Shan Yi, Ji Meng, Xing Zhaoquan, Dong Zhaogang, Xu Xiaofei
School of Foreign Studies, Nantong University, Nantong, China.
School of Languages and Cultures, The University of Sydney, Sydney, Australia.
JMIR Form Res. 2023 Apr 5;7:e42782. doi: 10.2196/42782.
Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect.
This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making.
We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the "Internal" subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients.
All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between "knowing a lot" and "knowing some." The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients' health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients' limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence.
Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making.
目前，乳腺癌是中国女性中最常被诊断出的癌症，也是癌症相关死亡的第六大主要原因。更糟糕的是，错误信息加剧了中国乳腺癌的负担。迫切需要调查中国患者对乳腺癌错误信息的易感性。然而，尚未有这方面的研究。
本研究旨在确定一些人口统计学特征（年龄、性别和教育程度）、一些健康素养技能以及内控点是否与随机抽取的中国男女患者对各类乳腺癌错误信息的易感性显著相关，以便为临床实践、健康教育、医学研究和卫生政策制定提供有见地的启示。
我们首先设计了一份问卷，包括4部分信息：年龄、性别和教育程度（第1部分）；自我评估的疾病知识（第2部分）；健康素养综合量表（AAHLS）、电子健康素养量表（eHEALS）、6项一般健康算术测试（GHNT - 6）以及多维健康控制点（MHLC）量表的“内控”子量表（第3部分）；以及从一些官方注册和认证网站收集的10条乳腺癌错误观念（第4部分）。随后，我们采用随机抽样的方法从山东大学齐鲁医院招募患者。问卷通过中国最受欢迎的在线调查平台问卷星进行发放。收集到的数据在Microsoft Excel文件中进行处理。我们使用预先定义的有效性标准手动检查每份问卷的有效性。之后，我们根据预先定义的编码方案，基于问卷不同部分不同评分范围的李克特量表对所有有效问卷进行编码。在后续步骤中，我们计算了AAHLS各子部分的总和以及2个健康素养量表（eHEALS和GHNT - 6）和10条乳腺癌错误观念的总和。最后，我们应用逻辑回归模型将第4部分的得分与问卷第1 - 3部分的得分相关联，以确定哪些因素显著影响中国患者对乳腺癌错误信息的易感性。
根据有效性标准，收集到的447份问卷全部有效。参与者的平均年龄为38.29（标准差11.52）岁。他们的平均教育得分是3.68（标准差1.46），这意味着他们的平均教育程度在12年级和大专之间。在447名参与者中，348名（77.85%）为女性。他们自我评估的疾病知识平均得分是2.50（标准差0.92），表明他们自我评估的疾病知识水平介于“了解很多”和“了解一些”之间。AAHLS中各子结构的平均得分分别为：功能健康素养6.22（标准差1.34）、沟通健康素养5.22（标准差1.54）、批判性健康素养11.19（标准差1.99）。电子健康素养的平均得分是24.21（标准差5.49）。GHNT - 6中6个问题的平均得分分别为1.57（标准差0.49）、1.21（标准差0.41）、1.24（标准差0.43）、1.90（标准差0.30）、1.82（标准差0.39）和1.73（标准差0.44）。患者的健康信念和自信心平均得分是21.19（标准差5.63）。他们对每个错误观念的平均得分在1.24（标准差0.43）到1.67（标准差0.47）之间，对10条错误观念的平均得分是14.03（标准差1.78）。通过解读这些描述性统计数据，我们发现中国女性患者反驳乳腺癌错误信息的能力有限主要归因于5个因素：（1）沟通健康素养较低；（2）对自我评估的电子健康素养技能有把握；（3）一般健康算术能力较低；（4）对一般疾病知识的自我评估积极；（5）更消极的健康信念和较低的自信心。
通过逻辑回归模型，我们研究了中国患者对乳腺癌错误信息的易感性。本研究中确定的乳腺癌错误信息易感性的预测因素可为临床实践、健康教育、医学研究和卫生政策制定提供有见地的启示。
