The Augmented Cognitive Mediation Model: Examining Antecedents of Factual and Structural Breast Cancer Knowledge Among Singaporean Women

Engaging and (the Illusion of) Learning? Examining the Relationship Between Different Social Media Activities and Reproductive Health Knowledge

Social media have become fundamental platforms for learning about health, including reproductive health knowledge. However, little is known about what specific user activity is conducive to learning about reproductive health and by what means. Drawing upon the cognitive mediation model, this study examines how different social media activities function in terms of elaboration and knowledge gain. Our hypothesized model was largely supported by a nationwide online survey with 1,000 Chinese women residing in both rural and urban areas. The results revealed the crucial role of information elaboration in bridging different social media activities with both subjective and factual reproductive health knowledge. Interestingly, public reposting of reproductive health information was found to be positively related to subjective knowledge but negatively related to factual knowledge, suggesting the emergence of an illusion of knowing among our participants. Multigroup SEM analyses revealed that the positive roles of scanning and private sharing in encouraging elaboration were more pronounced among users with lower levels of need for cognition. The findings are expected to contribute to a more nuanced understanding of health learning based on users' social media activities and intrinsic motivations for learning.

Examining COVID-19 Tweet Diffusion Using an Integrated Social Amplification of Risk and Issue-Attention Cycle Framework

Drawing upon the social amplification of risk (SARF) and the issue-attention cycle framework, we examined the amplification of COVID-19 risk-related tweets through (a) topics: key interests of discussion; (b) temperament: emotions of tweets; (c) topography (i.e., location); and (d) temporality (i.e., over time). We computationally analyzed 1,641,273 tweets, and conducted manual content analysis on a subset of 6,000 tweets to identify how topics, temperament, and topography of COVID-19 tweets were associated with risk amplification - retweet and favorite count - using negative binomial regression. We found 11 dominant COVID-19 topics-health impact, economic impact, reports of lockdowns, report of new cases, the need to stay home, coping with COVID-19, news about President Trump, government support, fight with COVID-19 by non-government entities, origins, and preventive measure in our corpus of tweets across the issue-attention cycle. The negative binomial regression results showed that at the pre-problem stage, topics on President Trump, speculation of origins, and initiatives to fight COVID-19 by non-government entities were most likely to be amplified, underscoring the inherent politicization of COVID-19 and erosion of trust in governments from the start of the pandemic. We also found that while tweets with negative emotions were consistently amplified throughout the issue-attention cycle, surprisingly tweets with positive emotions were amplified during the height of the pandemic - this counter-intuitive finding indicated signs of premature and misplaced optimism. Finally, our results showed that the locations of COVID-19 tweet amplification corresponded to the shifting COVID-19 hotspots across different continents across the issue-attention cycle. Theoretical and practical implications of risk amplification on social media are discussed.

A Moderating Role of Gender in Online Health Information Seeking Behaviors for Colorectal Cancer Knowledge among Korean Americans Aged 50 to 75 Years

Korean Americans have consistently reported the underutilization of colorectal cancer (CRC) screening, despite their high rates of CRC incidence and mortality. Research has indicated suboptimal CRC knowledge in Korean Americans as one of the main barriers to their recommended CRC screening. Also, research has shown the potential of online health information seeking (OHIS) to improving cancer knowledge and the gender-based differences in the link between OHIS and cancer knowledge. Thus, this study aimed to examine the association between OHIS and CRC knowledge and the moderating effect of gender in this association among Korean Americans. A cross-sectional survey with purposive sampling was conducted of 421 Korean Americans aged 50 to 75 years in the Southeastern U.S. Three-step hierarchical multiple regression analyses were performed to investigate if three blocks of variables-Block 1: control variables (sociodemographics and health-related information), Block 2: independent variables (OHIS and gender), and Block 3: an (OHIS × gender) interaction term-significantly reduce unexplained variance in CRC knowledge. The analyses showed that the final model fits best accounting for 29.3% of the variance in CRC knowledge. Also, the analyses showed that OHIS was positively associated with CRC knowledge and gender moderated the association between OHIS and CRC knowledge. The findings close the knowledge gap existing in the body of literature on the connection of OHIS to CRC knowledge in Korean Americans. Findings also extend the understanding of gender-specific approaches leveraging OHIS for CRC prevention education among Korean Americans.

