The doctor‒patient relationship in the digital age: the case of hypertensive patients in Burkina Faso

The doctor‒patient relationship in the digital age: the case of hypertensive patients in Burkina Faso | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The doctor‒patient relationship in the digital age: the case of hypertensive patients in Burkina Faso Yaméogo Relwendé Aristide, Mahamoudou Massaoud, Mandi D Germain, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7834832/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Introduction The development of technologies has improved access to information for both doctors and patients. This accessibility can lead to conflicts during care and undermine the trust patients place in doctors. The objective of this study was to study the impact of online documentary research on the quality of the doctor‒patient relationship. Materials and methods Our study took place in the cardiology departments of teaching hospital Yalgado Ouédraogo and Bogodogo from March 1, 2024, to July 10, 2024. The study included hypertensive patients followed for at least six months. Validated questionnaires on the evaluation of trust in doctors, compliance with treatment, doctor‒patient agreement score, information asymmetry score between the doctor and the patient, online information search score and doctor quality score were used and filled in by external investigators at the service during a face‒to-face interview. All the scores are transformed and reduced to a value of 100. Structural equation modelling was used to analyse the correlations between variables and doctors' confidence. The test was statistically significant if p < 0.05. Results Our study involved 406 patients. The average age of the patients was 59 years, with a sex ratio of 0.49. One hundred thirty-five patients (33%) had access to the internet, and 70 (17%) were searching for information online. We noted a positive correlation between the quality of the doctor and confidence in the doctor (standardized coefficient = 0.55, p < 0.001) and a negative correlation between online information search and confidence in the doctor (standardized coefficient = − 0.114, p = 0.005). Physician quality has a positive correlation with variables such as compliance, patient‒physician agreement, and perceived information asymmetry (p < 0.001). Conclusion The search for information online can negatively impact trust in doctors. However, the impact on trust depends on the quality of the doctor. This highlights the importance of humanizing patient care in medical practice. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Hypertension Confidence Information internet Burkina Faso Figures Figure 1 Figure 2 Introduction The doctor‒patient relationship refers to all relationships between the doctor and the patient as part of a medical procedure or therapeutic monitoring. She is considered to be the pivot of medicine [ 1 ]. In 1951, Talcoot Parsons described the paternalistic model [ 2 ], perceived by the author as structurally asymmetric in favour of doctors. Over the years, the doctor/patient relationship has changed. The need to participate in medical decision-making has increased over time. This situation is currently favoured by the ease of access to information through the internet and the use of smartphones. In 2011, the Association Québécoise des Établissements de Santé et des Services Sociaux (AQESSS) reported that more than half of Quebecers aged 18 and over would use the internet for health-related topics [ 3 ]. This ability of the patient to access information sometimes had an impact on the degree of trust he had in the doctor. Indeed, trust is an attitude, a psychological state occurring in a context of uncertainty, risk and vulnerability whose definition varies depending on the authors and the context of use [ 4 ]. Annette Baier defines trust as the act of accepting being vulnerable to the will of others [ 5 ]. To some extent, trusting others would involve putting oneself in one’s power and, in doing so, risking being wrong if one does not take seriously the ethical requirements related to this power. In 2012, Fox. S and Duggan. M [ 6 ], in a national survey of 3,014 adults living in the United States, reported that half of the 53% of smartphone owners used their devices to obtain health information and that one-fifth of them owned health apps. Digital technology contributes to the popularization of medical information once it is monopolized by caregivers. Currently, many patients come to medical consultations after having previously conducted online research on their health issues [ 7 ]. However, the variability in the quality of information, often controversial with that of the doctor, contributes to altering trust in the doctor/patient relationship, especially in the management of chronic diseases. To this end, Oudshoorn. N in "Telecare Technologies and the transformation of healthcare" expressed a warning about the harmful effects that patient-centered health services can have on the doctor‒patient relationship [ 8 ]. Like in other countries, the Burkinabe health system is facing the use of digital health technologies by patients. With access to mobile technologies, especially (97%) and mobile internet (77%) [ 9 ], the Burkinabe population uses the internet in search of health information. In 2023, Yaméogo et al. [ 10 ], in their study on "Self-medication in the digital age: survey of the population of the city of Ouagadougou (Burkina Faso)", reported a frequency of self-medication of 55% among adults over 18 years old. The use of the internet, the search for health information and the perception of the safety of self-medication over the internet were factors associated with the practice of self-medication. The distrust of health workers or the health care system accounted for 16% of the factors promoting self-medication. To discuss the impact of digital technology on doctor confidence in Burkina Faso and in the absence of data according to our review of the literature, we found it appropriate to conduct a study on the doctor/patient relationship in the digital age among hypertensive patients in Burkina Faso. We hypothesized that the patient’s search for online information could alter the quality of the doctor–patient relationship and consequently have a negative effect on the treatment compliance of hypertensive patients. Conceptual framework We relied on the theory of care compliance that we adapt to the doctor‒patient relationship [ 11 ]. The doctor–patient relationship is based on confidence. This confidence is based on the doctor’s qualities (skills, communication, empathy) to solve the patient’s health problems. With the development of the internet, patients can search for information online to better understand their disease or treatment. This research can lead to an asymmetry in the perception of information and a disagreement on the patient’s care needs and have consequences for the doctor’s confidence and compliance with treatment. Materials and methods The study took place in the cardiology departments of teaching hospital Yalgado Ouédraogo and Bogodogo. This was an analytical cross-sectional study conducted from March 1, 2024, to July 10, 2024. The source population of our study was all patients followed in cardiology departments for heart disease. The target population was all hypertensive patients followed in cardiology departments in both hospitals. The following were included in our study: Hypertensive patients over 18 years of age; Patients consenting to participate in the study; Patients with the ability to answer questions. The data for our study were collected by investigators who had no connection with the management of patients in the different services to reduce response bias during an interview. The data were collected in a single face-to-face pass. The interviewers were trained in the use of the Kobotoolbox, and a pretest was carried out to assess questionnaire comprehension and response quality. For the calculation of the sample size, we considered that 50% of patients trusted their doctors for the management of their disease, with a margin of error of 5%. This information allowed us to obtain a minimum sample size of 384 patients with the Schwartz formula: . $$\:n=\:{z}^{2}x\frac{p(1-p)}{{m}^{2}}$$ n = sample size z = confidence level according to the normal centered reduced (for a 95% confidence level, z = 1.96) p = estimated proportion of the population that exhibits the unknown characteristic in our case; we used a p = 