From two-step flow to the Internet: The changing array of sources for genetics information seeking

Social capital or non-human sources? A cross-context study on information source selection of migrant farmer workers

Insufficient examination of social factors obscures the reason why non-human information sources are under-utilised by social groups with lower information literacy. This study explores the mechanism of information source selection (ISS) of Chinese migrant farmer workers (MFWs) in different industries by conducting a cross-context analysis. After iterative analyses of multiple cases, a theoretical model of information source selection within an individual’s information world is constructed. It explains why MFWs make more use of social capitals than non-human information sources in information seeking. Besides, the information needs are examined form both the needed information and the need itself. A classification of social capital as human information source is created and the roles that social capitals and non-human information sources play in ISS are identified. This study provides novel theoretical insights into the ‘old’ issue of ISS, and thus has practical implications for public information service providers and MFW-related policy makers.

Effect of exposure to COVID-19 infodemic on infection-preventive intentions among Korean adults

Aim

This study determined the effect of exposure to coronavirus disease 2019 (COVID‐19) infodemic on infection‐preventive intentions among Korean adults.

Design

This was a cross‐sectional study that used structural equation model.

Methods

Data were collected between 14 April–7 July 2020 from 300 adults in their 20s to 60s residing in South Korea. Analysis was performed using SPSS 20.0 and AMOS 20.0.

Results

Exposure to COVID‐19 infodemic had a direct effect on the reduction of COVID‐19‐related knowledge and personal preventive health intentions. COVID‐19‐related knowledge had a direct impact on increased perceived severity, perceived vulnerability, perceived self‐efficacy, and personal preventive health intentions. Perceived severity, perceived vulnerability, and perceived self‐efficacy had a direct effect on increasing preventive intentions for personal health; and perceived severity had a direct effect on preventive intentions for public health.

Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey

INTRODUCTION

Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors.

METHODS

A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population.

RESULTS

Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79).

DISCUSSION

The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.

Quality and readability of web-based Arabic health information on COVID-19: an infodemiological study

BACKGROUND

This study sought to assess the quality and readability of web-based Arabic health information on COVID-19.

METHODS

Three search engines were searched on 13 April 2020 for specific Arabic terms on COVID-19. The first 100 consecutive websites from each engine were analyzed for eligibility, which resulted in a sample of 36 websites. These websites were subjected to quality assessments using the Journal of the American Medical Association (JAMA) benchmarks tool, the DISCERN tool, and Health on the Net Foundation Code of Conduct (HONcode) certification. The readability of the websites was assessed using an online readability calculator.

RESULTS

Among the 36 eligible websites, only one (2.7%) was HONcode certified. No website attained a high score based on the criteria of the DISCERN tool; the mean score of all websites was 31.5 ± 12.55. As regards the JAMA benchmarks results, a mean score of 2.08 ± 1.05 was achieved by the websites; however, only four (11.1%) met all the JAMA criteria. The average grade levels for readability were 7.2 ± 7.5, 3.3 ± 0.6 and 93.5 ± 19.4 for the Flesch Kincaid Grade Level, Simple Measure of Gobbledygook, and Flesch Reading Ease scales, respectively.

CONCLUSION

Almost all of the most easily accessible web-based Arabic health information on COVID-19 does not meet recognized quality standards regardless of the level of readability and ability to be understood by the general population of Arabic speakers.

"I'm Healthy, It's Not Going To Be Me": Exploring experiences of carriers identified through a population reproductive genetic carrier screening panel in Australia

Advancing genetic testing technologies mean that population-based carrier screening for multiple inherited conditions is now available. As the number of genetic conditions being screened increases, there is a need for research into how people experience these screening programs. This research aimed to explore how women experience simultaneous carrier screening for three inherited conditions: cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS). A qualitative approach was adopted using in-depth semi-structured interviews to explore the experiences of ten female participants: five SMA carriers, three CF carriers, and two FXS premutation carriers. Eight participants were pregnant when offered screening by their general practitioner or obstetrician and the decision to have screening was described as straightforward. Participants reported experiencing emotional responses such as anxiety and stress while waiting for either their partner's carrier screen result (CF or SMA carriers) or the pregnancy's CVS result (FXS carrier) and sought additional information about the relevant condition during this time. Most participants were in favor of population carrier screening for these conditions, preferably prior to conception. Genetic counselors played an essential role in supporting couples after they received a carrier result given the variable consent processes undertaken when screening was offered. Further research should focus on the development of reliable online information tailored to people receiving carrier results and strategies for raising awareness of the availability of population carrier screening within the community. © 2016 Wiley Periodicals, Inc.