Examining Antecedents of Factual Knowledge and Perceived Familiarity of COVID-19 Contact Tracing App: A Modified Cognitive Mediation Model

This study employs a modified cognitive mediation model to investigate the role of health valuation and fear in shaping media attention, factual knowledge, and perceived familiarity with COVID-19 contact tracing apps. Data were collected from a national survey of 906 Singaporeans, and structural equation modeling was used to analyze the results. Findings indicated that both fear of COVID-19 and health valuation were positively associated with newspapers, television, and social media attention, with health valuation demonstrating a stronger association with each media type. This suggests that health valuation, as an intrinsic motivation, is more critical in information-seeking behavior related to emerging health technologies. However, media attention on all platforms did not correlate with factual knowledge of COVID-19 contact tracing apps, whereas attention to social media was positively associated with perceived familiarity with these apps. This result highlights the potential influence of social media in shaping public perceptions, warranting further investigation into the quality and accuracy of the information disseminated. News elaboration was found to have a positive association with both factual knowledge and perceived familiarity with COVID-19 contact tracing apps. This underscores the need for effective communication strategies to promote accurate understanding of health technologies and emphasizes the role of individual motivations in shaping media consumption and information processing.

Research on Knowledge Learning of COVID-19 Video Viewers: Based on Cognitive Mediation Model

During the COVID-19 epidemic, social media has become the main channel for people to learn information related to the epidemic, among which information in the form of videos has played a significant role in the prevention and control of COVID-19. However, few studies have analyzed the process of knowledge learning of individuals through watching COVID-19 videos. Therefore, to explore the process of COVID-19 video viewers' knowledge acquisition, this paper constructs a knowledge learning path model based on the cognitive mediation model and dual coding theory. A sample of 255 valid questionnaires was collected to validate this model. The results of this study show that an individual's perceived risk of COVID-19 affects their surveillance motivation positively, while surveillance motivation further stimulates the attention and elaboration about the information in COVID-19 videos. Among them, attention positively influences the elaboration about the information. Ultimately, both an individual's attention and elaboration positively influence the knowledge he or she acquires from the COVID-19 videos. This paper not only verifies the hypothesized relationships in the original cognitive mediation model, but also extends the model to the context of video knowledge learning. Analyzing the knowledge learning process of COVID-19 video viewers, this paper can provide suggestions for government propaganda departments and relevant media to improve public knowledge of COVID-19.

Toward an Extended Infodemiology Framework: Leveraging Social Media Data and Web Search Queries as Digital Pulse on Cancer Communication

This study aims to extend the infodemiology framework by postulating that effective use of digital data sources for cancer communication should consider four components: (a) content: key topics that people are concerned with, (b) congruence: how interest in cancer topics differ between public posts (i.e., tweets) and private web searches, (c) context: the influence of the information environment, and (d) information conduits. We compared tweets (n = 36, 968) and Google web searches on breast, lung, and prostate cancer between the National Cancer Prevention Month and a non-cancer awareness month in 2018. There are three key findings. First, reliance on public tweets alone may result in lost opportunities to identify potential cancer misinformation detected from private web searches. Second, lung cancer tweets were most sensitive to external information environment - tweets became substantially pessimistic after the end of cancer awareness month. Finally, the cancer communication landscape was largely democratized, with no prominent conduits dominating conversations on Twitter.

Sourcing and framing in cancer control continuum: A content analysis of Malaysian English and Chinese online cancer news

Background

In health news production, sourcing and framing are two critical mechanisms that influence how newsreaders think about and perceive the severity of a health issue. Understanding how local media covers the cancer control continuum is vital. However, very limited studies have looked at the effect of sourcing and framing in cancer news coverage, and it is still unknown how sources and news frames shape cancer coverage, especially in non-Western countries.

Objective

This study examines framing and sourcing patterns in news stories reporting on cancer control in Malaysian mainstream (English) and ethnicity (Chinese) online news sites, uncovering underlining associations between essential news components, source, and framing.

Methods

We used a predesigned code book to conduct a quantitative content analysis on cancer news stories (n = 841) published on two Malaysian English and Chinese online news sites from 2017 to 2019. Cancer news received adequate coverage in Malaysian English and Chinese media and was also session-centered.

