Information Seeking in Uncertainty Management Theory: Exposure to Information About Medical Uncertainty and Information-Processing Orientation as Predictors of Uncertainty Management Success

How Information Repertoire Affects Vaccine Hesitancy: Processes of Information Verification and Cognitive Elaboration

As information consumption plays a critical role in addressing vaccine hesitancy in the hybrid media environment, it becomes crucial to understand how individuals' use of a combination of channels and sources affects their vaccine hesitancy. Based on information repertoire approaches emphasizing the multiplicity of channels and sources, we investigated different patterns of information repertoire related to the COVID-19 pandemic and how these patterns affected vaccine hesitancy through different informational mechanisms. Our results based on a U.S. sample suggest that while a richer information repertoire related to increased confidence in vaccines through increased information verification, this richness also corresponded with deepened vaccine hesitancy through heightened cognitive elaboration and perceived information inconsistency. Our findings support the utility of repertoire approaches for better understanding health information acquisition in the complex media ecology.

Effects of prognostic communication strategies on emotions, coping, and appreciation of consultations: An experimental study in advanced cancer

OBJECTIVES

We aimed to investigate effects of prognostic communication strategies on emotions, coping, and appreciation of consultations in advanced cancer.

METHODS

For this experimental study, we created 8 videos of a scripted oncological consultation, only varying in prognostic communication strategies. Disease-naive individuals (n = 1036) completed surveys before and after watching 1 video, while imagining being the depicted cancer patient. We investigated effects of the type of disclosure (prognostic disclosure vs. communication of unpredictability vs. non-disclosure) and content of disclosure (standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on emotions, coping, and appreciation of consultations. Moderating effects of individual characteristics were tested.

RESULTS

Participants generally reported more satisfaction (p < .001) after prognostic disclosure versus communication of unpredictability and less uncertainty (p = .042), more satisfaction (p = .005), and more desirability (p = .016) regarding prognostic information after numerical versus word-based estimates. Effects of different survival scenarios were absent. Prognostic communication strategies lacked effects on emotions and coping. Significant moderators included prognostic information preference and uncertainty tolerance.

SIGNIFICANCE OF RESULTS

In an experimental setting, prognostic disclosure does not cause more negative emotions than non-disclosure and numerical estimates are more strongly appreciated than words. Oncologists' worries about harming patients should not preclude disclosing (precise) prognostic information, yet sensitivity to individual preferences and characteristics remains pivotal.

Death Preparedness: Development and Initial Validation of the Advance Planning Preparedness Scale

Delayed advance planning and costs of life sustaining treatments at end of life significantly contribute to the economic burden of healthcare. Clinician barriers include perceptions of inappropriate timing, lack of skills in end-of-life communication and viewing readiness as a behavior rather than a death attitude. This study developed and validated a measurement of psychological preparedness for advance directive completion. Confirmatory factor analysis (N = 543) of a 35 item pool (Cronbach α = .96) supported five sub-scales; psychological comfort (α = .87), desire to know (α = .88), thinking (α = .84), willingness (α = .82) and existential reflection (α = .79) with a possible common factor (α = .84). Results suggested significant predictors of completing directives in 30 days included discussion (OR .08, p < .001), preparedness (OR 4.08, p = .03) and uncertainty (OR 4.37, p = .02). APP = 35 is a reliable and valid measure with utility to assess readiness for completion of EOL documents.

Information scanning in the COVID-19 pandemic: a test and expansion of the channel complementarity theory using latent class analysis

BACKGROUND

During health crisis, individuals need information to comprehend their circumstances. Channel complementarity theory posits that in meeting their informational needs, people will use different sources in a complementary fashion. This paper puts to test the main tenet of channel complementarity theory by focusing on information scanning (i.e. routine health information exposure) in the context of the COVID-19 pandemic in Chile.

METHOD

A survey was conducted among a sample of Chilean adults (N = 2,805). The questionnaire addressed information scanning across six sources (television, radio, internet, social media, family, and friends or coworkers) and explores how socioeconomic and demographic variables, as well as COVID-19 perceived risk related to scanning. Latent class analysis was employed to identify patterns of complementarity across channels.

RESULTS

The analysis yielded a solution of five classes, namely 'high complementarity and high frequency' (21%), 'high complementarity and low frequency' (34%), 'high frequency on television and digital media' (19%), 'mass media predominant' (11%), and 'no scanning' (15%). Educational attainment, age, and COVID-19 perceived risk were associated with scanning.