Genetic Information-Seeking Behaviors and Knowledge among Family Members and Patients with Inherited Bone Marrow Failure Syndromes

Inherited bone marrow failure syndromes (IBMFS) including Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, and Shwachman-Diamond syndrome are rare genetic disorders characterized by hematologic complications and increased risk of cancer. Patients and their families likely experience obstacles in obtaining sufficient health information given their disorders' rarity. To investigate this possibility, we examined information-seeking behaviors and levels of general and disorder-specific genetic knowledge among 315 members of 174 families with an IBMFS, and how information-seeking behaviors and socio-demographic factors may be associated with their genetic knowledge. Cross-sectional survey data indicated that participants were most likely to have ever used the Internet or healthcare providers for genetic information. On average, participants correctly answered 57 % of items assessing general genetic knowledge and 49-59 % of disorder-specific knowledge items. Greater knowledge was associated with greater education and ever experiencing genetic counseling, attending a scientific meeting, and seeking information from the Internet and scientific literature. Among families with Fanconi anemia (whose family support organization has the longest history of providing information), greater disorder-specific genetic knowledge was also associated with seeking information from support groups and other affected families. Results suggest that families with IBMFS have uncertainty regarding genetic aspects of their disorder, and highlight potential channels for delivering educational resources.

Genetic risk assessment for women with epithelial ovarian cancer: referral patterns and outcomes in a university gynecologic oncology clinic

Little is known about genetic service utilization and ovarian cancer. We identified the frequency and outcome of genetic counseling referral, predictors of referral, and referral uptake for ovarian cancer patients. Using pathology reports, we identified all epithelial ovarian cancer patients seen in a university gynecologic oncology clinic (1/04-8/06). Electronic medical records (EMR) were used to document genetic service referral, time from diagnosis-to-referral, point-in-treatment at referral, personal/family cancer history, demographics, and genetic test results. Groups were compared using chi-squared and Fisher's exact test for categorical variables and t-tests for continuous variables. The study population consisted of 376 women with ovarian cancer, 72 (19 %) of who were referred for genetic counseling/testing, primarily during surveillance. Of those referred, 42 (58 %) had personal or family genetic counseling and 34 (47 %) were ultimately tested or identified due to known family mutation. Family history and prior cancer were associated with referral. Family history, living in a larger community, higher-stage disease, and serous histology were associated with undergoing genetic counseling. Risk assessment identified 20 BRCA1/2 (5.3 %) and 1 HNPCC (0.3 %) mutation carriers. Based on recent estimates that 11.7-16.6 % of women with ovarian cancer are BRCA carriers and 2 % are HNPCC carriers, results suggest under-identification of carriers and under-utilization of genetic services by providers and patients. Interventions to increase medical providers' referrals, even in a specialized oncology clinic, are necessary and may include innovations in educating these providers using web-based methods. Ease of referral by the introduction of an electronic cancer genetic referral form represents another new direction that may increase genetic risk assessment for high-risk women with ovarian cancer.

Exploring dispositional tendencies to seek online information about direct-to-consumer genetic testing

Varying perspectives exist regarding the implications of genetic susceptibility testing for common disease, with some anticipating adverse effects and others expecting positive outcomes; however, little is known about the characteristics of people who are most likely to be interested in direct-to-consumer genetic testing. To that end, this study examines the association of individual dispositional differences with health risk perceptions and online information seeking related to a free genetic susceptibility test. Healthy adults enrolled in a large health maintenance organization were surveyed by telephone. Eligible participants (N = 1,959) were given access to a secure website that provided risk and benefit information about a genetic susceptibility test and given the option to be tested. Neuroticism was associated with increased perceptions of disease risk but not with logging on. Those scoring high in conscientiousness were more likely to log on. We found no evidence that neuroticism, a dispositional characteristic commonly linked to adverse emotional response, was predictive of online genetic information seeking in this sample of healthy adults.

