread panic among the public, including healthcare professionals, thereby increasing their sensitivity to information as both information demanders and providers. This phenomenon usually exceeded the information and information ability they had and led to a high risk of information anxiety.

Information anxiety typically consists of five subcomponents, including not understanding information; feeling overwhelmed by the amount of information to be understood; not knowing if certain information exists; not knowing where to find information; and knowing exactly where to find the information, but not having the key to access it (Wurman, 1989). At present, information anxiety has been common among front-line healthcare professionals during the COVID-19 pandemic (Alenazi et al., 2020). Although anxiety has received much attention (Lai et al., 2020), fewer studies have explored information anxiety among front-line healthcare professionals (McMullan et al., 2019; Luo et al., 2020; Crowe et al., 2021), which was kind but quite different from the anxiety in existing research, such as signs, subcategory, and behavior (Charpentier et al., 2022).

Information anxiety can reduce the work performance and quality of life of healthcare professionals, thereby damaging their health (Li et al., 2020; Luo et al., 2020). There are several conditions behind why front-line healthcare professionals might suffer from information anxiety, such as environmental, sociodemographic, psychosocial, and occupational conditions (Roger et al., 2024; Ambrose et al., 2024; Hameed et al., 2022). The involvement of information characteristics in information anxiety has been investigated for a long time (Muse et al., 2012). Considering methods, scholars already have methods for identifying and classifying conditions of information anxiety, which require front-line healthcare professionals to fill in a subjective questionnaire. It led to information anxiety conditions being confined to a predetermined framework, making it difficult to understand the relationship between situation and conditions. More importantly, front-line healthcare professionals, with their rich experiences in medical work, do not develop information anxiety driven by a single condition but only when multiple conditions act simultaneously. Therefore, concurrent combinations of multiple causal conditions impact front-line healthcare professionals’ information anxiety during public health emergencies. To protect healthcare professionals’ mental and physical health, it is essential to understand concurrent combinations of their information anxiety conditions, and further identify the pathway in which these conditions impact information anxiety.

While the previous study primarily examined identified and analyzed conditions impacting information anxiety (Erfanmanesh et al., 2014; Naveed, 2016), effective methods are urgently needed to understand how different conditions combine to impact the information anxiety of front-line healthcare professionals. On this basis, Grounded theory (GT) was a qualitative research methodology that enabled researchers to examine areas from different angles (Strauss and Corbin, 2014), and qualitative comparative analysis (QCA) advocated subtle changes in the combination of conditions that might produce different outcomes (Greckhamer et al., 2018). It enables the analysis of the multiple concurrent conditions impacting information anxiety in public health emergencies and the conclusion and comparison of the pathways impacting information anxiety based on cases. The holistic and case-based advantages of GT and QCA allow us to understand healthcare professionals’ information anxiety during the COVID-19 pandemic. The contributions of the study are as follows: (1) Information anxiety conditions from a contextual perspective were identified and classified, to form a framework for information anxiety and its conditions among front-line healthcare professionals during the COVID-19 pandemic; (2) Pathways of front-line healthcare professionals’ information anxiety during the COVID-19 pandemic were concluded and compared, and targeted solutions to protect the mental health of healthcare professionals in future public health emergencies and ensure the continuous and stable operation of medical institutions were proposed.

Considering the causal complexity of information anxiety, the condition is an attribute that impacts information anxiety, the configuration is the combination of conditions that produce the same outcome, and configurations with the same core causal conditions could be concluded into pathways that impact information anxiety of front-line healthcare professionals. The research questions of this study are as follows:

RQ1: What conditions are necessary to impact the information anxiety of front-line healthcare professionals during the COVID-19 pandemic?

RQ2: What pathways can impact the information anxiety of front-line healthcare professionals during the COVID-19 pandemic?

2. Literature review

2.1. Mental health of healthcare professionals during the COVID-19 pandemic

Healthcare professionals are at high risk of developing mental health issues during the COVID-19 pandemic, such as post-traumatic stress disorder, anxiety, depression, and distress (Saragih et al., 2021). Working place, gender, age, relationship, isolation status, and marital status (Di Tella et al., 2020; Alonso et al., 2021) have been proven to be important conditions that impact mental health issues. Furthermore, characteristics of public health emergencies, especially the COVID-19 pandemic, exacerbate these mental health issues of healthcare professionals, such as suddenness, publicness, severity, and variability (Sovold et al., 2021). On this basis, many studies explored measures to protect healthcare professionals against negative mental health outcomes. Higher moral resilience, self-perceived social support, and self-efficacy (Spilg et al., 2022; Ortiz-Calvo et al., 2022; Serrano-Ripoll et al., 2020) were effective in addressing mental health issues during the COVID-19 pandemic. Large-scale surveys provided data support for understanding the mental health of healthcare professionals during the COVID-19 pandemic, and systematic reviews provided literature support for sorting out the progress of mental health research.

Anxiety is a common psychiatric disorder in the general population. Studies have been conducted to identify conditions of anxiety, such as sociodemographic (Shen et al., 2020), psychosocial (Shi et al., 2022), and environmental (Ayhan-Balik et al., 2022) conditions. Healthcare professionals’ anxiety is more likely influenced by infection risk, supplies, isolation, and working time (Fang et al., 2021). There are differences in anxiety among healthcare professionals during the COVID-19 pandemic. For example, front-line healthcare professionals generally experience anxiety during the COVID-19 pandemic, some of which develop into mental disorders (Tong et al., 2023; Alonso et al., 2021). However, with every infectious disease outbreak, an information epidemic (infodemic) breaks out simultaneously (Xu and Sasahara, 2021), making information an important cause of anxiety for healthcare professionals. Studies have explored information seeking anxiety of healthcare professionals, where demographics, information quantity, and environment are important conditions (Erfanmanesh et al., 2014; Naveed, 2016). Information seeking anxiety is a type of information anxiety that reflects information anxiety about the information search process rather than information characteristics. Furthermore, the overall understanding of information anxiety and its conditions is yet to be explored.

2.2. Information anxiety

Information anxiety (IA) is produced by the ever-widening gap between what we understand and what we think we should understand. It happens when information doesn’t tell us what we want or need to know (Wurman, 1989). Information anxiety conditions have been a focus of existing research. On this basis, the outcome variables of information anxiety are usually subcategories of information anxiety, such as information-seeking anxiety (Naveed, 2016) and work information anxiety (Song et al., 2023). The former is a subcategory based on behavior, while the latter is a subcategory based on themes. In terms of behavior, information anxiety in information-seeking behavior has been widely studied (Ross et al., 2024). However, healthcare professionals not only engage in information-seeking behavior but also engage in a large amount of information-providing behavior. In terms of theme, context, and occupation are the main reasons for the differences in themes. In addition, the level of information anxiety measured by the Information Anxiety Scale is also an important outcome variable (Erfanmanesh et al., 2014), but it shows significant differences in existing studies based on measurement indicators. Furthermore, information quantity and quality, emotion, and task are the antecedent conditions impacting information anxiety in the present study (Xiang et al., 2021). It is worth noting that many studies constructed models to explore the factors of antecedent conditions, or to explore the moderating effect of conditions on outcome variables.

The conditions of information anxiety of front-line healthcare professionals are quite different compared to those of anxiety during public health emergencies. Firstly, information characteristics are important conditions for information anxiety, not anxiety (Altino et al., 2017). Secondly, information characteristics generally do not directly impact information anxiety, which can be caused by relatively independent conditions. For example, Huang et al. (2022) believed that perceived information overload was positively associated with unverified information sharing, and this relationship was partially mediated by anxiety. Ozdin and Sukriye (2020) indicated that female gender, living in urban areas, and previous psychiatric illness history were found as risk conditions for anxiety according to regression analysis. Therefore, the difference between information anxiety and anxiety conditions not only illustrates the importance of understanding the information anxiety of front-line healthcare professionals from a holistic perspective but also demonstrates the necessity to analyze information characteristics about the situation in which healthcare professionals were placed.

