Keywords
diagnostic health information seeking
Xiaohongshu
liver cancer
BERTopic
platform medicalisation
Abstract
China carries approximately half of the global new burden of primary liver cancer, and the extended disease trajectory of "hepatitis B – cirrhosis – hepatocellular carcinoma" places patients and family caregivers in a state of sustained, stage-specific health information-seeking needs. With the popularisation of user-generated-content (UGC) platforms such as Xiaohongshu (also known as Rednote), a growing number of users bypass or supplement formal medical consultation by treating these platforms as informal "clinics". However, existing research has largely focused on post-diagnosis caregiver discourse and emotional support, while paying insufficient attention to the pre-diagnosis behaviour of users uploading imaging reports and soliciting lay diagnostic judgement—what we term diagnostic health information seeking (DHIS)—and to the quality of the replies they receive. Drawing on health information-seeking behaviour (HISB) models and information quality theory, this study integrates two independently scraped Xiaohongshu datasets ("liver cancer" and "liver lesion"), yielding 2,761 texts (2,218 question-oriented comments and 543 platform-side replies). A c-TF-IDF–based BERTopic-style pipeline combined with rule-based coding is applied to a three-track design. Three findings emerge. First, diagnostic seeking accounts for 31.5% of pre-diagnosis comments (liver-lesion context) but only 3.4% of post-diagnosis comments (liver-cancer context), a nearly tenfold gap (χ²(1) = 333.84, p < .001). Second, emotional seeking shows the reverse pattern (11.5% vs. 20.7%, χ²(1) = 31.68, p < .001). Third, among 543 question–reply dyads, 40.1% of diagnostic questions received no response; among those that were answered, only 13.6% received professional medical advice, while 15.2% received low-quality reassurance or deflection. We propose the concept of platform medicalisation and offer implications for platform governance, credential verification for content creators, and digital health-literacy interventions.
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