Living post treatment: definitions of those with history and no history of cancer

INTRODUCTION

Breast cancer is the leading cause of cancer, and the second leading cause of cancer death in women. Due to advances in medicine, the 10 year survival rate is 80%, resulting in a large and growing number of breast cancer survivors. Definitions of cancer survivorship from a number of professional organizations and researchers vary, but the research is scant on the meaning of cancer survivorship to people with and without a prior cancer history.

METHODS

Two studies were conducted (1) to compare individuals with and without a prior personal cancer diagnosis in terms of those who identified as survivors vs. those who did not identify as survivors and (2) to explore explanations of those with and without a prior personal cancer for the term cancer survivor. In Study 1, individuals were surveyed at cancer-themed community health fairs. In Study 2, women were surveyed at a breast oncology clinic.

RESULTS

In Study 1 comparing those with and without a prior cancer diagnosis, prior cancer history was the best predictor of survivorship identity, and only three individuals without a prior cancer history included family and friends as survivors. In Study 2 of those with a personal history, longer time since diagnosis, type of cancer (ductal), and comparative risk (higher) were associated with survivor identity.

CONCLUSION

Completion of treatment was seen as a 'rite of passage', and thus, may be seen as a shift from the patient identity, which may have negative connotations, to the positive identity of survivor.

IMPLICATIONS

Definitions of survivorship vary considerably, and caution should be used when applying the term to those who have no prior personal cancer diagnosis and to those who have had a more recent cancer diagnosis with a more severe disease course.

Profile of e-patients: analysis of their cancer information-seeking from a national survey

Researchers have yet to fully understand how competent e-patients are in selecting and using health information sources, or, more importantly, who e-patients are. This study attempted to uncover how cancer e-patients differ from other cancer information seekers in terms of their sociodemographic background, social networks, information competence, and selection of cancer information sources. We analyzed data from the National Cancer Institute's 2005 Health Information National Trends Survey, and a series of chi-square tests showed that factors that distinguished cancer e-patients from other cancer information seekers were age, gender, education, employment status, health insurance, and membership in online support groups. They were not different in the other factors measured by the survey. Our logistic regression analysis revealed that the e-patients were older and talked about their health issues with friends or family more frequently compared with online health information seekers without cancer. While preferring information from their doctors over the Internet, e-patients used the Internet as their primary source. In contrast to previous literature, we found little evidence that e-patients were savvy health information consumers who could make informed decisions on their own health. The findings of this study addressed a need for a better design and delivery of health information literacy programs for cancer e-patients.

How can we reach them? Information seeking and preferences for a cancer family history campaign in underserved communities

Individuals with a family history of cancer are at elevated risk for the disease, and web-based tools are available to assist in assessing risk. Preferences for a potential campaign to promote awareness of the role of family history in cancer risk were sought, guided by McGuire's Input-Output Persuasion Model. A randomized telephone survey administered to five underserved communities assessed potential campaign messages, channels, sources, receivers, and destinations and use of the Internet (n = 101). Information sources sought about hereditary cancer and their predictors were assessed. Nearly half of the sample was African American and had annual income below $25,000. Most (59%) had Internet access at home. Few differences emerged as a function of race (African American vs. Other). The Internet was the most common (43%) first source sought for hereditary cancer information, followed by physicians (23%). In univariate multinomial logistic regression models, those with a high school education or more and those with greater family history (trend) were more likely than those without to choose the Internet as their first source of information over physicians. Our survey provided a wealth of information for understanding how to best launch our family history cancer risk communication campaign. Education level affected information seeking, and efforts are under way to lessen this potential barrier.