0.5 m = margin of error tolerated (we want to know the actual proportion within 5%) The minimum size of our sample was n: 384 The data were collected via a questionnaire designed with Kobotoolbox. The questionnaire was administered by trained interviewers. A pretest was conducted to account for misunderstandings in the questionnaire. The data collected were as follows: Sociodemographic data; Data on hypertension history and complications; Confidence assessment data from the Trust in Physician Scale tool [ 12 ]; The evaluation of information retrieval on the internet takes into account the relevance, understanding, adequacy and usefulness of the information [ 11 , 13 ]; The evaluation of the doctor’s quality by taking into account the doctor’s skills, empathy and communication [ 11 , 14 – 16 ]; The assessment of information perception asymmetry [ 11 , 17 , 18 ]; The evaluation of the concordance between the doctor and the patient [ 11 , 19 ]; Patient compliance with the doctor’s recommendations [ 11 , 16 ] The rating scales used a five-point Likert scale: "not at all agree" = 1, "not agree" = 2, "no opinion" = 3, "agree" = 4 and "completely agree" = 5. The scores were reversed for negative questions. The data were analysed via R software. All scale scores were transformed and reduced to 100 according to the following formula: $$\:score=\frac{(sum\:of\:points\:per\:question-number\:of\:questions)}{4\:x\:number\:of\:questions\:}x100$$ The scores were subdivided into three classes: Low for a score of 50, Average for a 50 75. From these scores, we calculated the averages and proportions. To verify our research hypothesis, we used structural equation modelling. This modelling allowed us to verify the three hypotheses and the influence of the variables on each other. The model was validated if: Root mean square error approximation (RMSEA) ≤ 0,05 Comparative Fit Index ≥ 0,95 Tucker Lewis Index ≥ 0,95 Verbal consent was obtained from all patients for their participation in the study. When there was a language barrier, a healthcare worker was used as a translator to reduce information bias. Patients were informed about the objectives of the study and, above all, that refusal to participate in the study would not affect the quality of their care. Data confidentiality was ensured to protect the patient’s anonymity by not collecting identification data. The study protocol was approved by the Health Research Ethics Committee under number 2024-07-224. All steps and actions mentioned in the approved protocol were followed. Results During our study period, we collected 408 patients, of whom two patients were excluded because of incomplete score evaluation data. The average age of the population was 59 12 years, with extremes of 22 and 89 years. The sex ratio was 0.49. One hundred thirty-five patients (33%) had access to the internet, and 70 (17%) were searching for information online. Table 1 shows the distribution of the sociodemographic characteristics of the patients based on the search for online information. Table 1 Sociodemographic characteristics of the patients Search for information online No N = 336 n (%) Yes N = 70 n (%) Population N = 406 n (%) p value Age 60 ± 12 ans 55 ± 11 ans 59 ± 12 ans 65 5 (1,5) 26 (7,7) 79 (23,5) 112 (33,3) 114 (33,9) 7 (10) 7 (10) 15 (21,4) 33 (47,1) 8 (11,4) 12 (2,9) 33 (8,1) 95 (23,3) 146 (35,8) 122 (29,9) Sex 0,068 Feminin Male 230 (68) 106 (32) 40 (57) 30 (43) 270 (67) 136 (33) Educational level Uneducated Elementary High-school University 161 (48) 64 (19) 87 (26) 24 (7) 1 (1,5) 1 (1,5) 39 (56) 29 (41) 162 (40) 65 (16) 126 (31) 53 (13) Internet accessibility 65 (19) 70 (100) 135 (33) < 0,001 Arterial hypertension was controlled in 72% (n = 292) of the patients. Table 2 shows the distribution of patients according to their history of arterial hypertension. Table 2 History of high blood pressure Search for information online No N = 336 n (%) Yes N = 70 n (%) Population N = 406 n (%) p value Control of hypertension 236 (70) 56 (80) 292 (72) 0,11 Presence of complications 83 (25) 19 (27) 102 (25) 0,7 Ischemic stroke Hemorrhagic stroke Cardiac failure Hypertensive CM FA Ischemic CM CKD Retinopathy 28 (33,7) 13 (15,7) 8 (9,6) 15 (18,1) 5 (6) 3 (3,6) 4 (4,8) 1 (1,2) 7 (36,8) 1 (5,3) 2 (10,5) 3 (1,8) 2 (10,5) 4 (21) 5 (26,3) 2 (10,5) 35 (34,3) 14 (13,7) 10 (9,8) 18 (17,6) 7 (6,9) 7 (6,9) 9 (8,8) 3 (2,9) CM: cardiomyopathy; AF: atrial fibrillation; CKD: chronic kidney disease The average doctor quality score of the population was 85 14. The average online information search score was 52 23. The mean perception score of information asymmetry was 84 16. The mean patient‒doctor concordance score was 82 18. The average compliance score was 85 15. The average information adequacy score was 85 13. Table 3 shows the distributions of the different scores. Table 3 Coefficients of structural equation modelling Search for information online No N = 336 n (%) Yes N = 70 n (%) Population N = 406 n (%) p value Doctor’s quality Score 86 ± 14 83 ± 14 85 ± 14 0,070 Low Moderate High 7 (2,1) 108 (32,1) 221 (65,8) 2 (2,8) 25 (35,7) 43 (61,4) 9 (2,2) (32,8) 264 (65) Online information search score 52 ± 23 Low Moderate High 33 (47,1) 30 (42,9) 7 (10) Perception score of information asymmetry 84 ± 15 84 ± 14 84 ± 16 0,2 Low Moderate High 9 (2,7) 160 (47,6) 167 (49,7) 8 (11,4) 27 (38,6) 35 (50) 17 (4,2) 187 (46,1) 202 (49,7) Patient‒doctor concordance score 82 ± 18 80 ± 17 82 ± 18 0,2 Low Moderate High 11 (3,3) 166 (49,4) 159 (47,3) 2 (2,9) 40 (57,1) 28 (40) 13 (3,2) 206 (50,7) 187 (46,1) Compliance score 85 ± 15 84 ± 14 85 ± 15 0,4 Low Moderate High 8 (2,4) 145 (43,2) 183 (54,4) 0 32 (45,7) 38 (54,3) 8 (2) 177 (43,6) 221 (54,4) Confidence score 85 ± 13 82 ± 13 85 ± 13 0,028 Low Moderate High 11 (3,3) 33 (9,8) 292 (86,9) 3 (4,3) 12 (17,1) 55 (78,6) 14 (3,4) 45 (11,1) 347 (84,5) We noted a positive correlation between the quality of the doctor and confidence in the doctor (standardized coefficient = 0.55, p < 0.001) and a negative correlation between online information search and confidence in the doctor (standardized coefficient = − 0.114, p = 0.005). The table below shows the different correlations. Physician quality has a positive correlation with variables such as compliance, patient‒physician agreement, and perceived information asymmetry (p < 0.001). Table 4 Coefficients of structural equation modelling Raw Coefficient Standardized Coefficient P value Regression Confidence ~ Quality of the doctor 0,521 0,55 < 0,001 Online information search -0,065 -0,114 0,005 Compliance Quality of the doctor 0,498 0,480 < 0,001 Online information search 0,008 0,014 0,755 Patient‒Doctor concordance Quality of the doctor 0,638 0,503 < 0,001 Online information search -0,027 -0,035 0,412 Perception of information asymmetry Quality of the doctor 0,745 0,645 < 0,001 Online information search -0,010 -0,015 0,698 Covariances Confidence Compliance -2,654 -0,019 0,702 Patient‒Doctor concordance 6,908 0,041 0,408 Perception of information asymmetry 0,292 0,002 0,965 Compliance Patient‒Doctor concordance 16,921 0,087 0,081 Perception of information asymmetry 26,720 0,170 0,001 Patient‒Doctor concordance Perception of information asymmetry 61,001 0,322 < 0,001 Variance Confidence 120,765 0,686 < 0,001 Compliance 162,384 0,769 < 0,001 Patient‒Doctor concordance 235,150 0,746 < 0,001 Perception of information asymmetry 152,478 0,584 = 0.95 and TLI > = 0.95). The search for information had a negative and statistically significant correlation with confidence. The quality of the doctor had a positive and statistically significant correlation with confidence. The quality of the doctor had a positive correlation with the perception of information asymmetry and the concordance of information between the doctor and the patient. Figure 2 below shows the correlation coefficients between the different variables according to the theoretical framework. Discussion Unequal access to the internet and online information Our study revealed that 33% of the 406 patients studied had access to the internet and that 17% used the internet to search for information about their health. Patients with internet access were generally younger (55 11 years) than those without internet access (60 12 years), with a statistically significant difference (p < 0.001). Searching for information online was also more common among patients with secondary or higher education, whereas uneducated individuals or those with primary education were very reluctant to search for information online. This result highlighted