CONCLUSIONS

Television was a central channel for information scanning during the pandemic in Chile and more than half of participants scanned COVID-19 information complementarily. Our findings expand channel complementarity theory to information scanning in a non-US context and provide guidelines for designing communication interventions aiming at informing individuals during a global health crisis.

Assessing the credibility of information sources in times of uncertainty: online debate about Finland's NATO membership

Purpose

This article aims to elaborate the context-sensitive nature of credibility assessment by examining how such judgments are made in online discussion in times of uncertainty caused by Finland's intent to join the North Atlantic Treaty Organization (NATO) in spring 2022.

Design/methodology/approach

The empirical findings draw on the qualitative content analysis of 3,324 posts submitted to a Finnish online discussion in February–March 2022. It was examined how the participants of online discussion assess the credibility of information sources referred to in debates on the NATO membership. It is assumed that the believability of the author of information is indicative of his or her expert power, for example based on the credentials of a scholar, while the credibility of information content, for example the provision of factual evidence is indicative of the source's informational power.

Findings

Political decision-makers, particularly the President of Finland were assessed as most credible information sources, due to their access to confidential knowledge and long-time experience in politics. The credibility assessments differed more strongly while judging the believability of researchers. On the one hand, their expertise was praised; on the other hand, doubts were presented about their partiality. Fellow participants of online discussion were assessed most negatively because information sources of these types are associated with low expert and informational power.

Research limitations/implications

As the study concentrated on credibility assessments made in a Finnish online discussion group, the findings cannot be extended to concern the credibility judgments occurring information in other contexts.

Originality/value

The study is among the first to characterize the role of expert and informational power in credibility assessment in times of uncertainty.

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Configurational Approach to Understand Preventive Behavior Adoption among a Non-Adhering Population During the COVID-19 Pandemic

This study examined the risk preventive responses of individuals, especially those who do not adhere to preventive measures (e.g. anti-maskers) for COVID-19, by integrating three dominant theories in risk and health communication. The complex causal relationship between motivational elements and individuals' preventive behavior adoption was studied using Fuzzy-Set Qualitative Comparative Analysis. With a survey (N = 372) of non-abiding populations, this study found generalizable and unique configurations of motivational elements. Different effects of key motivational variables from three theories were found with different demographic factors. Theoretical and practical implications were also discussed.

Health Information Seeking as a Coping Strategy to Reduce Alzheimer's Caregivers' Stress

Individuals with Alzheimer's disease and other forms of dementia (referred to as AD) deteriorate over time, and there will likely be a corresponding increase in levels of burden and stress for caregivers. Despite the significant contributions made by informal caregivers, there are no widely available mechanisms that meet the information needs of informal caregivers. Using a qualitative approach, the current study focuses on AD caregiver information seeking. The study involved conducting interviews to answer the following research questions: (1) What motivating factors lead informal caregivers of people with AD to seek out information?; (2) Is there a relationship between information seeking and resulting perceived stress levels?; and (3) Why do informal caregivers choose to utilize certain resources more than others during their information seeking process? Findings revealed that caregivers' largest motivation for seeking information is to learn how to better care for their loved one. Caregivers tend to rely on mediated resources that they find credible, and interpersonal resources such as people with similar experiences to their own. Many participants were satisfied with information available, but others felt that their interactions with healthcare professionals created more stress and emotional anguish than anticipated. This study offers an initial step in finding ways to meet the needs of those who seek to mitigate their stress through information seeking. By studying the information needs of the caregiving population, healthcare workers and communicators will be more knowledgeable about the relationship between information seeking and stress and coping.

Predictors of Women's Awareness of the Benefits and Harms of Mammography Screening and Associations with Confusion, Ambivalence, and Information Seeking

In recent years, there has been a shift toward promoting informed decision making for mammography screening for average-risk women in their 40s. Professional organizations such as the American Cancer Society and U.S. Preventive Services Task Force recommend that women weigh the potential benefits and harms of mammography prior to initiating screening. This decision-making process assumes that women are aware of both the benefits and harms of screening, yet little is known about the prevalence and antecedents of such awareness. Moreover, it is conceivable that women who are aware of both the benefits and harms may interpret this information as conflicting - which could be concerning, as researchers have documented adverse effects of exposure to conflicting health information in prior research. Using data from a population-based survey of U.S. women aged 30-59 (N = 557), the current study found that awareness of mammography's harms is relatively low compared to awareness of benefits. Health news exposure and interpersonal communication about health were associated with greater awareness of harms. In addition, women's awareness of both the benefits and harms was positively associated with confusion about breast cancer screening recommendations, ambivalence about getting a mammogram, and mammogram-related information seeking from online sources. Implications for cancer screening communication are discussed.