Information anxiety is a multidimensional construct that is operationalized as having elements (Ross et al., 2024). Theoretical models are used to explore the relationship between antecedent and outcome conditions, such as the Stimulus-Organism-Response (S-O-R) framework (Soroya et al., 2021). At present, few studies have explored the information anxiety of front-line healthcare professionals from the perspective of configuration and pathway, especially in the context of the COVID-19 pandemic. However, the study of the impact of epidemic outbreaks on the mental health of healthcare workers has received widespread attention, with anxiety being the most concerning topic for researchers (Serrano-Ripoll et al., 2020). Furthermore, the factors that impact the information anxiety of healthcare professionals are often considered to be independent, and how factors such as information characteristics impact information anxiety is also analyzed. The identified factors that impact information anxiety and the analysis of their correlation provide a theoretical basis for this study.

2.3. Research methods for information anxiety

Recently, the acquisition of conditions impacting information anxiety or anxiety relies on large-scale questionnaires (Subasi et al., 2021), and logistic regression methods help in the analysis of questionnaire data (Icten et al., 2022). Based on the above methods, conditions are often limited to the existing frameworks of literature, which do not apply to the complex situation of public health emergencies and the special group of front-line healthcare professionals. Furthermore, it is impossible to form an overall understanding of conditions in different situations.

Grounded Theory (GT) is a qualitative research methodology that aims to explain social phenomena (Brunet et al., 2022), which is useful when it comes to acquiring insight into new areas that have been unexplored (Strauss and Corbin, 2014). Information anxiety of front-line healthcare professionals is a common social phenomenon during the COVID-19 pandemic, and its conditions are rarely studied yet. Accordingly, Grounded theory has strong adaptability and pertinence to this study.

Qualitative comparative analysis (QCA) is an approach that combines quantitative and qualitative research (Ragin, 1987), which is becoming an important approach in several fields, such as psychology, health care science services, public environmental, and occupational health (van Rensburg et al., 2021; Leila et al., 2016). Previous studies have applied QCA to identify configurations of mental health status. For example, Ding et al. (2022) found that the occurrence of health-information avoidance is not the result of a single condition but the result of a configuration of health-information literacy, negative emotions, perceived information, health-information presentation, cross-platform distribution, and the network information environment. Front-line healthcare professionals have experience in dealing with public health emergencies, so analyzing information anxiety from the perspective of multiple conditions can better understand the psychological state, which is suitable for this study.

QCA follows the following research process (Huarng and Roig-Tierno, 2016): (1) Data calibration depends on the type of data collected and the form of data distribution, amongst other conditions, which is to rank or create order amongst values of the variable (Bhattacharya, 2022). Data observations are assigned set membership values ranging between 0 to 1 (Ragin, 1987). 0 (non-membership) and 1 (membership) are two qualitative states of set-membership values in crisp-set. In contrast, 0 (non-membership), 0.5 (partial-membership), and 1 (membership) are qualitative states of set-membership values in a fuzzy-set (Bhattacharya, 2022). (2) Necessity analysis involves a causally interpreted relation between the outcome and one simple condition. If the consistency score is 0.9 or higher, a condition is “necessary” or “almost always necessary” (Valaei et al., 2017). (3) Configuration is the combination of conditions. There may be multiple configurations that produce the same outcome, and a condition may contribute to producing both the outcome (Y) and its negation (∼Y) depending on the configuration it is in (Verweij and Vis, 2021). (4) Pathway analysis is the interpretation of the case based on the induction of configurations (Ragin, 1987). The QCA analysis process helps to provide a step-by-step and in-depth understanding of information anxiety so that medical institutions and the government can combine their resources to protect the mental health of healthcare professionals during public health emergencies and promote the normal and orderly operation of medical institutions.

3. Material and methods

3.1. Study setting

Data collection and data analysis were the two main steps of this study. Compared to a Focus Group Interview and Systematic Review, semi-structured interviews help to obtain each participant's unique information anxiety experience (Naveed and Anwar, 2022). A semi-structured interview was used to collect data and eventually to obtain texts about information anxiety conditions. Grounded theory was used to identify and classify information anxiety conditions and to construct a conceptual framework about the relationship between antecedent and outcome conditions of information anxiety. According to the conceptual framework, QCA was used to analyze whether the antecedent conditions are necessary for the outcome conditions of information anxiety, on the basis of which the configuration and pathway of information anxiety were analyzed and compared, as shown in Figure 1. Although studies have attempted to use Comparative Analysis Method (Girard and Allison, 2008), QCA provides a holistic perspective on experiences for this study.

Figure 1.

Data collection and analysis process of this study.

3.2. Data collection

Participants and sampling. Twenty-four front-line healthcare professionals who underwent medical treatment and nurses during the COVID-19 pandemic in a Wuhan hospital (China) with over 5000 beds were recruited in the semi-structured interviews through network announcements. The network announcement briefly described the research object, research content, and participants’ criteria.

To ensure the randomization of front-line healthcare professionals, they were identified and selected based on the following criteria: (1) ≥ 18 years of age, (2) working time ≥ 1 year and participated in healthcare work during the COVID-19 pandemic, (3) exclude trainees, students, and off-duty workers, and (4) able to read and provide informed consent. To ensure the representativeness of the participants, front-line healthcare professionals came from nine departments including the infection department, cardiovascular department, cardiac surgery, etc. Furthermore, they came from the top hospital in China and could carry out extensive communications and cooperation with other regions and countries during the COVID-19 pandemic.

Subsequently, all participants provided written informed consent, and semi-structured interviews were arranged with their permission. Participants were informed that their answers were collected for academic purposes only.

Interviews and transcriptions. Gender, Age, Role, Title of public health technician, Education, and Working experience were collected through a questionnaire, as shown in Table 1. An overview of participants’ profiles is shown in Table 2.

Table 1.
Summary of participants’ characteristics.

Demographic variable Descriptives

Gender

Male 7 (29.1%)

Female 17 (70.8%)

Age

＜31 years 3 (12.5%)

31～40 years 19 (79.1%)

＞40 years 2 (8.3%)

Role

Physician 9 (37.5%)

Nurse 15 (62.5%)

Title of public health technician

Physician/Nurse 13 (54.1%)

Doctor/Nurse in charge 7 (29.1%)

Assistant Director Physician/Nurse 2 (8.3%)

Director Physician/Nurse 2 (8.3%)

Education

Bachelor 13 (54.1%)

Master or Doctor 11 (45.8%)

Working experience

＜6 years 12 (50.0%)

6～10 years 8 (33.3%)

11～20 years 2 (8.3%)

＞20 years 2 (8.3%)

Demographic variable	Descriptives
Gender
Male	7 (29.1%)
Female	17 (70.8%)
Age
＜31 years	3 (12.5%)
31～40 years	19 (79.1%)
＞40 years	2 (8.3%)
Role
Physician	9 (37.5%)
Nurse	15 (62.5%)
Title of public health technician
Physician/Nurse	13 (54.1%)
Doctor/Nurse in charge	7 (29.1%)
Assistant Director Physician/Nurse	2 (8.3%)
Director Physician/Nurse	2 (8.3%)
Education
Bachelor	13 (54.1%)
Master or Doctor	11 (45.8%)
Working experience
＜6 years	12 (50.0%)
6～10 years	8 (33.3%)
11～20 years	2 (8.3%)
＞20 years	2 (8.3%)

Table 2.