Who goes to a library for cancer information in the e-health era? A secondary data analysis of the Health Information National Trends Survey (HINTS)

This study identifies characteristics of Americans who chose the library as their primary cancer information source over the Internet by examining demographic characteristics, online use experience, concerns of information quality, and perceptions of cancer information seeking. A secondary data analysis is conducted using the Health Information National Trends Survey (HINTS) of the National Cancer Institute (NCI). Findings reveal that people who are more likely to choose the library are, compared to their Internet counterparts, people who lack online experience, are distrustful of online cancer information, and are more aware of cancer sources. However, they are not necessarily more adept cancer information seekers and do not have a greater expectation of getting quality information from the library. These findings suggest how the library plays its role as an information source for cancer information consumers in the e-health environment. Implications of the findings are discussed in a way that libraries could invest their efforts to reduce the digital health divide and to advance consumer health information literacy.

Cancer risk and risk communication in urban, lower-income neighborhoods

OBJECTIVES

Family history of cancer is an important risk factor for the disease, and communicating with family and physicians about family history is critical to cancer risk assessment. This study examined cancer risk communication with family and physicians.

METHODS

A telephone interview was administered to randomly selected participants (n=217) from 5 urban, lower-income communities in 2006 and 2007. A large proportion of the population were minorities and of lower socio-economic status (47% African American, 43% incomes <$25,000). Most (76%) believed family history was important, and approximately half talked to their family (50%) or their physician (49%) about their cancer risk.

RESULTS

Respondents were equally likely as family members to initiate discussions about cancer risk, but respondents were more likely to initiate discussions with physicians. Logistic regression models were fit to talk to family, talk to physician, and perceived risk. In multivariable analysis, higher income and greater worry were associated with talking to family about risk, and higher income was associated with talking to physician about risk. Gender, family history and worry were associated with greater perceived risk.

CONCLUSION

Efforts to decrease income barriers to cancer risk communication are needed.

Tools for assessing readability and quality of health-related Web sites

With the Internet becoming a growing source of information on genetics, genetic counselors and other health-care providers may be called upon to guide their patients to appropriate material, which is written at a suitable reading level for the individual and contains quality information. Given that many health-related Web sites are written at a high school or higher reading level, without direction from a genetic counselor or health-care provider, many Internet users may currently be turning to health-related Web sites that they do not understand. Additionally, Internet users may not know how to evaluate the quality of information they find, which could lead to them access inaccurate or irrelevant information. To aid in the process of finding and designing Web sites that are appropriate for patients, the current article provides guidelines for assessing readability and quality of health-related content. Additionally, a demonstration of an assessment is provided. Finally, limitations of these assessments are discussed.

Promotion of cancer family history awareness: Jameslink Cancer Risk Assessment Tool at community health fairs

This article examines the impact of providing personalized familial cancer risk assessments with the Jameslink Cancer Risk Assessment Tool. Users of the Jameslink (N = 166) at eight community health fairs completed a survey including demographic, psychosocial and behavioral variables to better understand responses to the Jameslink. No differences were found between whites and those of other races for variables of interest, indicating suitability of the Jameslink for diverse populations. Those with higher Jameslink-assessed risk had higher perceived risk of cancer. Approximately half (53.8%) reported that they would speak to their physician about their Jameslink-assessed risk. A regression found Jameslink-assessed risk, cancer worry, and perceived risk of cancer predicted intentions to speak to a physician about their risk. In addition, open-ended data provided suggestions to improve the Jameslink. Changes in content and format were suggested; however most were happy with the program and encouraged its promotion. The lack of findings for differences as a function of race bolsters the use of computerized Cancer Risk Assessment Tools in diverse communities. The positive feedback of users and the close association between cancer risk assessment, perceived risk, and intention to speak to a physician are supportive of continued use and development of Cancer Risk Assessment Tools in the community to promote awareness of cancer risk.