Results

Two logistic regression models demonstrated the internal relationships between sourcing, framing, and different elements in cancer coverage. In terms of news sources, the results revealed that medical journals were the most likely to be cited when the news focused on medical research, followed by primary cancer prevention. When the news concentrated on statistical cancer reports and environmental/occupational risk factors, government agencies were more likely to be interviewed. Of news frames, when the news articles engaged with medical institutions and mentioned medical publications, the lifestyle frame was very likely to be shown, but the environmental frame was more likely to be portrayed when interviewing medical practitioners.

Conclusion

This study is the first comprehensive assessment to analyze and compare Malaysian English and Chinese online cancer news coverages and uncover underlying associations between news components, sourcing, and framing paradigms. We contributed to the scholarly understanding of cancer news coverage. This study can serve as a model for future health promotion researchers, journalists, and policymakers. Implications for cancer risk communication research, health journalist practices, and health policymaking were discussed.

Do Health Information Sources Influence Health Literacy among Older Adults: A Cross-Sectional Study in the Urban Areas of Western China

BACKGROUND

Previous studies have found that the dissemination pattern and delivery mechanism of information can provide crucial resources and empowerment for individuals to the promotion of health literacy. The present study investigates how health information sources are associated with health literacy among older adults in west China, and tries to explain the mechanisms underlying the link between health information sources and health literacy in the Chinese context.

METHODS

The cross-sectional study employed a representative sample of 812 urban citizens aged 60 and older in 2017 in Western China.

RESULTS

We found that health information sources including healthcare practitioners (B = 4.577, p < 0.001), neighbors (B = 2.545, p < 0.05), newspapers (B = 4.280, p < 0.001), and television (B = 4.638, p < 0.001) were positively associated with health literacy. Additionally, age (B = -1.781, p < 0.001) was negatively associated with health literacy, and the socio-economic status factors including minority (B = -10.005, p < 0.001), financial strain status of perceived very difficult (B = -10.537, p < 0.001), primary school (B = 11.461, p < 0.001), junior high school (B = 18.016, p < 0.001), polytechnic school or senior high school (B = 21.905, p < 0.001), college and above (B = 23.433, p < 0.001) were significantly linked to health literacy, and suffering from chronic diseases (B = 3.430, p < 0.01) was also positively related to health literacy.

CONCLUSIONS

Health information sources including healthcare practitioners, neighbors, newspapers, and television have a strong influence on health literacy, which implies that the four main types of sources are the important patterns of health information dissemination in the reinforcement of health literacy. In addition, the present findings also indicate age, minority and disease differences in health literacy and confirm the influence of enabling factors including educational attainment and financial strain on health literacy. Based on these findings and their implications, specific evidence is presented for the reinforcement of health literacy in interpersonal and mass communication, and in the educational and financial settings in the Chinese context. The present results also suggest that the age-specific, minority-specific and disease-specific measures should be taken to promote health literacy among older adults.

Pathway linking health information behaviors to mental health condition during the COVID-19 infodemic: A moderated mediation analysis

Background

The COVID-19 outbreak is no longer a pure epidemiological concern but a true digital infodemic. Numerous conflicting information and misinformation occupy online platforms and specifically social media. While we have lived in an infodemic environment for more than 2 years, we are more prone to feel overwhelmed by the information and suffer from long-term mental health problems. However, limited research has concentrated on the cause of these threats, particularly in terms of information processing and the context of infodemic.

Objective

This study proposed and tested moderated mediation pathways from two types of health information behaviors (social media engagement and interpersonal communication) on information overload and mental health symptoms-long-term stress.

Methods

We conducted a cross-sectional online survey between May and June of 2021 among the Malaysian public. The final sample size was 676 (N = 676). A conceptual model was built to guide the data analysis. We conducted structural equation modeling (SEM), moderation and mediation analyses to examine each direct pathway, moderating and mediating effects.