Overview of participants’ individual profiles.

ID	Gender	Age	Role	Title of public health technician	Education	Working experience
P1	Female	31～40 years	Physician	Assistant Director Physician	Master or Doctor	6～10 years
P2	Male	31～40 years	Physician	Physician	Master or Doctor	＜6 years
P3	Male	31～40 years	Physician	Doctor in charge	Master or Doctor	6～10 years
P4	Female	＜31 years	Nurse	Nurse	Bachelor	6～10 years
P5	Female	31～40 years	Nurse	Nurse in charge	Master or Doctor	11～20 years
P6	Female	31～40 years	Nurse	Assistant Director Nurse	Master or Doctor	11～20 years
P7	Female	31～40 years	Nurse	Nurse	Bachelor	6～10 years
P8	Female	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P9	Female	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P10	Female	31～40 years	Nurse	Nurse in charge	Bachelor	6～10 years
P11	Female	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P12	Female	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P13	Male	31～40 years	Physician	Doctor in charge	Master or Doctor	＜6 years
P14	Male	31～40 years	Physician	Doctor in charge	Master or Doctor	＜6 years
P15	Female	＜31 years	Nurse	Nurse	Bachelor	＜6 years
P16	Female	31～40 years	Physician	Physician	Master or Doctor	＜6 years
P17	Male	＞40 years	Physician	Director Physician	Master or Doctor	＞20 years
P18	Female	31～40 years	Nurse	Nurse in charge	Bachelor	6～10 years
P19	Male	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P20	Female	31～40 years	Physician	Doctor in charge	Master or Doctor	6～10 years
P21	Female	＜31 years	Nurse	Nurse	Bachelor	＜6 years
P22	Female	31～40 years	Nurse	Nurse	Bachelor	6～10 years
P23	Female	31～40 years	Nurse	Nurse	Bachelor	＜6 years
P24	Male	＞40 years	Physician	Director Physician	Master or Doctor	＞20 years

The interviewer used the interview guide written by several researchers familiar with the literature and the reality of front-line healthcare professionals. The interview guide included introductory questions focused on understanding the concept of information anxiety. These were followed by main questions informed by the research aim and relevant literature that covered: Please describe your information anxiety experiences in detail. Subsequently, the interviewer tested the interview guide with three front-line healthcare professionals who met the criteria. The purpose of the test interview was to determine if the questions were straightforward to respond to. Based on feedback received during the test interview, questions were revised. Data from the test interview were not analyzed for the study.

Then, two steps are used to complete the semi-structured interviews: 1) front-line healthcare professionals were encouraged to deviate from the interview questions and discuss information anxiety experiences that had significant meaning to them, and 2) the interview asks questions based on the clues provided by participants. The interviewer clarifies the meaning of the questions in the interview, so that participants understand that each question is helpful for the research, and encourage them to answer the questions more accurately.

Both the participants and interviewer were Chinese. Participants took part in semi-structured interviews, which were recorded throughout for subsequent analysis. Participants were asked to describe the details of their information anxiety experience. The interviews for each participant ranged from 15 to 33 min (M = 20 min). Twenty-four interviews were then transcribed verbatim by IFLYTEK. Two researchers were responsible for checking the consistency of text and voice word by word. All interviews were conducted in Chinese, and corpuses were presented in English. We conducted a follow-up. After the interview, we asked the participants for their suggestions on measures taken by medical institutions and the government to alleviate information anxiety. Their suggestions assisted in improving health services and policy-making.

3.3. Data analysis

3.3.1. Grounded theory

Although there were numerous conditions impacting the information anxiety of front-line healthcare professionals, no widely accepted framework has emerged. Grounded theory is important to understand the experiences of front-line healthcare professionals’ information anxiety from a holistic perspective and discover conditions of information anxiety that have not been addressed in previous research. Therefore, Grounded theory was used to identify and classify the antecedent and outcome conditions.

Coding. Transcribed data of this study were analyzed using Open, Axial, and Selective coding approaches (Corbin and Strauss, 2008). Two researchers coded independently to obtain the Initial coding and Axial coding results of the outcome condition, and the other two researchers coded independently to obtain the Initial coding and Axial coding results of the antecedent condition. The coding results of the antecedent and outcome achieved a reliability of 85%. Two experts checked the Initial coding and Axial coding results, achieving a validity of 95%. The controversial results were decided by a third expert. The category with the highest frequency was used as the Selective coding result. During the coding process of outcome conditions, a specific category of information anxiety was identified when one condition played a major role. The combinations of antecedent conditions are configurations, configurations with the same core causal conditions could be concluded into pathways. On this basis, the impact of condition configuration on different categories of information anxiety was the focus of this study. Saturation was reached within 24 interviews (Glaser and Strauss, 1967). Three interviews were used to determine that there were no additional conditions, and these interviews were not used for analysis in this study.

Constructing a framework of information anxiety conditions. A conceptual framework of information anxiety was constituted according to the coding results. Selective coding results of information anxiety classification were used as outcome conditions, and Axial coding results of condition classification were used as antecedent conditions. Outcome and antecedent conditions were selected to identify configurations impacting information anxiety accurately.

3.3.2. Qualitative comparative analysis

QCA has been widely used in health-related empirical studies in recent years, which is commonly used to explain the configuration of health-informed behavioral or psychological states. Furthermore, social phenomena rarely happen in a linear way, and there may be multiple configurations of conditions leading to an outcome. Therefore, QCA had advantages for identifying necessary conditions and configurations of front-line healthcare professionals’ information anxiety during public health emergencies. The steps of this study were as follows.

Calibration. Many calibration methods were employed to overcome the lack of precise theoretical guidance and subjectivity (Huang et al., 2022). However, due to the participants’ language expression habits and conversation styles, it is difficult to count the frequency of condition occurrences accurately and lacks analytical feasibility. Therefore, 0 and 1 were assigned as the thresholds for fully out and fully in the impact of information anxiety. This means that a condition is assigned a value of 1 when the participant explicitly indicated that it had an effect on information anxiety and 0 otherwise. As a result, there was also no crossover point in this study, and the data set for conditions of information anxiety was the crisp-set. Subsequent analysis can follow the csQCA method.

Necessity analysis. Consistency refers to the proportion of outcome contained by a condition and the proportion of the intersection of the outcome and the condition to the outcome (Valaei et al., 2017). A condition could be considered necessary if the consistency is greater than 0.9 (Schneider and Wagemann, 2013). Necessary conditions of information anxiety were first calculated and analyzed in this study.

Configuration analysis. Configuration is the combination of conditions that produce the same outcome (Verweij and Vis, 2021). The results of QCA are mostly presented in the same way. Specifically, “●” represents the core causal condition present; “·” represents the peripheral condition present; “⊗” represents the core causal condition absent; “⊗” represents the peripheral condition absent; blank represents the presence or absence of conditions does not matter. The configuration of information anxiety could be obtained according to the presence or absence of core causal conditions.

Pathway analysis. Configurations with the same core causal conditions could be concluded into pathways that impact information anxiety. On this basis, substitution relationships could be analyzed between the conditions in the configuration. This is helpful for medical institutions and the government to address the conditions that impact information anxiety specifically. For example, medical institutions cannot directly change the social environment that impacts information anxiety in medical work, but they can solve the problem of information quality in the same configuration.