a factor of unequal access to digital data on the basis of both age and level of education, with important implications for equitable access to health information. Even though the penetration rates of mobile telephony and internet access are steadily increasing, the digital skills of the population remain low, especially for documentary research [20]. These results are in agreement with several studies from the literature, notably that of Diviani et al. [21], which indicated that age and level of education significantly influenced the likelihood of using the internet for health purposes. In particular, young adults and those with higher levels of education are more comfortable with new information and communication technologies and tend to search more actively for medical information online. In addition, a study by McMullan [22] showed that patients who used the internet to search for health information often had a better sense of control over their own health. This sense of autonomy was directly related to patients' ability to make informed decisions, which was similar to the observations made in our study, where patients who searched online tended to have better control over their hypertension. Online information search: a factor in reducing information asymmetry Patients who searched for information online tended to perceive less information asymmetry than did their doctors (p = 0.032). This reduced perception of asymmetry could be beneficial, as it shows that patients feel better informed and therefore more involved in decisions about their health. However, this reduction in asymmetry did not seem to have a significant effect on overall confidence in the doctor; this observation highlights the complexity of the relationship between patients' search for autonomy and their perception of the role of the doctor. This result aligns with the theory of patient empowerment via the internet described by Eysenbach [23]. Information empowerment allows patients to approach consultations with more knowledge, which reduces the gap between their understanding of their health status and that of the doctor. However, it is important to emphasize that the literature also warns against the risks of misinformation found online. Studies in Nigeria [24] have shown that many patients who search for medical information online fall on unreliable sites, which can sometimes worsen information asymmetries instead of reducing them. A study by Madathil et al. [25] revealed that the varying quality of medical information online could lead to confusion and even inappropriate health behaviors, especially if patients do not check the validity of their sources of information. Indeed, the World Health Organization (WHO) has warned against the proliferation of false medical information on the internet, which is particularly problematic in countries where the regulation of online content is still weak. The quality of the doctor: an important element for patient‒physician compliance and agreement Our research showed that the perceived quality of the doctor had a strong correlation with patient compliance (standardized coefficient = 0.480, p < 0.001) and concordance (agreement on diagnosis and treatment) (standardized coefficient = 0.503, p < 0.001). These results showed that the more patients perceived the doctor as competent and empathetic, the more they followed his recommendations, which is a key factor for the success of medical treatments. On the other hand, searching for information online had no significant effect on compliance (p = 0.755) or concordance (p = 0.412). This could be explained by the fact that, even if patients inquire online, they would end up adhering to their doctor’s recommendations if they were perceived as competent and caring. These results are consistent with the literature, which has demonstrated that the perception of quality of care is a determining factor in adherence to medical treatments [26,27]. Perceived empathy, in particular, has been cited in the literature as one of the key elements for improving therapeutic compliance [28]. When patients feel that their doctors understand their emotional concerns and personal difficulties, they are more likely to follow medical advice. This is particularly true for chronic diseases such as high blood pressure, where a long-term relationship with a doctor is essential. However, the shortage of skilled medical personnel in many parts of sub-Saharan Africa may affect the perceived quality of care. Patients, especially those in rural areas, often find themselves with limited access to qualified doctors; this can alter their perception of the quality of care received [29]. This partly explains why the perceived quality of the doctor is such a determining factor for therapeutic compliance in Africa. The quality of the doctor: a guarantee of the patient’s trust in the doctor in the era of technologies A moderate negative correlation was observed between the search for information online and trust in the doctor (standardized coefficient = -0.114, p = 0.005). This meant that patients who inquired online tended to express less trust in their doctor. This dynamic could result from the fact that the information found online is not always consistent with medical recommendations, which could lead to a questioning of the doctor’s authority. However, the perceived quality of the doctor remained a crucial factor positively influencing patient confidence (standardized coefficient = 0.55, p < 0.001). In other words, even if the search for information online could sometimes undermine trust, the perceived quality of the doctor remained a determining factor in maintaining this relationship of trust. The negative correlation observed between online information retrieval and trust in the physician was in line with several findings from the literature. A study by Lee et al. [30] demonstrated that the increasing use of online medical information sources could create a conflict of opinion between patients and doctors, especially when the information found differed from that provided by healthcare professionals. This lack of consistency could lead to doubt in the patient and affect confidence in the doctor’s recommendations, which is consistent with the results of this study. Moreover, in several African countries, such as Burkina Faso, where traditional medicine and local practices are still strongly rooted, the search for information online could introduce additional complexity. Indeed, patients who combine traditional practices with modern medical information could find themselves facing contradictions, which could increase their distrust of the health system. However, some studies, such as that of Tan and Goonawardene [31], show that an open dialogue about information found online can minimize this effect. Doctors who take the time to discuss their patients' online research, explaining points of convergence and divergence with standard medical information, manage to restore trust while strengthening the relationship with the patient. Limits of our study The study does not establish causality between online information search and doctor-patient trust due to its cross-sectional design. The impact is limited to hypertensive patients in two hospitals, which decreases generalizability. Self-reported data can introduce social desirability and recall bias. The Burkinabe context was not fully validated for measurement tools, which had an impact on reliability. The outcomes may have been affected by factors that were not measured, such as digital literacy and cultural attitudes towards medical authority. Conclusion The results of this study revealed a complex relationship between online information retrieval, the perceived quality of medical care, and trust in physicians. While online information research could undermine patients’ trust in their physicians, it also appeared to have a positive impact in terms of patient engagement and the perception of information asymmetry. Physicians need to be aware of the growing importance of online information in patient health management and adapt their communication accordingly. Promoting an open dialogue on the information that patients find online could strengthen trust and improve adherence to treatments. This research offers useful insights for managing physician‒patient relationships in the digital age, particularly with respect to chronic diseases such as hypertension, where long-term follow-up and patient engagement are essential. Abbreviations AQESSS : Association Québécoise des Établissements de Santé et des Services Sociaux RMSEA: Root mean square error approximation CFI: Comparative Fit Index Tucker Lewis Index CM: cardiomyopathy AF: atrial fibrillation; CKD: chronic kidney disease Declarations Ethical approval and consent to participate The study was approved by the ethics committee under number 2024-07-224. Consent to publication The patients’ oral consent was obtained for their participation in the study. Data confidentiality was ensured to protect the patient’s anonymity by not collecting identification data. 