Cognitive-Social Health Information Processing Research Articles

Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development.

Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. DERR1-10.2196/46657.

Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial.

BackgroundMany prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage.ObjectiveWe used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors.MethodsPC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use.ResultsA larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant.ConclusionsA combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement.Trial RegistrationClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482

User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care.

We describe an iterative three-phase approach used to develop a cancer survivorship health-coaching intervention to guide self-management and follow-up care for post-treatment breast, colorectal, and prostate cancer survivors. Informed by theory (e.g., Cognitive-Social Health Information Processing Model (C-SHIP)), relevant literature, and clinical guidelines, we engaged in a user-centered design process. In phase I, we conducted depth interviews with survivors of breast (n = 34), prostate (n = 4), and colorectal (n = 6) cancers to develop a health coaching prototype. In phase II, we utilized user-testing interviews (n = 9) to test and refine the health coaching prototype. For both phases, we used a template analysis independently coding each interview. In phase I, majority (n = 34, 81%) of survivors were positive about the utility of health coaching. Among these survivors (n = 34), the top areas of identified need were emotional support (44%), general health information (35.3%), changes in diet and exercise (29.3%), accountability and motivation (23.5%), and information about treatment effects (17.7%). The prototype was developed and user-tested and refined in phase III to address the following concerns: (1) the amount of time for calls, (2) density of reading materials, (3) clarity about health coaches' role, (4) customization. Collectively, this resulted in the development of the Extended Cancer Educational for Long-Term Cancer Survivors health-coaching (EXCELSHC) program, which represents the first cancer survivorship follow-up program to support follow-up care designed-for-dissemination in primary care settings. EXCELSHC is being tested in a clinical efficacy trial. Future research will focus on program refinement and testing for effectiveness in primary care.

Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages.

Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation. Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up. Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support. TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.

Development and usability testing of the e-EXCELS tool to guide cancer survivorship follow-up care.

The aim of this study is to describe a user-centered (e.g., cancer survivors and clinicians) development process of an eHealth tool designed to facilitate self-management of cancer survivorship follow-up care. Guided by Cognitive-Social Health Information Processing (C-SHIP) model and informed by core self-management skills, we engaged in a user-centered design process. In phase I, we conducted in-depth interviews with survivors of breast (n = 33), prostate (n = 4), and colorectal (n = 6) cancers, and (n = 9) primary care providers to develop content and design of the web tool. Phase II utilized iterative user testing interviews (n = 9) to test the web-based tool prototype. Data from both phases were independently coded using a template/content analytic approach. The top 5 functions identified in phase I for the web-based platform included: (a) educational materials to learn and prepare for health encounters (80%); (b) questions for health providers (74%); (c) ability to track contact information of providers (67%); (d) provide general information (64%); and, (e) support information (62%). Users of the prototype reported patient burden, tool fatigue, introduction timing of the tool, relevance, and security/privacy as concerns in phase II. This study demonstrates the value of using a theoretically informed and user-centered design process to develop relevant and patient-centered eHealth resources to support cancer survivorship. A larger study is needed to establish the efficacy of this eHealth tool as an intervention to improve adherence to follow-up care guidelines.

Decision-Making in Prostate Cancer – Choosing Active Surveillance Over Other Treatment Options: A Literature Review

A literature review was done using the Cognitive-Social Health Information Processing (C-SHIP) framework to identify how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. Findings indicated men who choose active surveillance have a stronger preference for active or collaborative decision-making than those who choose other treatments. Men primarily choose active surveillance to avoid the side effects of incontinence and erectile dysfunction. This literature review informed the study by Bayliss, Duff, Strieker, and Walker (2016) and found physician recommendation to be the most influential factor when patients make a treatment decision.

Decision-Making in Prostate Cancer: Active Surveillance Over Other Treatment Options

A qualitative-descriptive study of four patients with prostate cancer used the Cognitive-Social Health Information Processing framework to understand how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. In accordance with the literature, it was found that the surgeon or general practitioner's recommendation was the most influential factor when patients are making a treatment decision.

Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women.

This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.

Monitoring processing style: to see or not to see.