4. Results

4.1. Conditions of information anxiety

Twenty-four interviews were analyzed, and the conditions were identified, as shown in Table 3. Information quantity anxiety (IQA), Information quality anxiety (IUA), and Information content anxiety (ICA) are outcome conditions of information anxiety. Information quantity anxiety (IQA) is the type of information anxiety that arises mainly from the quantity of information, including three subcategories: Lack of information, Limited information, and Excessive information. Information quality anxiety (IUA) is the type of information anxiety that arises mainly from the quality of information, including three subcategories: Inaccurate information, Untruthful information, and Unreliable information. Information content anxiety (ICA) is the type of information anxiety that arises mainly from the content of information, including one subcategory of Discomforting information. In addition, Personal concerns, Information characteristics, Information environment, and Information content are antecedent conditions of information anxiety. Personal concerns are spontaneous concerns of front-line healthcare professionals during public health emergencies, including one subcategory of Personal concerns (PER). Information characteristics are the attributes of information that may trigger anxiety, including three subcategories: Information value (VAL), Information quantity (QUA), and Information quality (INQ). The information environment is the environment in which healthcare professionals receive information and perform information activities, including three subcategories: Social environment (SOC), Hospital environment (HOS), and Relatives (REL). Information content is the text, pictures, videos, and other content that exist in communication activities, including one subcategory of Information content (INC).

Table 3.
Classification of information anxiety conditions.

Category Selective coding Axial coding Initial coding

Information anxiety (outcome conditions) Information quantity anxiety (IQA) Lack of information I don't know the details of each hospital. (P5 [Female, 31–40, Nurse in charge])

Limited information My knowledge of this virus is very limited . (P17 [Male, ＞40, Director Physician])

Excessive information Get too much information . (P4 [Female, ＜31, Nurse])

Information quality anxiety (IUA) Inaccurate information The information received is not the same as the official information released . (P7 [Female, 31–40, Nurse])

Untruthful information I do not know if the video received in the phone is true or false . (P14 [Male, 31–40, Doctor in charge])

Unreliable information The first feeling is that the source of this information is not reliable . (P24 [Male, ＞40, Director Physician])

Information content anxiety (ICA) Discomforting information See the pictures sent from other hospitals. (P1 [Female, 31–40, Assistant Director Physician])

antecedent conditions Personal concerns Personal concerns (PER) Worry about whether I am well protected. (P5 [Female, 31–40, Nurse in charge])

Information characteristics Information value (VAL) It is anxiety about the unknown disease. (P9 [Female, 31–40, Nurse])

Information quantity (QUA) More and more information on the outbreak. (P8 [Female, 31–40, Nurse])

Information quality (INQ) I actually read less information online at that time, because I didn't know the accuracy . (P23 [Female, 31–40, Nurse])

Information environment Social environment (SOC) I heard the news that the city would suspend travel , and then I was afraid that I wouldn't be able to buy food. (P7 [Female, 31–40, Nurse])

Hospital environment (HOS) We have to follow the hospital procedures , so both doctors and patients feel very nervous. (P22 [Female, 31–40, Nurse])

Relatives (REL) My friends came to ask me, and then I did not know what the virus was, so I was a little scared. (P7 [Female, 31–40, Nurse])

Information content Information content (INC) Many conspiracies about the COVID-19 pandemic on the Internet makes me feel uncomfortable. (P11 [Female, 31–40, Nurse])

Category	Selective coding	Axial coding	Initial coding
Information anxiety (outcome conditions)	Information quantity anxiety (IQA)	Lack of information	I don't know the details of each hospital. (P5 [Female, 31–40, Nurse in charge])
Limited information	My knowledge of this virus is very limited . (P17 [Male, ＞40, Director Physician])
Excessive information	Get too much information . (P4 [Female, ＜31, Nurse])
Information quality anxiety (IUA)	Inaccurate information	The information received is not the same as the official information released . (P7 [Female, 31–40, Nurse])
Untruthful information	I do not know if the video received in the phone is true or false . (P14 [Male, 31–40, Doctor in charge])
Unreliable information	The first feeling is that the source of this information is not reliable . (P24 [Male, ＞40, Director Physician])
Information content anxiety (ICA)	Discomforting information	See the pictures sent from other hospitals. (P1 [Female, 31–40, Assistant Director Physician])
antecedent conditions	Personal concerns	Personal concerns (PER)	Worry about whether I am well protected. (P5 [Female, 31–40, Nurse in charge])
Information characteristics	Information value (VAL)	It is anxiety about the unknown disease. (P9 [Female, 31–40, Nurse])
Information quantity (QUA)	More and more information on the outbreak. (P8 [Female, 31–40, Nurse])
Information quality (INQ)	I actually read less information online at that time, because I didn't know the accuracy . (P23 [Female, 31–40, Nurse])
Information environment	Social environment (SOC)	I heard the news that the city would suspend travel , and then I was afraid that I wouldn't be able to buy food. (P7 [Female, 31–40, Nurse])
Hospital environment (HOS)	We have to follow the hospital procedures , so both doctors and patients feel very nervous. (P22 [Female, 31–40, Nurse])
Relatives (REL)	My friends came to ask me, and then I did not know what the virus was, so I was a little scared. (P7 [Female, 31–40, Nurse])
Information content	Information content (INC)	Many conspiracies about the COVID-19 pandemic on the Internet makes me feel uncomfortable. (P11 [Female, 31–40, Nurse])

Based on the coding results, Personal concerns, Information characteristics, Information environment, and Information content were antecedent conditions that impact information anxiety. Information anxiety can be classified into three categories: information quantity anxiety, information quality anxiety, and information content anxiety. A framework of information anxiety conditions is shown in Figure 2.

Figure 2.

A framework of information anxiety conditions.

4.2. Necessary conditions analysis of information anxiety

A condition is “necessary” or “almost always necessary” if the consistency score is 0.9 or higher. Necessary conditions of information anxiety are presented in Table 4.

Table 4.
Results of necessary conditions analysis for information anxiety.

IQA IUA ICA

Consistency Coverage Consistency Coverage Consistency Coverage

PER 0.750000 0.631579 0.818182 0.473684 0.812500 0.684211

∼PER 0.250000 0.800000 0.181818 0.400000 0.187500 0.600000

VAL 0.562500 0.600000 0.545455 0.400000 0.562500 0.600000

∼VAL 0.437500 0.777778 0.454545 0.555556 0.437500 0.777778

QUA 0.375000 0.750000 0.181818 0.250000 0.312500 0.625000

∼QUA 0.625000 0.625000 0.818182 0.562500 0.687500 0.687500

INQ 0.312500 0.454545 0 . 909091 0.909091 0.437500 0.636364

∼INQ 0.687500 0.846154 0.090909 0.076923 0.562500 0.692308

SOC 0.875000 0.636364 1.000000 0.500000 0.937500 0.681818

∼SOC 0.125000 1.000000 0.000000 0.000000 0.062500 0.500000

HOS 0.625000 0.625000 0.727273 0.500000 0.687500 0.687500

∼HOS 0.375000 0.750000 0.272727 0.375000 0.312500 0.625000

REL 0.500000 0.888889 0.181818 0.222222 0.375000 0.666667

∼REL 0.500000 0.533333 0.818182 0.600000 0.625000 0.666667

INC 0.375000 0.545455 0.545455 0.545455 0.437500 0.636364

∼INC 0.625000 0.769231 0.454545 0.384615 0.562500 0.692308

	IQA	IUA	ICA
PER	0.750000	0.631579	0.818182	0.473684	0.812500	0.684211
∼PER	0.250000	0.800000	0.181818	0.400000	0.187500	0.600000
VAL	0.562500	0.600000	0.545455	0.400000	0.562500	0.600000
∼VAL	0.437500	0.777778	0.454545	0.555556	0.437500	0.777778
QUA	0.375000	0.750000	0.181818	0.250000	0.312500	0.625000
∼QUA	0.625000	0.625000	0.818182	0.562500	0.687500	0.687500
INQ	0.312500	0.454545	0 . 909091	0.909091	0.437500	0.636364
∼INQ	0.687500	0.846154	0.090909	0.076923	0.562500	0.692308
SOC	0.875000	0.636364	1.000000	0.500000	0.937500	0.681818
∼SOC	0.125000	1.000000	0.000000	0.000000	0.062500	0.500000
HOS	0.625000	0.625000	0.727273	0.500000	0.687500	0.687500
∼HOS	0.375000	0.750000	0.272727	0.375000	0.312500	0.625000
REL	0.500000	0.888889	0.181818	0.222222	0.375000	0.666667
∼REL	0.500000	0.533333	0.818182	0.600000	0.625000	0.666667
INC	0.375000	0.545455	0.545455	0.545455	0.437500	0.636364
∼INC	0.625000	0.769231	0.454545	0.384615	0.562500	0.692308