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1","display":"","copyAsset":false,"role":"figure","size":150675,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework of the doctor–patient relationship and the impact of digital technology\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7834832/v1/b8da8b58938219393410ef33.png"},{"id":96376861,"identity":"db175e27-dca9-4c76-ade5-92c6b4586b90","added_by":"auto","created_at":"2025-11-20 11:30:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":95402,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic of the theoretical framework with correlation coefficients\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7834832/v1/783084aa66ee641bdb556656.png"},{"id":96456897,"identity":"0b14cd28-9461-40ad-868f-cf4f6a763f13","added_by":"auto","created_at":"2025-11-21 10:08:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1447603,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7834832/v1/e4f5e9e4-1314-4193-9f9f-f95c981a4e07.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The doctor‒patient relationship in the digital age: the case of hypertensive patients in Burkina Faso","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe doctor‒patient relationship refers to all relationships between the doctor and the patient as part of a medical procedure or therapeutic monitoring. She is considered to be the pivot of medicine [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 1951, Talcoot Parsons described the paternalistic model [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], perceived by the author as structurally asymmetric in favour of doctors. Over the years, the doctor/patient relationship has changed. The need to participate in medical decision-making has increased over time. This situation is currently favoured by the ease of access to information through the internet and the use of smartphones. In 2011, the Association Québécoise des Établissements de Santé et des Services Sociaux (AQESSS) reported that more than half of Quebecers aged 18 and over would use the internet for health-related topics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This ability of the patient to access information sometimes had an impact on the degree of trust he had in the doctor. Indeed, trust is an attitude, a psychological state occurring in a context of uncertainty, risk and vulnerability whose definition varies depending on the authors and the context of use [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Annette Baier defines trust as the act of accepting being vulnerable to the will of others [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. To some extent, trusting others would involve putting oneself in one’s power and, in doing so, risking being wrong if one does not take seriously the ethical requirements related to this power. In 2012, Fox. S and Duggan. M [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], in a national survey of 3,014 adults living in the United States, reported that half of the 53% of smartphone owners used their devices to obtain health information and that one-fifth of them owned health apps. Digital technology contributes to the popularization of medical information once it is monopolized by caregivers. Currently, many patients come to medical consultations after having previously conducted online research on their health issues [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the variability in the quality of information, often controversial with that of the doctor, contributes to altering trust in the doctor/patient relationship, especially in the management of chronic diseases. To this end, Oudshoorn. N in \"Telecare Technologies and the transformation of healthcare\" expressed a warning about the harmful effects that patient-centered health services can have on the doctor‒patient relationship [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Like in other countries, the Burkinabe health system is facing the use of digital health technologies by patients. With access to mobile technologies, especially (97%) and mobile internet (77%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the Burkinabe population uses the internet in search of health information.\u003c/p\u003e\u003cp\u003eIn 2023, Yaméogo et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], in their study on \"Self-medication in the digital age: survey of the population of the city of Ouagadougou (Burkina Faso)\", reported a frequency of self-medication of 55% among adults over 18 years old. The use of the internet, the search for health information and the perception of the safety of self-medication over the internet were factors associated with the practice of self-medication. The distrust of health workers or the health care system accounted for 16% of the factors promoting self-medication. To discuss the impact of digital technology on doctor confidence in Burkina Faso and in the absence of data according to our review of the literature, we found it appropriate to conduct a study on the doctor/patient relationship in the digital age among hypertensive patients in Burkina Faso. We hypothesized that the patient’s search for online information could alter the quality of the doctor–patient relationship and consequently have a negative effect on the treatment compliance of hypertensive patients.\u003c/p\u003e"},{"header":"Conceptual framework","content":"\u003cp\u003eWe relied on the theory of care compliance that we adapt to the doctor‒patient relationship [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The doctor–patient relationship is based on confidence. This confidence is based on the doctor’s qualities (skills, communication, empathy) to solve the patient’s health problems. With the development of the internet, patients can search for information online to better understand their disease or treatment. This research can lead to an asymmetry in the perception of information and a disagreement on the patient’s care needs and have consequences for the doctor’s confidence and compliance with treatment.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe study took place in the cardiology departments of teaching hospital Yalgado Ouédraogo and Bogodogo. This was an analytical cross-sectional study conducted from March 1, 2024, to July 10, 2024. The source population of our study was all patients followed in cardiology departments for heart disease. The target population was all hypertensive patients followed in cardiology departments in both hospitals.\u003c/p\u003e\u003cp\u003eThe following were included in our study:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHypertensive patients over 18 years of age;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatients consenting to participate in the study;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatients with the ability to answer questions.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eThe data for our study were collected by investigators who had no connection with the management of patients in the different services to reduce response bias during an interview. The data were collected in a single face-to-face pass. The interviewers were trained in the use of the Kobotoolbox, and a pretest was carried out to assess questionnaire comprehension and response quality.\u003c/p\u003e\u003cp\u003eFor the calculation of the sample size, we considered that 50% of patients trusted their doctors for the management of their disease, with a margin of error of 5%. This information allowed us to obtain a minimum sample size of 384 patients with the Schwartz formula:\u003c/p\u003e\u003cp\u003e.