Abstract
BackgroundThe 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.ObjectiveThe 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.MethodsSurvey 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.ResultsLess 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).ConclusionsSocial 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.
Highlights
OverviewThe exclusion of ethnic and racial minorities and vulnerable populations from accessing Web-based health information [1,2,3] exacerbates cancer-related health disparities
Differences between respondents who cited the Internet as a cancer prevention information (CPI) carrier and those who did not are described in the subsequent section and detailed in Multimedia Appendix 1
Members (56/108, 52.0%) were more likely than patients (44/143, 39.0%) to report that they would use the Internet for CPI, with a chi-square test showing that this difference was statistically significant (χ21,N=251=4.01, P
Summary
OverviewThe exclusion of ethnic and racial minorities and vulnerable populations from accessing Web-based health information [1,2,3] exacerbates cancer-related health disparities. Despite a “tectonic shift” in how cancer patients and their families obtain information and make decisions about their health, including primary and secondary prevention [4], 1 in 5 American adults does not use the Internet. These nonusers are disproportionally likely to be senior citizens, Spanish speakers, adults with less than a high school education, people with low income [5], and cancer survivors [6]. 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. Additional factors underlying these differences should be explored to better tailor CPI eHealth information to diverse communities’ information needs
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