Interactions among Actual Uncertainty, Desired Uncertainty, and Uncertainty Discrepancy on Anxiety and Information Seeking

This study investigated the role of uncertainty in information management processes by integrating insights from uncertainty management theory and the theory of motivated information management. Specifically, we examined the extent to which uncertainty appraisals moderated the effects of uncertainty on anxiety and information seeking about family health history (FHH) from spouses. Data from 626 married individuals suggested that desired uncertainty moderated uncertainty's effect on anxiety such that uncertainty led to more anxiety when individuals wanted to be more certain. Uncertainty also exerted stronger effects on anxiety and information seeking when one's actual uncertainty was low. Efficacy remained a predictor of information seeking, consistent with the literature. Findings offer theoretical implications about the interaction effects among different conceptualizations of uncertainty (i.e., actual, desired, and uncertainty discrepancy) and practical applications for encouraging information seeking about FHH.

Educational needs of patients and caregivers living with sickle cell disease results in development of web-based patient decision aid

AIMS

We performed an assessment to understand perceived decisional needs among those living with sickle cell disease. Additionally, we desired understanding of their preferred methods and quality of learning and sought guidance in development of a web-based patient decision aid.

DESIGN

The purpose of this qualitative study was to determine ways patients and caregivers receive education about sickle cell disease and available therapies. We sought to understand preferences for education, quality of current knowledge and information they would like to obtain.

METHODS

Recruitment for the initial needs assessment occurred between October 2013 -April 2014. Further recruitment for clarification of internet-based searches occurred between January 2015 -September 2016. We conducted a total of 201 semi-structured qualitative interviews with patients and caregivers.

RESULTS

Six themes emerged: healthcare provider education is good but does not meet all the learning needs of the patient/caregiver; patients/caregivers feel a strong desire to seek information about treatment options on their own; adult patients and parents diverged in their core objectives in seeking information: quality of life (QOL) was the major outcome of interest in considering potential treatment options; experience of peers is preferred source for learning about treatment options; and educational needs may be supplemented with a web-based interactive educational tool.

CONCLUSION

Patients with sickle cell disease and their caregivers are motivated by a desire to improve QOL in seeking treatment options and use many methods to seek education to supplement what they learn from their healthcare providers and may benefit from the use of a web-based decision aid. Impact Educational needs of patients/caregivers with sickle cell disease were identified and provide the basis to inform the design of educational strategies for them. Nurses and others can assist with learning needs by sharing the website and answering questions that arise.

Uncertainty Management and Decision Making: Parents' Experiences During their First Visit to a Multidisciplinary Clinic for their Child's Vascular Anomaly

PURPOSE

To gain a better understanding of parental decision making in situations of uncertainty and multidisciplinary care, we explored parents' decision-making experiences while seeking care for their child's vascular anomaly at a multidisciplinary clinic at a large Midwestern children's hospital.

DESIGN AND METHODS

We collected data using semi-structured interviews with 29 parents after they met with multiple specialists for the care of their child's vascular anomaly.

RESULTS

The findings revealed parents' attempts to manage decision-related uncertainty about their child's vascular anomaly included seeking information, avoiding information, and seeking support from the specialists. Parents described how information management both facilitated and obstructed decision making.

CONCLUSIONS

Overall, the study reveals several benefits and challenges of making decisions about the management of uncertain childhood conditions, like vascular anomalies, in a multidisciplinary context. The information-rich environment produces information-management dilemmas that challenge parents' decision making efforts. Therefore, parents relied on the support of the team of specialists to make decisions about their child's treatment.

PRACTICE IMPLICATIONS

The study offers practical implications concerning the barriers of autonomy in decision making. Healthcare professionals should acknowledge the potential for parents' to have shifting information and decision-making goals and preferences, and should explicitly support parents throughout the decision-making process.

Withdrawal and Misuse Concerns of Consumers regarding Opioid Analgesic and Anxiolytic, Hypnotic and Sedative Medicines