\u003c/p\u003e\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\:{z}^{2}x\\frac{p(1-p)}{{m}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003cp\u003en = sample size\u003c/p\u003e\u003cp\u003ez = confidence level according to the normal centered reduced (for a 95% confidence level, z = 1.96)\u003c/p\u003e\u003cp\u003ep = estimated proportion of the population that exhibits the unknown characteristic in our case; we used a p = 0.5\u003c/p\u003e\u003cp\u003em = margin of error tolerated (we want to know the actual proportion within 5%)\u003c/p\u003e\u003cp\u003eThe minimum size of our sample was n: 384\u003c/p\u003e\u003cp\u003eThe data were collected via a questionnaire designed with Kobotoolbox. The questionnaire was administered by trained interviewers. A pretest was conducted to account for misunderstandings in the questionnaire.\u003c/p\u003e\u003cp\u003eThe data collected were as follows:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSociodemographic data;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eData on hypertension history and complications;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConfidence assessment data from the Trust in Physician Scale tool [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e];\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe evaluation of information retrieval on the internet takes into account the relevance, understanding, adequacy and usefulness of the information [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e];\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe evaluation of the doctor’s quality by taking into account the doctor’s skills, empathy and communication [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e];\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe assessment of information perception asymmetry [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e];\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe evaluation of the concordance between the doctor and the patient [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e];\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatient compliance with the doctor’s recommendations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eThe rating scales used a five-point Likert scale: \"not at all agree\" = 1, \"not agree\" = 2, \"no opinion\" = 3, \"agree\" = 4 and \"completely agree\" = 5. The scores were reversed for negative questions.\u003c/p\u003e\u003cp\u003eThe data were analysed via R software. All scale scores were transformed and reduced to 100 according to the following formula:\u003c/p\u003e\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:score=\\frac{(sum\\:of\\:points\\:per\\:question-number\\:of\\:questions)}{4\\:x\\:number\\:of\\:questions\\:}x100$$\u003c/div\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe scores were subdivided into three classes:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLow for a score of 50,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAverage for a 50 \u0026lt; score 75,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHigh for a score \u0026gt; 75.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eFrom these scores, we calculated the averages and proportions. To verify our research hypothesis, we used structural equation modelling. This modelling allowed us to verify the three hypotheses and the influence of the variables on each other. The model was validated if:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRoot mean square error approximation (RMSEA) ≤ 0,05\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eComparative Fit Index ≥ 0,95\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTucker Lewis Index ≥ 0,95\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e Verbal consent was obtained from all patients for their participation in the study. When there was a language barrier, a healthcare worker was used as a translator to reduce information bias. Patients were informed about the objectives of the study and, above all, that refusal to participate in the study would not affect the quality of their care. Data confidentiality was ensured to protect the patient’s anonymity by not collecting identification data. The study protocol was approved by the Health Research Ethics Committee under number 2024-07-224. All steps and actions mentioned in the approved protocol were followed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring our study period, we collected 408 patients, of whom two patients were excluded because of incomplete score evaluation data. The average age of the population was 59 12 years, with extremes of 22 and 89 years. The sex ratio was 0.49. One hundred thirty-five patients (33%) had access to the internet, and 70 (17%) were searching for information online. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of the sociodemographic characteristics of the patients based on the search for online information.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of the patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSearch for information online\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eN = 336\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eN = 70\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003cp\u003eN = 406\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 ± 12 ans\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 ± 11 ans\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 ± 12 ans\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge range in year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≤ 35\u003c/p\u003e\u003cp\u003e]35–45]\u003c/p\u003e\u003cp\u003e]45–55]\u003c/p\u003e\u003cp\u003e]55–65]\u003c/p\u003e\u003cp\u003e\u0026gt; 65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (1,5)\u003c/p\u003e\u003cp\u003e26 (7,7)\u003c/p\u003e\u003cp\u003e79 (23,5)\u003c/p\u003e\u003cp\u003e112 (33,3)\u003c/p\u003e\u003cp\u003e114 (33,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (10)\u003c/p\u003e\u003cp\u003e7 (10)\u003c/p\u003e\u003cp\u003e15 (21,4)\u003c/p\u003e\u003cp\u003e33 (47,1)\u003c/p\u003e\u003cp\u003e8 (11,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (2,9)\u003c/p\u003e\u003cp\u003e33 (8,1)\u003c/p\u003e\u003cp\u003e95 (23,3)\u003c/p\u003e\u003cp\u003e146 (35,8)\u003c/p\u003e\u003cp\u003e122 (29,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeminin\u003c/p\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230 (68)\u003c/p\u003e\u003cp\u003e106 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (57)\u003c/p\u003e\u003cp\u003e30 (43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e270 (67)\u003c/p\u003e\u003cp\u003e136 (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUneducated\u003c/p\u003e\u003cp\u003eElementary\u003c/p\u003e\u003cp\u003eHigh-school\u003c/p\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161 (48)\u003c/p\u003e\u003cp\u003e64 (19)\u003c/p\u003e\u003cp\u003e87 (26)\u003c/p\u003e\u003cp\u003e24 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1,5)\u003c/p\u003e\u003cp\u003e1 (1,5)\u003c/p\u003e\u003cp\u003e39 (56)\u003c/p\u003e\u003cp\u003e29 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (40)\u003c/p\u003e\u003cp\u003e65 (16)\u003c/p\u003e\u003cp\u003e126 (31)\u003c/p\u003e\u003cp\u003e53 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInternet accessibility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e65 (19)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e70 (100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e135 (33)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eArterial hypertension was controlled in 72% (n = 292) of the patients. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of patients according to their history of arterial hypertension.