In this issue you will find a paper by Sherman et al., entitled effect of ‘monitoring processing style’ on post-surgical neuropathic pain in women with breast cancer.” This commentary focuses on the evidence base relevant to the ‘monitoring processing style’ (monitoring), based on the accumulating body of work on this construct. Monitoring is a temporally stable dispositional tendency to attend to, scan for, and amplify threatening health-related cues or information. Most of the research on monitoring has been assessed using the Monitor-Blunter Style Scale (MBSS), a brief self-report instrument with well-established reliability, validity, and utility (Miller, 1987). The MBSS has successfully been used to categorize individuals as either high monitors or low monitors (blunters). The monitoring construct is theoretically derived from the Cognitive–Social Health Information-Processing (C-SHIP) model (Roussi and Miller, 2014), which delineates five key cognitive-affective variables that mediate the response to health threats: a) health-relevant knowledge and perceptions regarding one’s personal health risks and vulnerabilities; b) health-relevant beliefs and expectancies about being able to obtain effective care, as well as self-efficacy expectancies (e.g., degree of confidence in one’s ability to cope with a health problem or adhere to recommendations); c) health-relevant values and goals (e.g., pros and cons of available medical regimens); d) health-relevant affects and emotions activated in health information processing (e.g., level of anxiety and concerns about a medical result or procedure); and e) health-relevant self-regulatory competences and skills for coping by generating and maintaining goal-oriented health-protective behaviors (e.g., for decision making, adherence, managing health-related distress, and for achieving effective communication and support). These variables are common denominators in virtually all current cognitive-social models of health behavior. Based on an extensive network of findings, high monitors generally display a signature cognitive-affective profile when facing health threats. Related to encodings, they know more about their health problem and are more likely to overestimate their personal health risks. They also have more negative beliefs and expectations regarding the health threat, and are more likely to exaggerate its severity and seriousness. In addition, high monitors place greater value on the pros of adhering to their medical care and on acquiring information about their health to help them problem-solve and reduce uncertainty, but are less satisfied with the information they receive from healthcare providers. At the affective level, high monitors experience more negative emotional responses to health threats, particularly greater worry, concerns, and distress, particularly when the threat is high, and are more in need of emotional support. At the self-regulatory level, when the health threat is more controllable and less severe, e.g., as when undertaking preventive measures for disease via routine screening, high monitors tend to demonstrate high adherence and effective coping. However, when facing more difficult-to-control and severe health threats, e.g., feedback of abnormal results or a diagnosis of cancer, high monitors tend to experience affects such as “intrusive ideation,” i.e., intrusive and repetitive thinking about the threat, and “avoidant ideation,” i.e., effortfully avoiding thinking about the threat, and consequent denial and disengagement (Miller, 1995). Thus, the high monitoring repertoire entails both effective and ineffective coping, the former when the health threat is more controllable and routine, and the latter when it is more uncontrollable, severe, and uncertain. The Sherman et al. article adds to this literature, by showing that monitoring is associated not only with cognitive-affective and behavioral factors, but also with post-surgical pain levels among women who have undergone breast cancer surgery. These results are significant since they suggest that sustained attention to health threats involves not only increased subjective stress among high monitors, but also higher somatic symptom monitoring and actual somatic symptoms over time. These findings parallel previous results showing that high monitors show greater physiological arousal in the face of health threats, as well as greater symptomatology (e.g., nausea and vomiting) in response to cancer treatments. Taken together, this body of research indicates that it is important to consider signature personality profiles such as monitoring when designing interventions at the biobehavioral level, including psychoeducational, counseling, psychotherapeutic, symptom management, and support interventions in the health context. In response to routine or short-term diagnostic and surgical procedures, interventions that provide detailed procedural and sensory preparatory information appear to be efficacious for high monitors, since information decreases uncertainty, risk perceptions, and worry. However, when facing more long-term, severe, and recurrent health threats, such as in the context of diagnosis, treatment or post-treatment phase, support and coping skills to enhance psychological and medical outcomes may be beneficial, in conjunction with information and reassurance about the consequences of the procedure. The agenda for future research is to improve patient-centered outcomes and quality of care by assessing and addressing monitoring processing styles in a preventive fashion so that psychosocial outcomes, pain management, and related symptom monitoring are enhanced, whether through use of traditional, digital, or web-based communication technologies.

Development and preliminary testing of PROGRESS: a Web-based education program for prostate cancer survivors transitioning from active treatment.