Opioid analgesic (OA) and anxiolytic, hypnotic and sedative (AHS) medicines use raise community concerns about risks of dependence: dose escalation, unintentional misuse. Objectives: We aimed to identify common consumer OA and AHS information gaps and concerns that led to information seeking from a hotline. Methods: We conducted a retrospective, mixed-method observational study of consumers' OA and AHS-related calls to an Australian national medicines call center (September 2002-30 June 2010). We analyzed these medicines' call characteristics compared to their respective rest of calls (ROC) and thematically explored narratives concerning withdrawal and misuse. Results: Of 123,217 calls, 7,395 (6.0%) involved OA and 7,789 (6.2%) AHS, with consistency between call characteristics. While female middle-aged callers predominated, more males called for these medicines than their complementary ROC. Uncertainty about unresolved OA and AHS concerns led to help-seeking that was consistent over eight years. Main motivations were inadequate information (OA 44.5%; AHS 41.2%), seeking a second opinion (OA 24.2%; AHS 24.2%), worrying symptoms (OA 21.6%; AHS 23.1%), and conflicting information (OA 4.9%; AHS 5.1%). Callers focused on withdrawal and issues related to inadvertent overuse or deliberate misuse (OA 9.2% vs. non-OA ROC 2.9%; AHS 12.6% vs. non-AHS ROC 2.7%). Primary themes were similar for both cohorts: concern about harm or aiming to minimize harm by information seeking, requesting a strategy, or reassurance. Conclusions: Consumers have under-recognized perceptions of harm from OA and AHS use, particularly withdrawal and misuse. Resources based on real world consumer concerns can encourage open dialogue between patients and their prescribers.

Exploring the Determinants of Online Health Information-Seeking Behavior Using a Meta-Analytic Approach

Although key factors of online health information-seeking behavior (OHISB), such as self-efficacy, Internet experience, and perceived ease of use, are analyzed in many studies, the research results are controversial. The purpose of this meta-analysis, based on 27 related empirical studies, is to explore the determinants of OHISB. The determinants of OHISB are classified into four categories: demographic characteristic factors, cognitive factors, internal factors, and external factors. According to the results of the analysis using Stata13.0, our study found a weak effect of perceived cost and health anxiety on the OHISB, while subjective norm, perceived usefulness, and attitude have a strong positive effect on the OHISB. Understanding the determinants of OHISB is beneficial in order to know why users utilize online health applications. The findings of the study can contribute to developing and extending the existing theoretical concepts.

The Effect of Age on Electronic Health Literacy: Mixed-Method Study

Background

The world’s internet penetration rate is increasing yearly; approximately 25% of the world’s population are internet users. In Asia, Taiwan has the fifth highest internet usage, and has an internet penetration rate higher than the world average. Electronic health (eHealth) literacy is the ability to read, understand, and utilize Web health information. eHealth literacy is gaining attention worldwide.

Objective

This study aimed compare the differences in eHealth literacy between traditional college students (aged between 18 and 22 years) and older adult students (aged between 55 and 72 years). It also summarizes the experiences and performances of these 2 groups in terms of searching online health-related information.

Methods

A mixed-method approach was used, including questionnaire surveys and interviews. A total of 208 respondents were interviewed: 65 traditional college students (31.3%) and 143 older adult students (68.7%). The results of the interviews were used to compare the eHealth literacy scores of the 2 groups.

Results

There were significant differences in the overall eHealth literacy scores (t₂₀₇=2.98; P=.001) and the functional eHealth literacy dimension (t₂₀₇=12.17; P<.001). The findings showed a significant gap in eHealth literacy between the 2 groups. Most participants believed that online health information could be largely read and understood. However, they were skeptical about the quality of the information and noted that it consisted of either subjective judgments or objective standards.

Conclusions

Traditional college students preferred esthetically pleasing health information, whereas older adult students focused on its promotion. Furthermore, the first group often used websites for solving health problems, whereas the second group forwarded health information through communication software.

Uncertainty related to multigene panel testing for cancer: a qualitative study on counsellors' and counselees' views

Multigene panel testing is mainly used to improve identification of genetic causes in families with characteristics fitting multiple possible cancer syndromes. This technique may yield uncertainty, for example when variants of unknown significance are identified. This study explores counsellors’ and counselees’ experiences with uncertainty, and how they discuss uncertainties and decide about multigene panel testing. Six focus groups were conducted including 38 counsellors. Twelve counselees who had received genetic counselling about a multigene panel test were interviewed. The focus group sessions and interviews were audio-recorded and transcribed verbatim. Transcripts were analysed inductively by two independent coders and data were examined to obtain a comprehensive list of themes. Counsellors identified several uncertainties, e.g. finding a variant of unknown significance, or detecting an unsolicited finding. Most difficulty was experienced in deciding what uncertain information to communicate to counselees and how to do so. The extent and manner of providing uncertain information differed between centres and between counsellors. Counsellors attached more value to counselees’ preferences in decision making compared to less extended tests. Counselees experienced difficulty in recalling which uncertainties had been discussed during genetic counselling. They primarily reported to have experienced uncertainty about their own and their relatives’ risk of developing cancer. Counselees felt they had had a say in the decision. This study showed that counsellors need more guidance on whether and how to convey uncertainty. Undesirable practice variation in the communication of uncertainty may be prevented by determining what information should minimally be discussed to enable informed decision making.