Results

According to the pathway analysis, we found that, during the infodemic period, engaging COVID-19 information on social media positively associated with information overload, but interpersonal communication was negatively related to it. As the proximal outcome, there was also a positive association between information overload and the final outcome, perceived stress. The moderation analysis only reported one significant interaction: risk perception weakened the association between social media engagement and information overload. A conditional indirect effect was demonstrated and the indirect associated between social media engagement and perceived stress mediated through information overload was further moderated by COVID-19 risk perception.

Conclusion

This research offers new grounds for understanding health information behaviors and their consequences in the COVID-19 infodemic. We particularly highlighted the distinct functions of health information behaviors in causing information overload, as well as the importance of personal health belief in this process. Our proposed model contributes to the strategies of developing health messaging strategies that may be utilized by public health researchers and health educators in the future.

Thinking, not talking, predicts knowledge level: Effects of media attention and reflective integration on public knowledge of nuclear energy

By applying the cognitive mediation model, this study seeks to investigate factors influencing public knowledge of nuclear energy in Singapore. In addition, this study seeks to extend the cognitive mediation model by explicating the knowledge variable into four facets - general science knowledge, perceived familiarity, content nuclear knowledge and contextual nuclear knowledge. Using data collected from an interviewer-led door-to-door survey with 1000 Singapore citizens and permanent residents (PRs), we found that attention to TV news, website news and social media news stimulated news elaboration and interpersonal discussion. However, attention to print newspaper was neither associated with news elaboration nor interpersonal discussion. We also found that news elaboration could enhance factual knowledge such as general science knowledge, content nuclear knowledge and contextual nuclear knowledge, while interpersonal discussion could enhance perceived familiarity. Theoretical and practical implications are discussed.

The Effects of Receiving and Expressing Health Information on Social Media during the COVID-19 Infodemic: An Online Survey among Malaysians

Social media is used by the masses not only to seek health information but also to express feelings on an array of issues, including those related to health. However, there has been little investigation on the influence of expressing and receiving information in terms of health-related engagement on social media. Moreover, little is known of the cognitive mechanisms underlying the expression and reception of health information on information overload (IO) during an infectious disease outbreak. Guided by the Cognitive Mediation Model (CMM), this study proposes a conceptual model to understand the effects of receiving and expressing COVID-19 information on social media on IO. Using an online survey conducted in Malaysia, our results indicated that risk perception positively predicted the reception and expression of information which, in turn, was positively associated with perceived stress and IO. Additionally, perceived stress triggered IO, indicating that the greater the perceived stress from health information engagement, the higher the likelihood of one experiencing IO during the pandemic. We conclude that the CMM can be extended to study IO as an outcome variable. More studies in diverse health contexts need to be conducted to enhance the conceptualization and operationalization of IO in health information processing.

Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment

Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups.

Linking Risk Perception to Breast Cancer Examination Intention in China: Examining an Adapted Cognitive Mediation Model

Drawn upon the cognitive mediation model, this study proposes an adapted model and examines the mechanisms by which Chinese women's risk perception of breast cancer becomes associated with their breast cancer examination intention. Our hypothesized model was largely supported by an online survey with a nationwide sample of 458 Chinese women. The results indicated that a person's perceived risk for breast cancer motivated information seeking and scanning using various mass media and online channels, which then positively predicted the person's quest for greater elaboration and more interpersonal discussion. In addition, elaboration was positively associated with breast cancer-related factual knowledge and subjective norms, whereas interpersonal discussion only exerted a positive relationship with subjective norms but not factual knowledge. As predicted, knowledge and subjective norms were positively associated with people's intentions to pursue breast cancer examination. Future research should consider both information seeking and scanning in the process of media learning and reflection. In addition to intrapersonal factors like knowledge, the interpersonal reasoning process that cultivates a favorable social influence is pivotal in promoting breast cancer examination in China.

Examining the roles of fatalism, stigma, and risk perception on cancer information seeking and avoidance among Chinese adults in Hong Kong

To examine how cancer fatalism, stigma, and risk perception influence information seeking and avoidance among Chinese adults in Hong Kong.

We administered an online survey to 616 Hong Kong Chinese adults using quota sampling and analyzed the data using structural equation modeling.

Fatalism was positively associated with susceptibility (β = .25, p < .001), severity (β = .11, p = .03), and fear (β = .17, p < .001), while stigma was negatively associated with severity (β = -.22, p < .001). Severity (β = -.19, p < .001) was negatively associated but fear was positively associated with cancer information avoidance (β = .14, p = .01).