This formative research study describes the development and preliminary evaluation of a theory-guided, online multimedia psycho-educational program (PROGRESS) designed to facilitate adaptive coping among prostate cancer patients transitioning from treatment into long-term survivorship. Guided by the Cognitive-Social Health Information Processing Model (C-SHIP) and using health communications best practices, we conducted a two-phase, qualitative formative research study with early stage prostate cancer patients (n = 29) to inform the Web program development. Phase 1 included individual (n = 5) and group (n = 12) interviews to help determine intervention content and interface. Phase 2 employed iterative user/usability testing (n = 12) to finalize the intervention. Interview data were independently coded and collectively analyzed to achieve consensus. Survivors expressed interest in action-oriented content on (1) managing treatment side effects, (2) handling body image and comorbidities related to overweight/obesity, (3) coping with emotional and communication issues, (4) tips to reduce disruptions of daily living activities, and (5) health skills training tools. Patients also desired the use of realistic and diverse survivor images. Incorporation of an established theoretical framework, application of multimedia intervention development best practices, and an evidence-based approach to content and format resulted in a psycho-educational tool that comprehensively addresses survivors' needs in a tailored fashion. The results suggest that an interactive Web-based multimedia program is useful for survivors if it covers the key topics of symptom control, emotional well-being, and coping skills training; this tool has the potential to be disseminated and implemented as an adjunct to routine clinical care.

A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population.

To characterize the barriers and facilitators thatprevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population, recruited through Philadelphia-area women, infants, and children clinics, in-person interviews were conducted with 30 women who had quit smoking for one or more pregnancies in the past 3 years to retrospectively describe their attempts to remain abstinent during the postpartum period. Responses were analysed using the constructs from the Cognitive-Social Health Information Processing model, which identifies the cognitive, affective and behavioral factors involved in goal-oriented self-regulatory actions, in the context of a vulnerable population of women. Motherhood demands were a significant source of relapse stress. Stresses associated with partner and family relationships also contributed to relapse. The presence of other smokers in the environment was mentioned by many women in our sample as affecting their ability to remain smoke-free postpartum. Participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health and receiving positive social support from families and friends. Results provide guidance for the design of smoking relapse interventions that may address the unique stressors reported by underserved postpartum women.

Factors predicting adherence to risk management behaviors of women at increased risk for developing lymphedema.

Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed the cognitive and emotional factors influencing adherence to lymphedema risk management. Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Center breast clinic. Participants (N = 103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication "Lymphedema: What Every Woman with Breast Cancer Should Know." Cognitive and affective variables were reassessed at 6 and 12 months post-baseline. Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12-month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance.

Abstract P6-09-05: Women's perceptions of lymphedema risk management: Psychological factors do matter

Abstract Introduction: Lymphedema arising from breast cancer surgery and treatment is characterized by arm impairment, physical disfigurement, emotional distress and diminished quality of life. Given no specific lymphedema cure, early detection and risk management strategies are recommended. The American Cancer Society (ACS) identifies simple behavioral strategies to minimize lymphedema risk; however, little is known about women's adherence to these recommendations over time. Even less is known about how women perceive lymphedema risk and the psychological factors that promote long-term adherence. Guided by the Cognitive-Social Health Information Processing model we assessed adherence to risk management strategies and identified psychological factors associated with adherence. Methods: Women (N = 103) diagnosed with primary breast cancer and scheduled for breast surgery initially completed the baseline questionnaire prior to surgery, and then received the ACS publication “Lymphedema: What Every Woman With Breast Cancer Should Know” as part of usual care. Follow-up questionnaires were completed by participants 6- and 12-months later. Baseline data collected included demographic and medical history variables, lymphedema-related knowledge and cognitive and affective factors (perceived risk, beliefs and expectancies, self-regulatory competencies, negative affect), and adherence to risk management strategies. Adherence was also assessed at 6- and 12-months. A mixed-model maximum-likelihood logistic regression was employed in data analyses. Results: Adherence to risk minimization strategies increased over time (p &amp;lt; .001) and varied with the specific strategy (p &amp;lt; .001). Risk minimization strategies fell into three broad groupings: 1) High levels of consistent adherence across time - wearing loose clothing, avoiding tight jewelry, avoiding blood pressure readings and avoiding trauma to the arm; 2) Moderate levels of adherence and greater variability across time - avoiding cutting cuticles, extreme sun exposure, carrying heavy bags, and temperature extremes, and consulting with a doctor when symptoms appear; 3) Low level of adherence - wearing protective gloves and using an electric razor. Baseline knowledge was associated with adherence to all strategies. In addition, increased self-efficacy to enact the strategies (OR = 1.82, p = 0.0001), greater beliefs in one's self-regulatory ability to manage distress (OR = 1.25, p = 0.0017), and decreased risk-related negative affect (OR = 0.96, p = 0.03) were associated with increased adherence to the recommendations. Conclusions: During the 12 months following breast cancer diagnosis, women demonstrated increased awareness of lymphedema risk management and adherence to the recommended strategies, although adherence to individual strategies varied. Psychological factors were associated with adherence to recommendations. Specifically, women with greater knowledge, self-efficacy to enact recommended strategies and ability to self-regulate negative emotions, and lower negative affect were more likely to be adherent. These findings suggest that for lymphedema education approaches to be maximally effective, they should incorporate psychological interventions designed to enhance self-efficacy and coping in women at risk to ensure long-term adherence. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-05.