Does consumer medicines interest reflect medicines use? An observational study comparing medicines call center queries with medicines use

BACKGROUND

Consumers have questions about their medication but the nature of these concerns and how they reflect medication use is unknown.

OBJECTIVES

To determine the characteristics and medicines interests of callers to an Australian medicines call center and whether the medicines interest of callers corresponds with medicines utilization.

METHODS

Data from consumers who contacted a national medicines call center between September 2002 and June 2010 were analyzed. Patterns of consumer medicines interest were described. Medicines were class-matched by Anatomical Therapeutic Classification, and compared with dispensed use (January 2006-June 2010).

RESULTS

In total 125,951 calls were received between 2002 and 2010. Callers were mainly female (76.8%), median age 48 years, calling for themselves (71.7%). Motivation to call related to safety (34.7%), efficacy (24.1%) and interactions (14.9%). For the comparison with medicines utilization, 85,416 calls with 124,177 individual medicine counts were analyzed (2006 and 2010). There were 976 unique 'medicines of interest'. Half (49.4%) of these questions involved just fifty unique medicines. Nervous system medicines (antiepileptics, psycholeptics, analgesics) and antibacterials consistently ranked highest for interest compared with use. Conversely, agents acting on the renin-angiotensin system, statins and drugs for acid related disorders ranked low for interest despite widespread use.

CONCLUSIONS

Consumer questions about medicines correlate poorly with overall medicines utilization. To promote quality health outcomes, clinicians should target their education to the relatively small number of medicines of real concern to patients.

Insights for public education provided by French media on ideas about prostate cancer – A media analysis study

Background: This study explored the French media’s presentation of ideas and medical information about prostate cancer (PC) that may influence men’s understanding, attitudes and behavior.

Methods: A qualitative media content analysis centered on PC information delivered by French professional media. The selected data were produced in the aftermath of the High Health Authority's decision in 2008 not to recommend systematic screening by prostate specific antigen(PSA) for men over 50. Source was the Media Archives of the French National Library. Content was analyzed from 15 television programs, 14 radio programs, and 55 articles from 35 popular French newspapers (online and printed, weekly and monthly) and 20 magazines. Audio content was narrated into textual form and submitted to manual coding along with the print content.

Results: Television and radio content focused on the nature of PC, screening and treatment,and conveyed a gender-centric position linked to male sexuality and virility. Newspapers and magazines targeted the testing controversy, the lack of consensus among professionals, and scientific advances in screening and treatment.

Conclusion: Media participation in the European testing debate is valuable for allowing patients to hear all opinions on PC risk factors. Debate on testing policy contributes to confusion and uncertainty regarding appropriate action.

Understanding the role of health information in patients' experiences: secondary analysis of qualitative narrative interviews with people diagnosed with cancer in Germany

OBJECTIVE

To analyse the role and meaning of health information in individuals' experiences with either breast, colorectal or prostate cancer in order to better understand unmet information needs of people with a cancer diagnosis.

DESIGN

This is a secondary analysis of data from a qualitative interview study including narrative interviews and maximum variation sampling. A thematic analysis was conducted, followed by an in-depth analysis based on the principles of grounded theory.

SETTING

Interviewees were sought across Germany through self-help organisations, primary care clinics, rehabilitation facilities, physicians and other healthcare professionals to develop cancer modules for the website krankheitserfahrungen.de (illness experiences.de).

PARTICIPANTS

Women with a diagnosis of breast cancer, individuals with a diagnosis of colorectal cancer and men with a diagnosis of prostate cancer.

RESULTS

The meaning and role of information in the illness experiences were clearly associated with gaining control in a seemingly uncontrollable situation in which others -people, the disease- take over. Four categories characterise the ways in which information helped interviewees to regain a sense of control following a diagnosis of cancer: 'becoming confident in one's treatment decision', 'taking responsibility for one's situation', 'understanding the consequences of the disease and treatment for one's life', and 'dealing with fear'. There was, however, always a fine line between information seeking and becoming overwhelmed by information.

CONCLUSIONS

Information needs to be understood as a management tool for handling the disease and its (potential) consequences. Patients' unmet needs for information might not be easily solved by a simple increase in the amount of information because emotional support and respect for patient autonomy might also play a role. The evaluation of one's own information behaviour and the information received is closely linked to how the illness unfolds. This makes it challenging to document unmet information needs and satisfaction with information independent of an individual's illness trajectory over time.