Notes: personal concerns (PER); information value (VAL); information quantity (QUA); information quality (INQ); social environment (SOC); hospital environment (HOS); relatives (REL); information content (INC); information quantity anxiety (IQA); information quality anxiety (IUA); information content anxiety (ICA).

Necessary conditions of information anxiety are present, as shown in Table 4. Firstly, no condition is necessary for information quantity anxiety. Secondly, two conditions of information quality (INQ) and social environment (SOC) are necessary for information quality anxiety with a consistency of 0.909091 and 1.000000, respectively. Thirdly, one condition of the social environment (SOC) is necessary for information content anxiety with a consistency of 0.937500. To visualize the results of necessary conditions analysis, the intersections of all antecedent conditions that lead to the outcome condition of information quantity anxiety, information quality anxiety, and information content anxiety were shown in Figure 3. The dashed box indicates the possible combinations among the antecedents in which one condition may exist together with the other conditions to predict the outcome condition of information anxiety.

Figure 3.

Diagram of intersections leading to information anxiety. Notes: information quantity anxiety (IQA); information quality anxiety (IUA); information content anxiety (ICA).

4.3. Configurations and pathways analysis of information anxiety

4.3.1. Configurations and pathways analysis of information quantity anxiety

There are multiple configurations to impact information quantity anxiety. The solution consistency is greater than 0.8, indicating that configurations are reliable, as shown in Table 5. C1 to C12 are configurations that constitute information quantity anxiety. Due to differences in core causal conditions, there are significant differences between configurations. According to the same core causal conditions, configurations can be classified to obtain pathways.

Table 5.
Configuration of information quantity anxiety.

C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12

PER · · ⊗ · · · · ⊗ ⊗ · ·

VAL ● ⊗ ⊗ ● ● ⊗ ● ⊗ ● ● · ⊗

QUA · ⊗ ⊗ · ⊗ ⊗ ⊗ ⊗ ⊗ ⊗ · ·

INQ ⊗ ⊗ ⊗ ⊗ ⊗ · ⊗ · · ⊗ ⊗ ·

SOC · · · ⊗ · · · · · ⊗ · ·

HOS ⊗ ● ● ⊗ · · ⊗ ⊗ ⊗ ● ● ●

REL ⊗ ● ● ⊗ ⊗ ⊗ ● · ⊗ ● ● ●

INC · · ⊗ ⊗ ⊗ ⊗ · · ⊗ ⊗

Consistency 1 1 1 1 1 1 1 1 1 1 1 1

Raw Coverage 0.125 0.125 0.125 0.0625 0.0625 0.125 0.0625 0.0625 0.0625 0.0625 0.0625 0.0625

Unique Coverage 0.125 0.0625 0.0625 0.0625 0.0625 0.125 0.0625 0.0625 0.0625 0.0625 0.0625 0.0625

Solution Consistency 1

Solution Coverage 0.9375

	C1	C2	C3	C4	C5	C6	C7	C8	C9	C10	C11	C12
PER	·	·		⊗	·	·	·	·	⊗	⊗	·	·
VAL	●	⊗	⊗	●	●	⊗	●	⊗	●	●	·	⊗
QUA	·	⊗	⊗	·	⊗	⊗	⊗	⊗	⊗	⊗	·	·
INQ	⊗	⊗	⊗	⊗	⊗	·	⊗	·	·	⊗	⊗	·
SOC	·	·	·	⊗	·	·	·	·	·	⊗	·	·
HOS	⊗	●	●	⊗	·	·	⊗	⊗	⊗	●	●	●
REL	⊗	●	●	⊗	⊗	⊗	●	·	⊗	●	●	●
INC			·	·	⊗	⊗	⊗	⊗	·	·	⊗	⊗
Consistency	1	1	1	1	1	1	1	1	1	1	1	1
Raw Coverage	0.125	0.125	0.125	0.0625	0.0625	0.125	0.0625	0.0625	0.0625	0.0625	0.0625	0.0625
Unique Coverage	0.125	0.0625	0.0625	0.0625	0.0625	0.125	0.0625	0.0625	0.0625	0.0625	0.0625	0.0625
Solution Consistency	1
Solution Coverage	0.9375

Notes: “●” represents core causal condition present; “·” represents peripheral condition present; “⊗” represents core causal condition absent; “⊗” represents peripheral condition absent; blank represents the presence or absence of conditions does not matter; personal concerns (PER); information value (VAL); information quantity (QUA); information quality (INQ); social environment (SOC); hospital environment (HOS); relatives (REL); information content (INC); information quantity anxiety (IQA); information quality anxiety (IUA); information content anxiety (ICA).

There are four pathways to impact information quantity anxiety: (1) Information Value Dominated (IVD) pathway . C1, C4, C5, and C9 indicate that information quantity anxiety can be reached when front-line healthcare professionals do not obtain high-value information. The common feature of configurations is that information value (VAL) is the core causal condition. (2) Social Stress Dominated (SSD) pathway . C2, C3, C11, and C12 indicate that information quantity anxiety can be reached when front-line healthcare professionals receive information from their family, colleagues, and close friends in medical work, which makes them feel social stress. The common features of configurations are that hospital environment (HOS) and relatives (REL) are the core causal conditions. (3) Information Interference Directed (IID) pathway . C7 and C10 indicate that information quantity anxiety can be reached when front-line healthcare professionals receive low-value information from relatives, which interferes with their normal medical work and life. The common features of configurations are that information value (VAL) and relatives (REL) are the core causal conditions. (4) Situational Avoidance Oriented (SAO) pathway . C6 and C8 indicate that information quantity anxiety can even be reached when front-line healthcare professionals have personal concerns triggered by low-quality information in situations such as medical work and life, so they choose to avoid the current situation. The common feature of configurations is that there is no core antecedent condition.

4.3.2. Configurations and pathways analysis of information quality anxiety

There are multiple configurations to impact information quality anxiety. The solution consistency is greater than 0.8, indicating that configurations are reliable, as shown in Table 6. C1 to C8 are configurations that constitute information quality anxiety. Due to differences in core causal conditions, there are significant differences between configurations. According to the same core causal conditions, configurations can be classified to obtain pathways.

Table 6.
Configuration of information quality anxiety.