A pilot test of a combined tobacco dependence treatment and lung cancer screening program

Lung cancer screening with computed tomography has demonstrated a significant reduction in mortality. While these findings are important for the lung cancer research field, the most important risk factor for lung cancer, i.e. smoking, should not be ignored. We performed a pilot study to examine the feasibility of delivering a program that included both tobacco dependence treatment and lung cancer screening. The objectives of this study were to: (1) estimate the proportion of smokers who complied with a 12-week treatment protocol that included both tobacco dependence treatment and lung cancer screening, (2) obtain preliminary estimates of abstinence and quit attempts at 4 and 6 months, and (3) obtain preliminary estimates of the cognitive social health information processing (C-SHIP) constructs and how they change following the intervention. In this randomized pilot study, 18 volunteers completed a 12-week protocol: half received the tobacco dependence treatment program before a CT scan (BCT) and the other received the CT scan first, followed by the treatment program (ACT). The treatment protocol included both nurse-delivered telephone counseling and either nicotine replacement therapy or varenicline. Only one person did not complete all follow-up evaluations. At 4 months post enrollment, the carbon monoxide confirmed quit rates were 33.3% in the BCT arm and 22.2% in the ACT arm (27.8% overall), and all but one had made a 24-h attempt to quit. At 6 months the confirmed abstinence decreased to 22.1% in the BCT arm and 11.1% in the ACT arm (16.7% overall), and 72.2% of participants had made a 24-h quit attempt. These preliminary results suggest that it might be better to deliver treatment before the screening test. Future randomized trials with a larger sample size are needed to confirm these findings.

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.

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.

Psychological Response to Test Results in an Ovarian Cancer Screening Program: A Prospective, Longitudinal Study.

To identify the psychological impact of receipt of an abnormal yet benign screening test result, the authors examined the response to a transvaginal ultrasound screening (TVS) test for ovarian cancer (OC) in asymptomatic women (N=540) undergoing an initial TVS screening test. Interviews were conducted prior to undergoing TVS screening and at 2 weeks and 4 months following this baseline. Women receiving an abnormal yet benign TVS test result (n=33) reported elevated OC-specific, but not general, distress at 2-week follow-up. Distress returned to baseline levels at 4-month follow-up. Consistent with the monitoring process and cognitive-social health information processing models, response to an abnormal TVS result was moderated by a monitoring coping style, low optimism, and a family history of OC.

Psychological impact of benign breast biopsy: A longitudinal, comparative study.

The impact of benign breast biopsy (BBB) on distress and perceptions of risk for breast cancer (BC) was examined. Interviews were conducted with 100 women shortly after notification of biopsy results and 4 and 8 months post-BBB. Compared with matched healthy comparison (HC) women without BBB, the BBB group evidenced greater BC-specific distress at baseline. BC-specific distress declined after BBB, remaining elevated relative to the HC group at the 8-month follow-up. Dispositional (optimism, informational coping style), demographic (education), clinical (family history of BC), and cognitive (BC risk perception) variables were associated with baseline levels of BC-specific distress or persistence of distress. Results support the monitoring process model (S. M. Miller, 1995) and the cognitive social health information processing model (S. M. Miller, Y. Shoda, & K. Hurley, 1996).

Applying cognitive-social theory to health-protective behavior: Breast self-examination in cancer screening.

This article applies recent developments in cognitive-social theory to health-protective behavior, articulating a Cognitive-Social Health Information Processing (C-SHIP) model. This model of the genesis and maintenance of health-protective behavior focuses on the individual's encodings and construals, expectancies, affects, goals and values, self-regulatory competencies, and their interactions with each other and the health-relevant information in the course of cognitive-affective processing. In processing health information, individuals are assumed to differ in both the accessibility of these mental representations and the organization of relationships among them. In this article, the model is applied to analyze and integrate the often-confusing findings on breast self-examination in cancer screening. Implications are considered for assessments and interventions to enhance adherence to complex, long-term, health-protective regimens, tailored to the needs and characteristics of the individual.