Explicating the health-related digital divide: A mediation mechanism between education level and online cancer information seeking frequency among Chinese adults

In China, highly educated adults seek online cancer information more frequently than less educated adults. This health-related digital divide may impede the less-educated from effectively preventing cancer. To explicate the divide, we introduce informational subjective norms (ISN) and information sufficiency threshold (IST) as two socio-psychological mediators between education level and online cancer information seeking (OCIS) frequency. ISN represents one's perceived social pressure about seeking cancer information, while IST manifests individual evaluation of the amount of information needed to prevent cancer. An online survey supported a serial mediation effect of ISN and IST. ISN and IST also independently mediated the relationship between education level and OCIS frequency. Besides, the mediation effect of ISN was stronger than that of IST. The findings suggest that increasing ISN among less educated Chinese adults could facilitate their OCIS and to narrow the health-related digital divide. These implications may also inform other developing countries.

Understanding the Pathway of Cancer Information Seeking: Cancer Information Services as a Supplement to Information from Other Sources

Cancer information services (CISs) can play an important role within the pathway of cancer information seeking, but so far, this role is not well understood. Callers (n = 6,255) who contacted the largest provider of cancer information in Germany participated in a survey in which they reported their information sources, information level, and needs leading to the call. Persons with prior information from a physician (n = 1,507) were compared to people with prior online information (n = 901) and people with prior information from both sources (n = 2,776). Nearly all callers (96.7%) stated prior sources, while physicians and the Internet were the most frequently reported sources. People, who only talked to a doctor before, are more likely to be a patient and in the disease stages during/after the first treatment or with recurrence than prior Internet users. The two groups do not differ in their prior information level but did differ in their information needs. CISs are an important supplement to other sources, while the information repertoire depends on patients’ stages during the cancer journey. Specific characteristics and needs of callers with different prior information sources help to individualize the service of CISs and similar providers.

Media Exposure, Cancer Beliefs, and Cancer-Related Information-Seeking or Avoidance Behavior Patterns in China

This study explored the relationships between media exposure, cancer beliefs, and cancer information-seeking or information-avoidance behaviors. Based on the planned risk information-seeking model and its extended framework, two predictive models were constructed: one for cancer information seeking and the other for cancer information avoidance. A structural equation modeling strategy was applied to survey data from China HINTS 2017 (n = 3090) to compare the impact of traditional mass media and social media exposure to cancer-related information on cancer information-seeking and information-avoidance behaviors. The study findings suggest that health-related information exposure through different media channels may generate distinctive information-seeking or information-avoidance behaviors based on various cancer beliefs. Additionally, the findings indicate that social media exposure to health-related and cancer curability beliefs does not lead to cancer information avoidance; both mass media and social media exposure encourage people to seek cancer-related information. Cancer fatalism is positively associated with cancer information-seeking and avoiding intentions, suggesting that negative cancer beliefs predict seemingly contradictory yet psychologically coherent information intentions and behaviors.

A Comparative Study of Internet Cancer Information Seeking among US and Chinese Publics: Perceived Needs versus Enabling Conditions (Preprint)

BACKGROUND Since the rise of the internet, online health information seeking has attracted worldwide scholarly attention. However, most scholars conducted such studies in single countries. Some scholars did design comparative studies across countries, but they were normally based on small non-probability college student samples. Data-driven multi-country comparison makes it possible to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking, which further helps practitioners evaluate the desirability of experiences and lessons in a given country being transferred and promoted in other countries. The results of this study can contribute to the health communication literature, particularly in the field of online cancer information seeking, by generating more reliable insights on country differences in internet cancer information seeking. OBJECTIVE The objective of the study is to examine the similarities and differences in determinants of internet cancer information seeking of US and Chinese general public (excluding cancer patients and survivors) under the framework of behavioral model of health services use. METHODS This study used the HINTS 2017 (US data) and HINTS-China data collected in 2017 to answer the research question. This study was only interested in people without cancer history and with internet access. For HINTS 2017, the sample size was 2,153; for HINTS-China 2017, the sample size was 2,358. To compare China and the United States, the researchers selected as predictors the same set of study variables in HINTS and HINTS-China 2017. Under the framework of behavioral model of health services use, these predictors included predisposing, need and enabling factors. RESULTS This study found that enabling conditions are more important in China, while perceived needs are more significant in the United States. Chinese online cancer information seekers are employed, have lower annual family income, see or hear their family members diagnosed with cancer and do not trust their family and friends as health information sources, but none of them can be used to describe their US counterparts, who are instead more associated with their perceptions of personal health status and fear of cancer. CONCLUSIONS Overall, under the framework of the behavioral model of health services use, the results reveal clear patterns of cross-country/cultural differences. Perceived needs of individuals may play bigger roles in influencing internet cancer information seeking behaviors in more individualistic cultures such as the United States. The importance of enabling conditions outweighs perceived needs in predicting internet health information seeking behaviors in more collectivistic countries such as China.

Beliefs and Information Seeking in Patients With Cancer in Southwest China: Survey Study

Background Although previous studies have reported the cancer information-seeking behaviors among patients in high-income countries, the cancer information-seeking practices of patients living in low- and middle-income areas are less known. Objective This study investigated the beliefs and information-seeking patterns of cancer patients in southwest China. Methods A questionnaire was designed, and data were collected in two hospitals (N=285) in southwest China. Statistical analyses included bivariate analyses and regressions. Results Patients’ attitudes towards cancer fatalism were significantly influenced by marital status (P<.001), education (P<.001), and household income (P<.001). Moreover, endorsing fatalistic belief was positively associated with age (r=0.35, P<.001). The regression model showed that younger patients (odds ratio [OR] 0.96, 95% CI 0.93-0.99) and those with higher education (OR 1.75, 95% CI 1.09-2.81) were more likely to seek information. Additionally, patients who were less confident in getting information were more likely to find information (OR 1.70, 95% CI 1.15-2.52), while fatalism belief was not significant in the regression (OR 0.65, 95% CI 0.22-1.95). Conclusions This study explored the information-seeking patterns of cancer patients in southwest China. It was found that many Chinese people endorsed cancer fatalism. These pessimistic beliefs about the potential to prevent and to cure cancer correlate with rather than cause cancer-related information seeking. However, self-efficacy about the confidence in finding needed cancer information was a significant predictor of information-seeking.