Public health communication and education on cancer risks among ethnic Chinese communities in Hong Kong should be sensitive and address underlying cultural beliefs and views that may impede active information seeking.

Examining Organizational, Cultural, and Individual-Level Factors Related to Workplace Safety and Health: A Systematic Review and Metric Analysis

One major gap in existing health communication research is that few studies have synthesized findings from the literature to map out what are the key factors related to workplace (a) safety awareness, (b) safety risks, (c) health awareness, and (d) health risks. This study bridges the gap by systematically reviewing what these organizational, cultural, and individual-level factors are, and examine the impact of workplace safety and health publications using traditional and alternative metrics in academic and non-academic settings. Through an iterative process of coding, the results revealed six categories of organizational (management commitment, management support, organizational safety communication, safety management systems, physical work environment, and organizational environment), two cultural (interpersonal support and organizational culture), and four individual-level (perception, motivation, attitude, and behavior) factors. In terms of impact, articles that were most impactful in academia (e.g., high citation count) may not necessarily receive the same amount of online attention from the public. Theoretical and practical implications for health communication were discussed.

Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model

OBJECTIVE

To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM).

METHODS

A total of 433 KAs aged 50 through 75 in a metropolitan area in the Southeastern U.S. completed a cross-sectional survey regarding sociodemographics, OHIS behaviors, information overload, health literacy, decisional balance, and CRC screening history. Path analyses were implemented to assess the hypothesized causal models by examining the relationships among these variables.

RESULTS

OHIS was positively associated with information overload and health literacy; information overload was negatively associated with health literacy. Health literacy was positively associated with decisional balance; decisional balance was positively associated with uptake of sigmoidoscopy and colonoscopy.

CONCLUSION

The findings supported both theoretical frameworks, HLSF and CMM, for OHIS to develop health literacy, leading to CRC screening. These findings highlight the significant roles of information overload and attitudes and beliefs about screening in enhancing health literacy and CRC screening among KAs.

PRACTICE IMPLICATIONS

Practice efforts for facilitating CRC screening among medically underserved older KAs should target improving access to and use of OHIS and culturally-tailored health information delivery.

Factors associated with insufficient awareness of breast cancer among women in Northern and Eastern China: a case-control study

OBJECTIVES

To investigate the awareness and knowledge level of breast cancer among Chinese participants.

DESIGN

Case-control study.

SETTINGS

This study was based on the database of the minister-affiliated hospital key project of the Ministry of Health of the People's Republic of China that included 21 Chinese hospitals between April 2012 and April 2013.

PARTICIPANTS

Matched study was designed among 2978 participants with Han ethnicity aged between 25 and 70.

PRIMARY AND SECONDARY OUTCOME MEASURES

Student's t-test, Pearson's χ² test, reliability analysis, exploratory factor analysis, and univariate and multivariate logistic regression analyses were performed to know the level of breast cancer knowledge and find the breast cancer awareness-associated factors.

RESULTS

80.0% (2383/2978) of the participants had poor awareness level of breast cancer. In-depth knowledge of breast cancer such as early symptoms and risk factors was poorly found among them. Television broadcast and relatives or friends with breast cancers were the main sources of information about breast cancer. Of all participants, 72.8% (2167/2978) had heard about breast cancer as a frequent cancer affecting women, and 63.3% (1884/2978) knew that family history of breast cancer was a risk factor for breast cancer. Over half of them were aware that a breast lump could be a symptom of breast cancer. Multivariate analysis identified the following variables that predicted awareness of breast cancer: young age (OR=0.843, 95% CI 0.740 to 0.961), occupation (agricultural worker) (OR=12.831, 95% CI 6.998 to 23.523), high household social status (OR=0.644, 95% CI 0.531 to 0.780), breast hyperplasia history (OR=1.684, 95% CI 1.273 to 2.228), high behavioural prevention score (OR=4.407, 95% CI 3.433 to 5.657).

CONCLUSION

Most women were aware of breast cancer as a disease, but their in-depth knowledge of it was poor. More publicity and education programmes to increase breast cancer awareness are necessary and urgent, especially for the ageing women and agricultural workers.