C1 C2 C3 C4 C5 C6 C7 C8

PER · · · ⊗ · · ·

VAL ● ● ⊗ ● ⊗ ⊗ ●

QUA ⊗ ⊗ ⊗ ⊗ ⊗ ⊗ ● ·

INQ ● ● ● ● ● ⊗ ● ●

SOC · · · · · · · ·

HOS ● ● ● ⊗ ⊗ · ● ⊗

REL ⊗ ⊗ ⊗ · ⊗ ⊗ · ·

INC ⊗ ⊗ ● ● ● ⊗ ●

Consistency 1 1 1 1 1 1 1 1

Raw Coverage 0.272727 0.181818 0.272727 0.0909091 0.0909091 0.0909091 0.0909091 0.0909091

Unique Coverage 0.181818 0.0909091 0.181818 0.0909091 0.0909091 0.0909091 0.0909091 0.0909091

Solution Consistency 1

Solution Coverage 1

	C1	C2	C3	C4	C5	C6	C7	C8
PER	·		·	·	⊗	·	·	·
VAL		●	●	⊗	●	⊗	⊗	●
QUA	⊗	⊗	⊗	⊗	⊗	⊗	●	·
INQ	●	●	●	●	●	⊗	●	●
SOC	·	·	·	·	·	·	·	·
HOS	●	●	●	⊗	⊗	·	●	⊗
REL	⊗	⊗	⊗	·	⊗	⊗	·	·
INC	⊗	⊗		●	●	●	⊗	●
Consistency	1	1	1	1	1	1	1	1
Raw Coverage	0.272727	0.181818	0.272727	0.0909091	0.0909091	0.0909091	0.0909091	0.0909091
Unique Coverage	0.181818	0.0909091	0.181818	0.0909091	0.0909091	0.0909091	0.0909091	0.0909091
Solution Consistency	1
Solution Coverage	1

There are three pathways to impact information quality anxiety: (1) Emotion Dominated (ED) pathway . C6 indicates that information quality anxiety can be reached when front-line healthcare professionals are directly influenced by information content, resulting in negative emotions. (2) Information Interference Directed (IID) pathway . C2 and C3 indicate that information quality anxiety can be reached when front-line healthcare professionals receive low-value information and low-quality information in medical work. Then, C1 indicates that information quality anxiety can be reached when front-line healthcare professionals receive low-quality information in medical work. Finally, C7 indicates that information quality anxiety can be reached when front-line healthcare professionals receive a small amount of low-quality information in medical work. It can be seen that information interfered with their normal medical work. The common features of configurations are that hospital environment (HOS) and information quality (INQ) are the core causal conditions. (3) Information Suspicion Directed (ISD) pathway . C5 and C8 indicate that information quality anxiety can be reached when front-line healthcare professionals are influenced by information content with low value and low quality. C4 indicates that information quality anxiety can be reached when front-line healthcare professionals are influenced by information content with low quality. Therefore, healthcare professionals suspected all kinds of information they received. The common features of configurations are that information quality (INQ) and information content (INC) are the core causal conditions.

4.3.3. Configurations and pathways analysis of information content anxiety

There are multiple configurations to impact information content anxiety. The solution consistency is greater than 0.8, indicating that configurations are reliable, as shown in Table 7. C1 to C10 are configurations that constitute information quality anxiety. Due to differences in core causal conditions, there are significant differences between configurations. According to the same core causal conditions, configurations can be classified to obtain pathways.

Table 7.
Configuration of information content anxiety.

C1 C2 C3 C4 C5 C6 C7 C8 C9 C10

PER · · · · ⊗ · · ·

VAL · ● ⊗ ⊗ ⊗ ● · · ⊗ ⊗

QUA · ⊗ ⊗ ⊗ ⊗ ⊗ · ⊗ ⊗ ·

INQ ⊗ ● ⊗ ⊗ ⊗ ● ⊗ ⊗ · ·

SOC · · · · · · ⊗ · · ·

HOS ⊗ ● · · · ● ⊗ ⊗ ⊗ ·

REL ⊗ ⊗ ● ● ⊗ ⊗ · ● ●

INC ⊗ · · ● ⊗ ⊗ ⊗

Consistency 1 1 1 1 1 1 1 1 1 1

Raw Coverage 0.125 0.125 0.125 0.125 0.125 0.1875 0.0625 0.0625 0.0625 0.0625

Unique Coverage 0.125 0.0625 0.0625 0.0625 0.0625 0.125 0.0625 0.0625 0.0625 0.0625

Solution Consistency 1

Solution Coverage 0.875

	C1	C2	C3	C4	C5	C6	C7	C8	C9	C10
PER	·		·	·		·	⊗	·	·	·
VAL	·	●	⊗	⊗	⊗	●	·	·	⊗	⊗
QUA	·	⊗	⊗	⊗	⊗	⊗	·	⊗	⊗	·
INQ	⊗	●	⊗	⊗	⊗	●	⊗	⊗	·	·
SOC	·	·	·	·	·	·	⊗	·	·	·
HOS	⊗	●	·	·	·	●	⊗	⊗	⊗	·
REL	⊗	⊗	●		●	⊗	⊗	·	●	●
INC		⊗		·	·		●	⊗	⊗	⊗
Consistency	1	1	1	1	1	1	1	1	1	1
Raw Coverage	0.125	0.125	0.125	0.125	0.125	0.1875	0.0625	0.0625	0.0625	0.0625
Unique Coverage	0.125	0.0625	0.0625	0.0625	0.0625	0.125	0.0625	0.0625	0.0625	0.0625
Solution Consistency	1
Solution Coverage	0.875

There are five pathways to impact information content anxiety: (1) Social Stress Dominated (SSD) pathway . C3, C5, C9, and C10 indicate that information content anxiety can be reached when front-line healthcare professionals receive information from their family, colleagues, and close friends, which makes them feel social stress. The common feature of configurations is that relatives (REL) are the core causal condition. (2) Emotion Dominated (ED) pathway . C7 indicates that information content anxiety can be reached when front-line healthcare professionals are directly influenced by information content, resulting in negative emotions. (3) Information Interference Directed (IID) pathway . C2 and C6 indicate that information content anxiety can be reached when front-line healthcare professionals receive low-value information and low-quality information in medical work, which interferes with their normal medical work and life. The common features of configurations are that information value (VAL), information quality (INQ), and hospital environment (HOS) are the core causal conditions. (4) Situational Avoidance Oriented (SAO) pathway . C1 and C8 indicate that information quantity anxiety can even be reached when front-line healthcare professionals have personal concerns triggered by low-value and low-quantity information in situations such as medical work, life, and social, so they choose to avoid the current situation. The common feature of configurations is that there is no core antecedent condition. (5) Situational Concerns Oriented (SCO) pathway . C4 indicates that information content anxiety can even be reached when front-line healthcare professionals have personal concerns triggered by information content in the medical work or social environment, so they are concerned about the current situation.

5. Discussion

5.1. Findings of information anxiety conditions and pathways

This study explored conditions and pathways of front-line healthcare professionals’ information anxiety during public health emergencies. Here are several main contributions of this study.

Four conditions that impact information anxiety were found, including information, environment, personal, and content. In terms of information, information quality, value, and other conditions have been the focus of information anxiety research (Kirby et al., 2018). Healthcare professionals would have information anxiety due to the quality and value of information in the process of urgent access to information, especially in public health emergencies. In terms of environment, a large number of public health emergencies occurred in hospitals where healthcare professionals worked. Information about the consumption of materials and the interference of other people's information from the hospital environment could lead to multiple pressures among healthcare professionals. In terms of personal, due to the particularity of occupation and the unknown of public health emergencies, healthcare professionals would worry about themselves and others. In terms of content, the urgency and crisis of the event reflected by the information content would lead to the speculation and association of the healthcare professionals. For example, P4 [Female, ＜31, Nurse] said, “It was not about anything else, but just because I felt anxious when I got the news of my colleague's illness.” Existing research has explored conditions such as information, environment, and personal during public health emergencies (Erfanmanesh et al., 2014; Naveed, 2016; Xiang et al., 2021) but rarely focuses on the intuitive feelings that the information content brings to healthcare professionals. The reason is that the types and topics of information content presented by the web and hospitals are generally more diverse. It is difficult for researchers to obtain and conduct comprehensive analysis. So, it is suggested to consider situational measures comprehensively to understand the concurrent combination of multiple conditions impacting information anxiety.