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHistory of high blood pressure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSearch for information online\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eN = 336\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eN = 70\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003cp\u003eN = 406\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eControl of hypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e236 (70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e292 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of complications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIschemic stroke\u003c/p\u003e\u003cp\u003eHemorrhagic stroke\u003c/p\u003e\u003cp\u003eCardiac failure\u003c/p\u003e\u003cp\u003eHypertensive CM\u003c/p\u003e\u003cp\u003eFA\u003c/p\u003e\u003cp\u003eIschemic CM\u003c/p\u003e\u003cp\u003eCKD\u003c/p\u003e\u003cp\u003eRetinopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (33,7)\u003c/p\u003e\u003cp\u003e13 (15,7)\u003c/p\u003e\u003cp\u003e8 (9,6)\u003c/p\u003e\u003cp\u003e15 (18,1)\u003c/p\u003e\u003cp\u003e5 (6)\u003c/p\u003e\u003cp\u003e3 (3,6)\u003c/p\u003e\u003cp\u003e4 (4,8)\u003c/p\u003e\u003cp\u003e1 (1,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (36,8)\u003c/p\u003e\u003cp\u003e1 (5,3)\u003c/p\u003e\u003cp\u003e2 (10,5)\u003c/p\u003e\u003cp\u003e3 (1,8)\u003c/p\u003e\u003cp\u003e2 (10,5)\u003c/p\u003e\u003cp\u003e4 (21)\u003c/p\u003e\u003cp\u003e5 (26,3)\u003c/p\u003e\u003cp\u003e2 (10,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (34,3)\u003c/p\u003e\u003cp\u003e14 (13,7)\u003c/p\u003e\u003cp\u003e10 (9,8)\u003c/p\u003e\u003cp\u003e18 (17,6)\u003c/p\u003e\u003cp\u003e7 (6,9)\u003c/p\u003e\u003cp\u003e7 (6,9)\u003c/p\u003e\u003cp\u003e9 (8,8)\u003c/p\u003e\u003cp\u003e3 (2,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCM: cardiomyopathy; AF: atrial fibrillation; CKD: chronic kidney disease\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe average doctor quality score of the population was 85 14. The average online information search score was 52 23. The mean perception score of information asymmetry was 84 16. The mean patient‒doctor concordance score was 82 18. The average compliance score was 85 15. The average information adequacy score was 85 13. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the distributions of the different scores.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCoefficients of structural equation modelling\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSearch for information online\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eN = 336\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eN = 70\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003cp\u003eN = 406\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoctor’s quality Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 ± 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 ± 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 ± 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,070\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (2,1)\u003c/p\u003e\u003cp\u003e108 (32,1)\u003c/p\u003e\u003cp\u003e221 (65,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2,8)\u003c/p\u003e\u003cp\u003e25 (35,7)\u003c/p\u003e\u003cp\u003e43 (61,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (2,2)\u003c/p\u003e\u003cp\u003e(32,8)\u003c/p\u003e\u003cp\u003e264 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOnline information search score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 ± 23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (47,1)\u003c/p\u003e\u003cp\u003e30 (42,9)\u003c/p\u003e\u003cp\u003e7 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerception score of information asymmetry\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 ± 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 ± 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 ± 16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (2,7)\u003c/p\u003e\u003cp\u003e160 (47,6)\u003c/p\u003e\u003cp\u003e167 (49,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (11,4)\u003c/p\u003e\u003cp\u003e27 (38,6)\u003c/p\u003e\u003cp\u003e35 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (4,2)\u003c/p\u003e\u003cp\u003e187 (46,1)\u003c/p\u003e\u003cp\u003e202 (49,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient‒doctor concordance score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 ± 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 ± 17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 ± 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (3,3)\u003c/p\u003e\u003cp\u003e166 (49,4)\u003c/p\u003e\u003cp\u003e159 (47,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2,9)\u003c/p\u003e\u003cp\u003e40 (57,1)\u003c/p\u003e\u003cp\u003e28 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (3,2)\u003c/p\u003e\u003cp\u003e206 (50,7)\u003c/p\u003e\u003cp\u003e187 (46,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 ± 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 ± 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 ± 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (2,4)\u003c/p\u003e\u003cp\u003e145 (43,2)\u003c/p\u003e\u003cp\u003e183 (54,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e32 (45,7)\u003c/p\u003e\u003cp\u003e38 (54,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (2)\u003c/p\u003e\u003cp\u003e177 (43,6)\u003c/p\u003e\u003cp\u003e221 (54,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConfidence score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 ± 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 ± 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 ± 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,028\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (3,3)\u003c/p\u003e\u003cp\u003e33 (9,8)\u003c/p\u003e\u003cp\u003e292 (86,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4,3)\u003c/p\u003e\u003cp\u003e12 (17,1)\u003c/p\u003e\u003cp\u003e55 (78,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (3,4)\u003c/p\u003e\u003cp\u003e45 (11,1)\u003c/p\u003e\u003cp\u003e347 (84,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eWe noted a positive correlation between the quality of the doctor and confidence in the doctor (standardized coefficient = 0.55, p \u0026lt; 0.001) and a negative correlation between online information search and confidence in the doctor (standardized coefficient = − 0.114, p = 0.005). The table below shows the different correlations. Physician quality has a positive correlation with variables such as compliance, patient‒physician agreement, and perceived information asymmetry (p \u0026lt; 0.001).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCoefficients of structural equation modelling\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRaw Coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandardized\u003c/p\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConfidence ~\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of the doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,55\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnline information search\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e-0,114\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of the doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,480\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnline information search\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient‒Doctor concordance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of the doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,503\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnline information search\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,412\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerception of information asymmetry\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of the doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,645\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnline information search\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCovariances\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConfidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompliance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2,654\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,702\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient‒Doctor concordance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,908\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,408\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of information asymmetry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,965\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompliance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient‒Doctor concordance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16,921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,081\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of information asymmetry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26,720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,170\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient‒Doctor concordance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of information asymmetry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,322\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConfidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120,765\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,686\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompliance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e162,384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,769\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient‒Doctor concordance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e235,150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,746\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of information asymmetry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152,478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,584\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe model was statistically validated in view of the validation criteria (CFI \u0026gt; = 0.95 and TLI \u0026gt; = 0.95). The search for information had a negative and statistically significant correlation with confidence. The quality of the doctor had a positive and statistically significant correlation with confidence. The quality of the doctor had a positive correlation with the perception of information asymmetry and the concordance of information between the doctor and the patient. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below shows the correlation coefficients between the different variables according to the theoretical framework.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eUnequal access to the internet and online information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study revealed that 33% of the 406 patients studied had access to the internet and that 17% used the internet to search for information about their health. Patients with internet access were generally younger (55 11 years) than those without internet access (60 12 years), with a statistically significant difference (p \u0026lt; 0.001). Searching for information online was also more common among patients with secondary or higher education, whereas uneducated individuals or those with primary education were very reluctant to search for information online. This result highlighted a factor of unequal access to digital data on the basis of both age and level of education, with important implications for equitable access to health information. Even though the penetration rates of mobile telephony and internet access are steadily increasing, the digital skills of the population remain low, especially for documentary research [20].\u003c/p\u003e\n\u003cp\u003eThese results are in agreement with several studies from the literature, notably that of Diviani et al. [21], which indicated that age and level of education significantly influenced the likelihood of using the internet for health purposes. In particular, young adults and those with higher levels of education are more comfortable with new information and communication technologies and tend to search more actively for medical information online.\u003c/p\u003e\n\u003cp\u003eIn addition, a study by McMullan [22] showed that patients who used the internet to search for health information often had a better sense of control over their own health. This sense of autonomy was directly related to patients\u0026apos; ability to make informed decisions, which was similar to the observations made in our study, where patients who searched online tended to have better control over their hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOnline information search: a factor in reducing information asymmetry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who searched for information online tended to perceive less information asymmetry than did their doctors (p = 0.032). This reduced perception of asymmetry could be beneficial, as it shows that patients feel better informed and therefore more involved in decisions about their health. However, this reduction in asymmetry did not seem to have a significant effect on overall confidence in the doctor; this observation highlights the complexity of the relationship between patients\u0026apos; search for autonomy and their perception of the role of the doctor.\u003c/p\u003e\n\u003cp\u003eThis result aligns with the theory of patient empowerment via the internet described by Eysenbach [23]. Information empowerment allows patients to approach consultations with more knowledge, which reduces the gap between their understanding of their health status and that of the doctor.\u003c/p\u003e\n\u003cp\u003eHowever, it is important to emphasize that the literature also warns against the risks of misinformation found online. Studies in Nigeria [24] have shown that many patients who search for medical information online fall on unreliable sites, which can sometimes worsen information asymmetries instead of reducing them. A study by Madathil et al. [25] revealed that the varying quality of medical information online could lead to confusion and even inappropriate health behaviors, especially if patients do not check the validity of their sources of information. Indeed, the World Health Organization (WHO) has warned against the proliferation of false medical information on the internet, which is particularly problematic in countries where the regulation of online content is still weak.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe quality of the doctor: an important element for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epatient‒physician\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;compliance and agreement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur research showed that the perceived quality of the doctor had a strong correlation with patient compliance (standardized coefficient = 0.480, p \u0026lt; 0.001) and concordance (agreement on diagnosis and treatment) (standardized coefficient = 0.503, p \u0026lt; 0.001). These results showed that the more patients perceived the doctor as competent and empathetic, the more they followed his recommendations, which is a key factor for the success of medical treatments.\u003c/p\u003e\n\u003cp\u003eOn the other hand, searching for information online had no significant effect on compliance (p = 0.755) or concordance (p = 0.412). This could be explained by the fact that, even if patients inquire online, they would end up adhering to their doctor\u0026rsquo;s recommendations if they were perceived as competent and caring.\u003c/p\u003e\n\u003cp\u003eThese results are consistent with the literature, which has demonstrated that the perception of quality of care is a determining factor in adherence to medical treatments [26,27].\u003c/p\u003e\n\u003cp\u003ePerceived empathy, in particular, has been cited in the literature as one of the key elements for improving therapeutic compliance [28]. When patients feel that their doctors understand their emotional concerns and personal difficulties, they are more likely to follow medical advice. This is particularly true for chronic diseases such as high blood pressure, where a long-term relationship with a doctor is essential.\u003c/p\u003e\n\u003cp\u003eHowever, the shortage of skilled medical personnel in many parts of sub-Saharan Africa may affect the perceived quality of care. Patients, especially those in rural areas, often find themselves with limited access to qualified doctors; this can alter their perception of the quality of care received [29]. This partly explains why the perceived quality of the doctor is such a determining factor for therapeutic compliance in Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe quality of the doctor: a guarantee of the patient\u0026rsquo;s trust in the doctor in the era of technologies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA moderate negative correlation was observed between the search for information online and trust in the doctor (standardized coefficient = -0.114, p = 0.005). This meant that patients who inquired online tended to express less trust in their doctor. This dynamic could result from the fact that the information found online is not always consistent with medical recommendations, which could lead to a questioning of the doctor\u0026rsquo;s authority.