Profile of e-patients: analysis of their cancer information-seeking from a national survey

Researchers have yet to fully understand how competent e-patients are in selecting and using health information sources, or, more importantly, who e-patients are. This study attempted to uncover how cancer e-patients differ from other cancer information seekers in terms of their sociodemographic background, social networks, information competence, and selection of cancer information sources. We analyzed data from the National Cancer Institute's 2005 Health Information National Trends Survey, and a series of chi-square tests showed that factors that distinguished cancer e-patients from other cancer information seekers were age, gender, education, employment status, health insurance, and membership in online support groups. They were not different in the other factors measured by the survey. Our logistic regression analysis revealed that the e-patients were older and talked about their health issues with friends or family more frequently compared with online health information seekers without cancer. While preferring information from their doctors over the Internet, e-patients used the Internet as their primary source. In contrast to previous literature, we found little evidence that e-patients were savvy health information consumers who could make informed decisions on their own health. The findings of this study addressed a need for a better design and delivery of health information literacy programs for cancer e-patients.     

The Internet as a health information source: findings from the 2007 Health Information National Trends Survey and implications for health communication

A wealth of health information is available online, but we do not fully understand the implications for health communication. This study examined whether health information seekers who turn to the Internet first differ from those who turn elsewhere. Data from the 2,338 respondents to the mail portion of the National Cancer Institute's Health Information National Trends Survey (HINTS) 2007 who reported looking for health information for themselves were analyzed. Logistic regression was used to examine whether health information seekers turning to the Internet first differed in terms of demographics, information preferences and seeking confidence, and communication with providers from those using other sources. In the final model, Internet users were younger, more educated, higher income, preferred numbers rather than words to describe chance, and think it is very important to get personal medical information electronically. There were no differences in terms of gender, health status, confidence seeking health information, or communication with providers. Health information seekers who turn to the Internet first are different, both in terms of demographics and information preferences. As the use of communication technologies increases, health communicators need to be attentive to the potential for communication inequalities.     

Examining the health information-seeking behaviors of Korean Americans

Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information-seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.     

How does searching for health information on the Internet affect individuals' demand for health care services?

The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003-07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual's number of visits to a health professional in the past 12 months. An individual's decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual's demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services.     

Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013

With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.     

Women's approaches to the use of new technology for cancer risk information

BACKGROUND: Women are currently offered multiple sources of breast cancer risk information, and the Internet is the most rapidly growing health information source. The objectives of this study were to identify women's preferences for receiving online breast cancer risk information, to identify barriers to accessing this information, and to identify differences in these factors between Internet users and non-users. METHODS: Eight focus groups were conducted with women aged 18 to 74 (n = 65) living in King County, Washington. RESULTS: Participants were interested in accessing online health information with the support of a real person to assist with information searches and in accessing personalized information online. Participants emphasized the importance of trust, both in the content provider and in the organization collecting their personal data. CONCLUSIONS: Web sites should provide personalized information and personal searching assistance. They should also include disclosures of content sources and a privacy policy that details how personal data is handled.     

Believing in Expertise: How Authors’ Credentials and Language Use Influence the Credibility of Online Health Information

Today, many people use the Internet to seek health advice. This study examines how an author’s expertise is established and how this affects the credibility of his or her online health information. In a 2 (authors’ credentials: medical vs. nonmedical) × 2 (authors’ language use: technical vs. every day) within-subjects design, 127 study participants, or “seekers,” judged authors’ expertise, benevolence, and integrity as well as the credibility of their medical statements. In addition, we assessed seekers’ awareness of their own knowledge and behavior. Results revealed that users consciously rewarded authors’ credentials and subconsciously punished technical language. Seekers were keenly aware of authors’ credentials and perceived authors with medical credentials to have a higher level of expertise and their information to be more credible. Technical language use negatively affected authors’ integrity and the credibility of their health information, despite seekers being unaware of it. Practical implications for health communication and implications for future research are outlined.     

Patient–Provider Discussion of Online Health Information: Results From the 2007 Health Information National Trends Survey (HINTS)

Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient–HCP relationships.     

Examining the Health Information–Seeking Behaviors of Korean Americans

Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information–seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.     

