Ginossar Tamar
University of New Mexico Cancer Center, Department of Communication and Journalism, University of New Mexico, albuquerque, NM, United States.
JMIR Cancer. 2016 Mar 9;2(1):e2. doi: 10.2196/cancer.5108.
The digital divide is a recognized public health problem caused by social determinants that exacerbate health disparities. Despite the "tectonic shift" in how most of the public obtains cancer information, underserved communities are at increased risk of being digitally marginalized. However, research that examines factors underlying eHealth information seeking in diverse health contexts is lacking.
The aim of this paper is to explore preferences and use of eHealth cancer prevention information (CPI) among patients and caregivers attending a minority-serving oncology clinic using the comprehensive model of information seeking as a theoretical framework. Specifically, the study examined the role of social determinants and prevention orientation in differences in preference and use of the Internet for CPI seeking among this diverse sample.
Survey methodology was used to identify social determinants and behavioral factors, including prevention orientation as correlates and predictors of respondents' (n=252) preferences and use of eHealth for CPI seeking.
Less than half (112/252, 44.4%) of respondents said that if faced with the need to seek CPI, they would seek this information online. In the final logistic regression model, education, ethnicity, age, and prevention orientation made significant contributions to the model (P<.05). Specifically, for each year increase in age, participants were 3% less likely to use the Internet for CPI seeking (P=.011). Compared to college graduates, respondents who did not complete high school were 11.75 times less likely to cite the Internet as a CPI carrier (P<.001) and those with a high school education were 3 times (2.99, P=.015) less likely. In addition, the odds that a Spanish speaker would cite the Internet as a CPI carrier were one-fifth (22%) of non-Hispanic whites (P=.032) and about one-quarter (26%) of English-speaking Latinos (P=.036). Finally, with each one point increase on the prevention orientation scale, respondents were 1.83 times less likely to cite online CPI seeking (P=.05).
Social determinants to health have profound influence on eHealth CPI seeking. Providers and policy makers should focus on meeting patients and family members' CPI needs following diagnosis and increase eHealth accessibility and availability of evidence-based CPI to diverse populations. Future research is needed to unravel further differences in eHealth CPI seeking, including those among Native Americans that emerged as an additional digitally underserved racial/ethnic group. Finally, additional factors underlying these differences should be explored to better tailor CPI eHealth information to diverse communities' information needs.
数字鸿沟是一个公认的公共卫生问题，由加剧健康差距的社会决定因素导致。尽管大多数公众获取癌症信息的方式发生了“结构性转变”，但服务不足的社区面临数字边缘化的风险却在增加。然而，缺乏在不同健康背景下研究电子健康信息寻求背后因素的研究。
本文旨在以信息寻求的综合模型为理论框架，探讨在一家为少数族裔服务的肿瘤诊所就诊的患者和护理人员对电子健康癌症预防信息（CPI）的偏好和使用情况。具体而言，该研究考察了社会决定因素和预防导向在这个多样化样本中，对偏好和使用互联网获取CPI的差异所起的作用。
采用调查方法来确定社会决定因素和行为因素，包括预防导向，作为受访者（n = 252）对电子健康获取CPI的偏好和使用情况的相关因素和预测因素。
不到一半（112/252，44.4%）的受访者表示，如果面临寻求CPI的需求，他们会在网上寻求此类信息。在最终的逻辑回归模型中，教育程度、种族、年龄和预防导向对模型有显著贡献（P <.05）。具体而言，年龄每增加一岁，参与者通过互联网寻求CPI的可能性就降低3%（P = 0.011）。与大学毕业生相比，未完成高中学业的受访者将互联网作为CPI载体的可能性低11.75倍（P <.001），而受过高中教育的受访者则低3倍（2.99，P = 0.015）。此外，说西班牙语的人将互联网作为CPI载体的几率是非西班牙裔白人的五分之一（22%）（P = 0.032），是说英语的拉丁裔的约四分之一（26%）（P = 0.036）。最后，预防导向量表上每增加一分，受访者通过在线寻求CPI的可能性就降低1.83倍（P = 0.05）。
健康的社会决定因素对电子健康CPI寻求有深远影响。医疗服务提供者和政策制定者应专注于在诊断后满足患者及其家庭成员的CPI需求，并提高电子健康的可及性以及为不同人群提供基于证据的CPI。未来需要开展研究，以进一步揭示电子健康CPI寻求方面的差异，包括在作为另外一个数字服务不足的种族/族裔群体出现的美国原住民之间的差异。最后，应探索这些差异背后的其他因素，以便更好地根据不同社区的信息需求定制CPI电子健康信息。