A conceptual framework of information anxiety conditions was constructed according to the coding results. At present, there is no widely accepted conceptual framework for information anxiety conditions. Existing studies combined with proven theories to design theoretical models. For example, Xiang et al. (2021) took the theory of intergroup emotion as an analytical framework to explore hotel employees’ information anxiety under normal epidemic prevention measures. However, the conceptual framework for this study was derived from the experiences stated by the participants in the interviews. The reason is that the situations in which healthcare professionals are placed during public health emergencies are complex, and the conditions impacting information anxiety are often interrelated. Therefore, the conditions of information anxiety need to be considered from a contextual perspective.

Information quality (INQ) and social environment (SOC) were necessary conditions for front-line healthcare professionals’ information anxiety. Previous studies have confirmed that two categories of conditions could impact information anxiety. For example, Alamsyah and Zhu (2022) indicated that government information quality was of vital importance in lowering citizens’ anxiety; Wong et al. (2021) concluded that older adults showed more anxiety signs when they relied on social media for COVID-19-related information. In this study, information quality (INQ) and social environment (SOC) could be attributed to worries about uncertain information and situations. Generally speaking, information anxiety happens when information doesn’t tell us what we want or need to know (Wurman, 1989); the low quality of information and the unpredictability of the social environment undoubtedly exacerbate the cognitive gap of healthcare professionals during public health emergencies. Therefore, it is necessary to take measures to reduce the uncertainty of healthcare professionals about information and the environment.

Identifying pathways has theoretical and practical significance: 1) This study sorted out the structure of information anxiety process among front-line healthcare professionals during the COVID-19 pandemic by identifying pathways, helping to illustrate the sequence of achieving the impacts. Among them, pathways that only contain one core condition include Emotion Dominated, Social Stress Dominated, and Information Value Dominated. It indicates that a single piece of information content will not directly cause information anxiety, but should be combined with personal concerns, information characteristics, and information environment. The pathways that contain two core conditions are Information Interference Directed and Information Suspicion Directed. It indicates that the information characteristics in public health emergencies can easily cause information anxiety in healthcare professionals. The pathways that contain three core conditions include Situational Avoidance Oriented and Situational Concerns Oriented, while personal concerns and information environment coexist in these pathways. It shows that the poor information environment and the aggravation of personal concerns are likely to change the psychological state of healthcare professionals during the COVID-19 pandemic, resulting in situational avoidance (unwilling to face the status quo) and situational concern (passive acceptance of the status quo). By identifying the pathways, medical institutions and governments can analyze the scenarios that future public health emergencies will meet, and thus block the information anxiety pathway in a targeted manner to maintain their mental health.

To further understand the pathways of information anxiety in the special context of the COVID-19 pandemic, seven pathways that impact information anxiety could be divided into two dimensions, as shown in Figure 4. The pathways formed in this study include conditions and configuration. Previous studies have focused more on the relationship between independent factors and information anxiety, without considering the concurrent impacts of associated antecedents. More importantly, the pathways highlighted the process sequence of antecedent conditions impacting information anxiety, which is triggered by information characteristics, information environment, information content, and personal concerns. Different conditions are interrelated and impact each other in the context, jointly impacting the information anxiety of healthcare professionals. As a result, the pathways further deepened and expanded the understanding of the information anxiety of healthcare professionals during the COVID-19 pandemic.

Figure 4.

Conditions, configurations, and pathways of information anxiety.

Its significance lies in further verifying the understanding of the causes of information anxiety among healthcare professionals in existing research. As mentioned, they had to not only obtain, judge, and use necessary information related to their own medical work and daily life but also respond to extensive information demands from patients, relatives, friends, and colleagues as important information providers, which usually exceeded the information and information ability they had, and led to a high risk of information anxiety. They are both information demanders and information providers. The former role reflects the personal anxiety towards information needs, while the latter role reflects the frustration exhibited by healthcare professionals who are unable to cope with external pressures. These two causes match the two dimensions of the information anxiety pathway.

Firstly, spontaneous information anxiety, meaning information anxiety, is triggered by personal concerns about information and environment, including Emotion Dominated (ED), Situational Avoidance Oriented (SAO), and Situational Concerns Oriented (SCO). The information anxiety of healthcare professionals is triggered by personal concerns, which are often caused by the inability to obtain effective and definitive information. Combined with their judgment of the situation and their attitude towards information, their anxiety levels will continue to deepen. This requires that in future public health emergencies, priority should be given to alleviating the personal concerns of healthcare professionals through smooth information channels and high-quality information content. Previous studies have confirmed the correlation between anxiety and personal attitude (Tomczyk, 2022). Similarly, personal concern (PER) plays a central role in information anxiety in this study. The reason is that front-line healthcare professionals are more sensitive to the information quantity, quality, value, content, and environment during public health emergencies. Infection risk is the main cause of concern for healthcare professionals based on interviews. For example, P1 [Female, 31–40, Assistant Director Physician] said that I was afraid of being infected with the virus, and I would be more worried if I were infected with the virus to my family. Therefore, information anxiety should be addressed from the concerns of healthcare professionals.

Secondly, extrinsic information anxiety, meaning information anxiety, is triggered by external conditions, including Social Stress Dominated (SSD), Information Value Dominated (IVD), Information Suspicion Directed (ISD), and Information Interference Directed (IID). The anxiety of healthcare professionals comes from the external environment, and a large amount of pressure has an impact on them. This requires effective measures to block the impact of the external environment on healthcare professionals in future public health emergencies. Most of the information anxiety that has been studied was extrinsic information anxiety (Wolenski and Pettit, 2023). In this study, external conditions are still the main cause of information anxiety among healthcare professionals. The reason is that information quality, quantity, and value problems in medical work interfere with normal treatment and nursing, causing healthcare professionals to be suspicious of information. For example, P7 [Female, 31–40, Nurse] said that I didn't know much about viruses, but my friends and relatives came to me to inquire about the virus because I worked in the hospital, which caused me great pressure. Therefore, helping healthcare professionals avoid interference in medical work should be considered.

5.2. Practical implications for information anxiety in future public health emergencies

The analysis of conditions and pathways was essential for understanding the information anxiety of front-line healthcare professionals during public health emergencies and providing evidence for medical institutions to take target measures among front-line healthcare professionals in future public health emergencies. In Figure 5, the key findings of this study, their reasons, and suggested measures are also presented.

Figure 5.

Summary of findings, reasons, and implications.

First, understanding concurrent combinations of information anxiety conditions from the contextual perspective should be considered by government and medical institutions. Existing studies focused on single or independent conditions that caused anxiety in healthcare professionals (Subasi et al., 2021). Regarding information anxiety, researchers focused on providing suggestions from information (Xu and Sasahara, 2021), personal, and environment (Charpentier et al., 2022). Therefore, it is necessary to define the key situations of information anxiety faced by healthcare professionals, comprehensively manage the high-risk conditions that cause information anxiety, and provide comprehensive information services. Then, it is worth presenting facts from a pragmatic and objective perspective to bring positive effects to healthcare professionals through medical institutions and governments, such as information on medical supplies, patient healing, and prevention. Based on the above conditions, a scale can be constructed to measure the level of information anxiety among healthcare professionals in public health emergencies, and to provide timely and effective intervention measures for specific conditions.