Connecting Internet Use with Gaps in Cancer Knowledge

This study applies the knowledge gap hypothesis to the specific domain of Internet use for cancer information. In particular, this study examines disparities in online information seeking by education and ethnicity, and subsequent gaps in cancer knowledge. Perceived risk of cancer and ease of connection to the Internet are concerned as contingent factors influencing knowledge gaps. A subsample of the 2003 Health Information National Trends Survey—those who have ever been online—was analyzed. Data supported the hypothesis that high education groups and White Americans were more likely to use the Internet for cancer information than were their counterparts, and online information seeking enlarged to some degree the cancer knowledge gaps between education groups. Perceived cancer risk had a weak but significant three-way interaction effect with ethnicity and online seeking on cancer knowledge, which suggests the importance of motivation in attenuating the knowledge gaps. The moderating role of ease of connection to the Internet was not supported. Discussion about the findings and further suggestions are offered.     

Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of the Cognitive-Social Health Information Processing (C-SHIP) model

Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.     

The Next 50 Years—Reducing the Continued Harm From Tobacco Use

Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.     

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.

In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.

Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale’s high-score cutoff (15.0) (p < 0 .001).

NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs’ know and think about the health information they are sharing with vulnerable populations.     

Connecting internet use with gaps in cancer knowledge

This study applies the knowledge gap hypothesis to the specific domain of Internet use for cancer information. In particular, this study examines disparities in online information seeking by education and ethnicity, and subsequent gaps in cancer knowledge. Perceived risk of cancer and ease of connection to the Internet are concerned as contingent factors influencing knowledge gaps. A subsample of the 2003 Health Information National Trends Survey-t-hose who have ever been online--was analyzed. Data supported the hypothesis that high education groups and White Americans were more likely to use the Internet for cancer information than were their counterparts, and online information seeking enlarged to some degree the cancer knowledge gaps between education groups. Perceived cancer risk had a weak but significant three-way interaction effect with ethnicity and online seeking on cancer knowledge, which suggests the importance of motivation in attenuating the knowledge gaps. The moderating role of ease of connection to the Internet was not supported. Discussion about the findings and further suggestions are offered.     

A Prescription for Internet Access: Appealing to Middle-Aged and Older Racial and Ethnic Minorities Through Social Network Sites to Combat Colorectal Cancer

The popularity and usage of social media networks or SNS (social networking sites) among American Internet users age 50 and over doubled between 2009 and 2010 and has steadily climbed. Part of this increased access may be the result of older adults who are living with a chronic disease and are reaching out for online support. Colorectal cancer (CRC) risk is among those concerns, particularly among middle-age and older minority populations where disparities exist. This exploratory study investigates information seeking behavior related to cancer factors (e.g. testing for colon cancer, cancer fatalism) and current social media usage among racial and ethnic minority groups (African American and Latinos) and Whites age 50 and older. The secondary data from the 2012 Health Information National Trends Survey (HINTS) was analyzed to compare these populations. Results show that African Americans and Latinos were only slightly more likely to use social network sites to seek out cancer information compared to Whites. However, Whites were more likely to use the Internet to seek health information compared to African Americans and Latinos. In this sample, Whites were also more likely to be informed by a physician about CRC testing (p <.01). Whites were also more fatalistic about CRC (p<.001) and more likely to have self-reported receiving a positive diagnosis (p <.001). Implications of this study suggest that use of both traditional health information sources (physician) and the Internet (social media networks, Internet sites) have increased among older Americans and can serve as critical channels for cancer information and education.     

Parental education and children's online health information seeking: Beyond the digital divide debate

Research has shown that increasing numbers of teenagers are going online to find health information, but it is unclear whether there are disparities in the prevalence of online health seeking among young Internet users associated with social and economic conditions. Existing literature on Internet uses by adults indicates that low income, less educated, and minority individuals are less likely to be online health seekers. Based on the analysis of data from the Pew Internet and American Life Project for the US, this study finds that teens of low education parents are either as likely as or even more likely than teens of high education parents to seek online health information. Multiple regression analysis shows that the higher engagement in health seeking by teens of low education parents is related to a lower prevalence of parental Internet use, suggesting that some of these teens may be seeking online health information on behalf of their low education parents. Implications of these findings are discussed in relation to the issues of the digital divide and digital empowerment.