Date of Award

December 2014

Degree Type


Degree Name

Doctor of Philosophy


Biomedical and Health Informatics

First Advisor

Derek Nazareth

Committee Members

Amy Coenen, Onur Asan, Hemant Jain, Timothy Patrick


Cultural Values, Deterrence Theory, Medical Data Misuse, Self-Disclosure, Social Exchange Theory, Survey Research



This dissertation, which is comprised of three essays, examined disclosure propensity of healthcare providers from the US and Thailand and disclosure of personal health problems of healthcare consumers in social media context.

Essay 1: A Deterrence Approach in Medical Data Misuse among Healthcare Providers

Information and communication technology (ICT) have long been available for use in health care. With the potential to improve the quality, safety, and efficiency of health care, the diffusion of these technologies has steadily increased in the health care industry. With the adoption of electronic health records, personal electronics devices, internet connections and social network connections, comes the increased risk of medical data breaches. Due to the sensitivity of the information involved, and the existence of laws governing the use of this data, the responsibilities of a healthcare provider after a data breach remain a concern. Based on previous breach reports, institutional insiders were among the leading causes of medical data breaches. The causes were related to unawareness of institutional information security policies and system misuse. Thus it has become important to understand how to reduce such behaviors. Previous studies suggested deterrence theory that relies on security countermeasures can deter individuals' misuse behaviors by increasing the perceived threat of punishment. Thus our model posits that security countermeasures decrease medical data misuse through the two mediators; perceived certainty of sanctions and perceived severity of sanctions. This model was tested by 176 healthcare providers from different institutions across the US. The results suggested that perceived severity of sanctions has more effect in reducing medical data misuse than perceived certainty of sanctions. Hospital information security policies and HIPAA has stronger effect on perceived severity of sanctions than perceived certainty of sanctions whereas EHR monitoring and auditing has stronger effect on perceived certainty of sanctions than perceived severity of sanctions. Results of the study and implications for the research are discussed.

Essay 2: Propensity to Misuse Medical Data in an International Context - Deterrence and Cultural Values

As information abuse by healthcare providers is a problem that is faced around the globe, our study examined the effect of deterrence within two cultures; Asian and American (Thailand and the US). The reason to compare these two countries is because the foundation of the structures of the laws and the hospital policies for medical data protection of these two countries are similar. Thus others confounding factors are minimized. In terms of cultural influences, Hofstede's cultural dimensions that describe the effects of society's culture on the values to its members are considered as factors that can have an interaction effect with deterrence. Four Hofstede's cultural values were used; individualism-collectivism (IDV); uncertainty avoidance (UAI); power distance (PD); and long-term orientation (LTO). Also, social norms and morality were included. This study employed espoused values of Hofstede's cultural values, since all individuals from a country will not have identical values. In this study, we examined 1) the effect of espoused cultural values on deterrence, and 2) the effect of Hofstede's national cultural values on deterrence in two different healthcare cultures. Our model was tested by 613 healthcare providers; 437 from Thailand and 176 from the US. The results suggested that technical countermeasures had stronger effect on certainty and severity perception for both Thai and US cases, whereas procedural countermeasures had uncertain effect on sanctions perception for both cultures. The young generation of Thais was found more individualized and tended to have the same perception on sanctions as the Westerners. Social norms played an important role in reducing medical data misuse for Thai providers, whereas moral beliefs were more important for the US providers. Individuals who espoused different cultural values had different responses on medical data misuse. Results of the study and implications for the research are discussed.

Essay 3: Intention to self-disclose personal health information in social media context

In recent years social media is quickly becoming a large part of people's everyday lives. With the availability of smartphones and tablets, coupled with a slew of apps for these devices, people now have ubiquitous access to social media. Virtual social media application encourages people to meet, and share information. Health problems represent one aspect that is shared in a social media context. Benefits and risks of self-disclosure are two main factors that determine social media users' intention to share their sensitive information on social network. This paper integrates social exchange theory, a theory that focuses on gains and losses of building a relationship, and the social penetration theory, a theory that explains human's self-disclosure, to construct the model for investigating self-disclosure intention on personal health problems of social medial users. In addition, we included factors that affect self-disclosure intention including ease of use of social media, social influence, and nature of health problems.

Through an online survey, we examined factors that determine self-posting in social media account with 374 social media users across the US. The results suggested that individual and social benefits of self- disclosure outweighed the risks and have significant effect on self-disclosure intention on personal health problems. The individual risks and social risks had little negative effect on self-posting about health problems. In addition, social influence, and social networking experiences were factors that encouraged social media users to reveal their personal health problems.