Second, information quality (INQ) and social environment (SOC) are necessary conditions for information anxiety, making them an important direction for medical institutions and governments to develop strategies to maintain their mental health in future public health emergencies. The first step is to improve the quality of information through measures such as ensuring information disclosure and transmission. Then, the impact of social environment should be avoided by diverting attention, changing social habits, and maintaining good daily routines. According to interviews with healthcare professionals, group counseling can eliminate uncertainty in information and social environment through communication, exchange of high-quality information, and deepening understanding of the existing environment. It is necessary for group counseling to eliminate uncertainty about information and social environment. At present, psychological counseling has been widely used in alleviating anxiety (Sun et al., 2021). However, one-to-one communication is undesirable, aggravating the information inequality among front-line healthcare professionals in public health emergencies. For example, P22 [Female, 31–40, Nurse] said I would be very nervous if I didn't know what others knew. Therefore, healthcare professionals with the same information anxiety signs should concentrate. Then, the psychologist should guide the group to discuss and solve problems in medical work or life so as to alleviate information anxiety through group counseling (Zarei et al., 2010).

Third, spontaneous information anxiety requires medical institutions and governments to alleviate personal concerns. According to the statement of the participants, the most worrying information during the COVID-19 pandemic is the health of themselves, their families, and colleagues, as well as the medical and living materials. Doctors and nurses should be provided with a physical examination first to eliminate their worries about infection. However, the increasing number of patients and pandemic-related deaths, exhausting workload, unavailability of ventilators and intensive care unit beds, and shortage of personnel protection equipment during public health emergencies have caused emotional and physical burnout over time among front-line healthcare professionals (Huang and Zhao, 2020). It is difficult for healthcare professionals to get medical examination results in time. This requires the opening of a regular, prioritized physical examination channel for healthcare professionals to alleviate the concerns and prevent the spread of infectious diseases. In addition, it is necessary to ensure normal communication of healthcare professionals so that they can understand the health of their colleagues’ health. Furthermore, extrinsic information anxiety requires isolating external pressure. The concurrent effects of external conditions such as information, environment, and content required the recruitment of volunteers to address external issues, relieving the pressure on physicians and nurses while helping patients. The role of volunteers in public health emergencies has been confirmed by previous studies (Tang et al., 2022). It is helpful to maintain the mental health of healthcare professionals by dealing with multiple and concurrent conditions through volunteers so as to concentrate more on dealing with public health emergencies.

Accordingly, potential next steps for utilizing the research findings effectively are as follows: considering conditions, this study identified the antecedents and outcome conditions, and identified the necessary conditions that impact information anxiety. In the future, further qualitative and quantitative analysis can be conducted on these conditions to construct a theoretical model of the impact on information anxiety, thereby forming a systematic understanding of information anxiety. Considering pathways, this study identified seven pathways and divided them into two dimensions. The development of strategies for coping with information anxiety among healthcare professionals in future public health emergencies can be based on defining typical situations and clearly distinguishing between their two types of psychological states in typical situations, providing theoretical support for the medical and health services.

6. Conclusion

To identify conditions and pathways of information anxiety, 24 front-line healthcare professionals who worked in a Wuhan hospital were recruited in semi-structured interviews. Grounded theory was used to identify and classify antecedent and outcome conditions of information anxiety. Furthermore, QCA was used to analyze configurations and pathways of information anxiety. The results show that information quality (INQ) and social environment (SOC) are necessary for information anxiety. Social Stress Dominated (SSD) is the most common pathway among healthcare professionals during the COVID-19 pandemic. Pathways of information anxiety can be divided into spontaneous information anxiety and extrinsic information anxiety. Identifying conditions and pathways of information anxiety among front-line healthcare professionals during the COVID-19 pandemic helps to understand the mental health of healthcare professionals during public health emergencies and urges medical institutions and governments to take target measures to maintain the mental health of healthcare professionals to ensure the normal operation of medical institutions in future public health emergencies.

There were some limitations. Firstly, the information content was not subdivided. Therefore, future research should classify information content by topics. Secondly, personal concerns played a crucial role in the information anxiety of front-line healthcare professionals, and subsequent research on personal concerns should be used as intermediary variables. Thirdly, all the participants were from China's top hospitals, they had extensive communications and cooperation with other countries during the COVID-19 pandemic. However, the generalizability of the research needs to be improved in other countries.

Footnotes

Data availability statement

The datasets generated and analysed during the current study are not publicly available due to the participant's requirements but are available from the corresponding author on reasonable request.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Our study was approved by Biomedical Ethic Committee of Wuhan University (approval no. IRB2022012). All patients provided written informed consent prior to enrollment in the study.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the National Social Science Fund of China (No: 20ATQ008).

ORCID iD

Xueying Peng

About the authors

Quan Lu (mrluquan@whu.edu.cn) received the B.S. degree from Wuhan University of Hydraulic and Electrical Engineering, Wuhan, China, in 1998, and the M.S. degree from Wuhan University, Wuhan, China, in 2001. He received his PhD degree from Wuhan University, Wuhan, China, in 2007. Since 2015, he has been serving as a professor at the School of Information Management at Wuhan University. His research interest includes information organization, information services, and health management.

Liang Tao (ltao_la@whu.edu.cn) received the B.S. degree from the University of Missouri, USA, in 2017, and the M.S. degree from California Lutheran University, USA, in 2019. He is currently pursuing the PhD degree at the School of Information Management at Wuhan University, Wuhan, China. His research interest includes information behavior, information services, and health management.

XueYing Peng (13545698372@163.com) received the B.S. degree from Central China Normal University, Wuhan, China, in 2019, and the M.S. degree from Central China Normal University, Wuhan, China, in 2022. She is currently pursuing the PhD degree at the School of Information Management at Wuhan University, Wuhan, China. Her research interest includes information behavior, information services, and health management.

Jing Chen (jchen@mail.ccnu.edu.cn) received the B.S. degree from Wuhan University of Hydraulic and Electrical Engineering, Wuhan, China, in 1998, and the M.S. degree from Wuhan University, Wuhan, China, in 2001. She received her PhD degree from Wuhan University, Wuhan, China, in 2007. She is a professor at the School of Information Management at Central China Normal University. Her research interest includes information behavior, knowledge management, and knowledge organization.

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	IQA		IUA		ICA
	Consistency	Coverage	Consistency	Coverage	Consistency	Coverage
PER	0.750000	0.631579	0.818182	0.473684	0.812500	0.684211
∼PER	0.250000	0.800000	0.181818	0.400000	0.187500	0.600000
VAL	0.562500	0.600000	0.545455	0.400000	0.562500	0.600000
∼VAL	0.437500	0.777778	0.454545	0.555556	0.437500	0.777778
QUA	0.375000	0.750000	0.181818	0.250000	0.312500	0.625000
∼QUA	0.625000	0.625000	0.818182	0.562500	0.687500	0.687500
INQ	0.312500	0.454545	0 . 909091	0.909091	0.437500	0.636364
∼INQ	0.687500	0.846154	0.090909	0.076923	0.562500	0.692308
SOC	0.875000	0.636364	1.000000	0.500000	0.937500	0.681818
∼SOC	0.125000	1.000000	0.000000	0.000000	0.062500	0.500000
HOS	0.625000	0.625000	0.727273	0.500000	0.687500	0.687500
∼HOS	0.375000	0.750000	0.272727	0.375000	0.312500	0.625000
REL	0.500000	0.888889	0.181818	0.222222	0.375000	0.666667
∼REL	0.500000	0.533333	0.818182	0.600000	0.625000	0.666667
INC	0.375000	0.545455	0.545455	0.545455	0.437500	0.636364
∼INC	0.625000	0.769231	0.454545	0.384615	0.562500	0.692308