In search of a familial cancer risk assessment tool

Approximately one in three individuals will be affected by cancer in their lifetime in the United States, and some are at elevated risk because of family history. Although assessment of family history of cancer and cancer risk is the standard of care, the current health-care system appears unable to meet this need. Because individuals are increasingly using the Internet, web-based cancer risk assessment tools (CRATs) may provide a way to meet this need. The purpose of this review was to evaluate the types of familial CRATs available on the Internet and their nature. The current review evaluated five CRATs identified through an Internet search based on (i) their ability to identify those at the highest risk of cancer (i.e. those with hereditary cancer syndromes), (ii) their strengths and limitations based on criteria adapted from Rich and colleagues (2004, 2005), (iii) their readability based on four readability calculations, and (iv) their quality based on criteria from Health on the Net. The general limitations of CRATs as a whole were also delineated, including concerns about availability to those who are poor and underserved and those who have lower levels of literacy. Recommendations for future tools include assessing risk for a greater number of diseases, using theoretically driven approaches to increase the likelihood that individuals will engage in appropriate health behaviors, and making a greater effort to reach diverse populations.

Information Seeking and Intentions to Have Genetic Testing for Hereditary Cancers in Rural and Appalachian Kentuckians

CONTEXT

Research is limited regarding the potential of genetic testing for cancer risk in rural Appalachia.

PURPOSE

This study examined perceptions of genetic testing in a population sample of Kentuckians, with a focus on Appalachian and rural differences. The goals were to examine cultural and psychosocial factors that may predict intentions to test for hereditary cancer, need for help with information seeking for decision making about genetic testing for hereditary cancer, and amount of help needed with information seeking for decision making about genetic testing for hereditary cancer in this population.

METHODS

Analysis of data from a general social survey of adults using random-digit dialing in Kentucky (N = 882).

FINDINGS

An ordinal regression found that younger age, having a family history of cancer, and greater worry predicted greater intentions to seek genetic testing. A logistic regression found that having more education, excellent subjective knowledge of genetics, and less worry about cancer predicted less need for help in seeking information about testing. An ordinal regression found that less subjective knowledge of genetics and greater worry predicted greater amount of help needed.

CONCLUSIONS

Additional counseling to explain limitations of genetic testing may be needed. Further, those with less knowledge about genetics and more worry about hereditary cancer may have greater need for help with information seeking for decision making, a need that may be further exacerbated by the lack of medical professionals, particularly genetic counselors, who may provide information about genetic testing in rural, Appalachian Kentucky.

Awareness of the National Cancer Institute's Cancer Information Service: results from the Health Information National Trends Survey (HINTS)

Established in 1975, the National Cancer Institute's (NCI's) Cancer Information Service (CIS) is a national information and education network that serves the nation by providing the latest scientific cancer information to the American public. The purpose of this study was to determine the public's awareness of the CIS and other national cancer and health organizations by analyzing data from the NCI's Health Information National Trends Survey (HINTS 2003). This study also examined sociodemographic, health, and communication correlates of awareness of CIS and other national health organizations: American Cancer Society (ACS), National Institutes of Health (NIH), and NCI. Results indicated that awareness of the CIS was low (32.8%). Some subgroups were more likely to be aware of the CIS than others. When comparing awareness levels of the four national health organizations, marked differences in patterns of awareness among specific subgroups emerged for many sociodemographic variables. For example, minority groups were significantly more aware of the CIS than Whites; however, for all three other organizations a greater percentage of Whites were aware of each organization. For the NIH, NCI, and ACS, respondents in the highest income group were most aware of each organization and, as income level increased awareness also increased. The CIS, respondents with the lowest income levels, however, were more aware of the CIS compared with middle- and high-income groups. A similar pattern was found for other sociodemographic variables. Results of this study will guide the development of a targeted promotional campaign for the CIS.

Genomics--the perfect information-seeking research problem

The intersection of the genetics era and information age poses unique and daunting challenges for health consumers who may not have the health literacy to keep pace. While rapid advances in genetics research promise enhanced care, the inherent complexities and individualistic nature of genetic information have resulted in a challenging information environment. The technical possibilities for acquiring genomic information are increasing at an exponential pace, as are the scientific advances relating to it. Furthermore, societal reactions to genomics, and possible privacy and discrimination issues, may constitute significant constraints. The health care infrastructure also has its limits, given the severe shortage of qualified cancer genetic counselors and general practitioners who are unprepared to address genetics, creating a demand for creative approaches to service delivery. The combination of individual salience, low health literacy, the consumer movement, and important policy problems, then makes genomics the perfect information seeking research problem.