\u003c/p\u003e\n\u003cp\u003eHowever, the perceived quality of the doctor remained a crucial factor positively influencing patient confidence (standardized coefficient = 0.55, p \u0026lt; 0.001). In other words, even if the search for information online could sometimes undermine trust, the perceived quality of the doctor remained a determining factor in maintaining this relationship of trust. The negative correlation observed between online information retrieval and trust in the physician was in line with several findings from the literature. A study by Lee et al. [30] demonstrated that the increasing use of online medical information sources could create a conflict of opinion between patients and doctors, especially when the information found differed from that provided by healthcare professionals. This lack of consistency could lead to doubt in the patient and affect confidence in the doctor\u0026rsquo;s recommendations, which is consistent with the results of this study. Moreover, in several African countries, such as Burkina Faso, where traditional medicine and local practices are still strongly rooted, the search for information online could introduce additional complexity. Indeed, patients who combine traditional practices with modern medical information could find themselves facing contradictions, which could increase their distrust of the health system. However, some studies, such as that of Tan and Goonawardene [31], show that an open dialogue about information found online can minimize this effect. Doctors who take the time to discuss their patients\u0026apos; online research, explaining points of convergence and divergence with standard medical information, manage to restore trust while strengthening the relationship with the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimits of our study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study does not establish causality between online information search and doctor-patient trust due to its cross-sectional design. The impact is limited to hypertensive patients in two hospitals, which decreases generalizability. Self-reported data can introduce social desirability and recall bias. The Burkinabe context was not fully validated for measurement tools, which had an impact on reliability. The outcomes may have been affected by factors that were not measured, such as digital literacy and cultural attitudes towards medical authority.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study revealed a complex relationship between online information retrieval, the perceived quality of medical care, and trust in physicians. While online information research could undermine patients\u0026rsquo; trust in their physicians, it also appeared to have a positive impact in terms of patient engagement and the perception of information asymmetry. Physicians need to be aware of the growing importance of online information in patient health management and adapt their communication accordingly. Promoting an open dialogue on the information that patients find online could strengthen trust and improve adherence to treatments. This research offers useful insights for managing physician‒patient relationships in the digital age, particularly with respect to chronic diseases such as hypertension, where long-term follow-up and patient engagement are essential.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAQESSS\u0026nbsp;: Association Qu\u0026eacute;b\u0026eacute;coise des \u0026Eacute;tablissements de Sant\u0026eacute; et des Services Sociaux\u003c/p\u003e\n\u003cp\u003eRMSEA: Root mean square error approximation\u003c/p\u003e\n\u003cp\u003eCFI: Comparative Fit Index\u003c/p\u003e\n\u003cp\u003eTucker Lewis Index\u003c/p\u003e\n\u003cp\u003eCM: cardiomyopathy\u003c/p\u003e\n\u003cp\u003eAF: atrial fibrillation;\u003c/p\u003e\n\u003cp\u003eCKD: chronic kidney disease\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee under number 2024-07-224.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients\u0026rsquo; oral consent was obtained for their participation in the study. Data confidentiality was ensured to protect the patient\u0026rsquo;s anonymity by not collecting identification data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThank you.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eConseil National de l\u0026rsquo;ordre du M\u0026eacute;decin.fr. Bulletin de l\u0026rsquo;ordre national des m\u0026eacute;decins. In: Relation m\u0026eacute;decin patient. France; 20. (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastel, P. Le m\u0026eacute;decin, son patient et ses pairs. Une nouvelle approche de la relation th\u0026eacute;rapeutique. Rev Fr Sociol [Internet]. 2005 [cit\u0026eacute; 26 janv 2024];46(3):443\u0026ndash;67. 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Internet Health Information Seeking and the Patient\u0026ndash;Physician Relationship: A Systematic Review. \u003cem\u003eJ. Med. internet Res. 19 janv\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e (1), e5729 (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Confidence, Information, internet, Burkina Faso","lastPublishedDoi":"10.21203/rs.3.rs-7834832/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7834832/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe development of technologies has improved access to information for both doctors and patients. This accessibility can lead to conflicts during care and undermine the trust patients place in doctors. The objective of this study was to study the impact of online documentary research on the quality of the doctor‒patient relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study took place in the cardiology departments of teaching hospital Yalgado Ouédraogo and Bogodogo from March 1, 2024, to July 10, 2024. The study included hypertensive patients followed for at least six months. Validated questionnaires on the evaluation of trust in doctors, compliance with treatment, doctor‒patient agreement score, information asymmetry score between the doctor and the patient, online information search score and doctor quality score were used and filled in by external investigators at the service during a face‒to-face interview. All the scores are transformed and reduced to a value of 100. Structural equation modelling was used to analyse the correlations between variables and doctors' confidence. The test was statistically significant if p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study involved 406 patients. The average age of the patients was 59 years, with a sex ratio of 0.49. One hundred thirty-five patients (33%) had access to the internet, and 70 (17%) were searching for information online. We noted a positive correlation between the quality of the doctor and confidence in the doctor (standardized coefficient = 0.55, p \u0026lt; 0.001) and a negative correlation between online information search and confidence in the doctor (standardized coefficient = − 0.114, p = 0.005). Physician quality has a positive correlation with variables such as compliance, patient‒physician agreement, and perceived information asymmetry (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe search for information online can negatively impact trust in doctors. However, the impact on trust depends on the quality of the doctor. This highlights the importance of humanizing patient care in medical practice.\u003c/p\u003e","manuscriptTitle":"The doctor‒patient relationship in the digital age: the case of hypertensive patients in Burkina Faso","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 11:30:27","doi":"10.21203/rs.3.rs-7834832/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-11T03:30:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T12:51:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243572354361944013236247821590665477478","date":"2025-11-29T04:21:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91338677123311047006048880808740989861","date":"2025-11-25T08:53:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-21T10:51:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230083927687546889474236994071000744603","date":"2025-11-13T09:21:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123388632771298346588776727352914503244","date":"2025-11-13T08:05:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T21:44:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-10T21:43:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-30T05:41:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-28T07:44:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-28T07:41:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1e641b8-fd68-4ffd-b77d-b53df91c3616","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":58060593,"name":"Health sciences/Diseases"},{"id":58060594,"name":"Health sciences/Health care"},{"id":58060595,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-12-11T03:38:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 11:30:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7834832","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7834832","identity":"rs-7834832","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}