The social context of interpersonal communication and health

The multi-dimensional impact of different sources of information on influenza vaccination of college students in China

Objective: To explore whether/how the willingness of Chinese college students to receive the influenza vaccines in the sample is affected by different information channels. Participants: Two hundred and four volunteers were recruited to participate in an anonymous online survey. All participants were college students, mainly undergraduates (81.86%), with a higher proportion of women (56.86%). Methods: Participants answered anonymous questionnaires through the website, including demographic data (age, gender, education, etc.), media exposure channels and frequency, views and attitudes toward influenza vaccines, etc. An ordered logistic regression analysis was conducted to explore the effects of different information sources on influenza vaccination among college students. Results: Exposure to traditional media, digital media, and interpersonal communication promotes college students' understanding of influenza vaccines. Exposure to digital media alleviates college students' hesitation to vaccinate, while interpersonal interaction and digital media exposure promote college students' willingness to vaccinate. Conclusions: Digital media is increasingly important in the lives of Chinese college students to promote healthy behaviors such as influenza vaccinations.

Learning to teach with patients and caregivers: a focused ethnography

BACKGROUND

Little is known about what happens when patients and caregivers are involved in an academic setting as co-teachers and how healthcare professionals approach a new model of partnership-based teaching. This study aimed to explore the learning and behavioural patterns of a group of healthcare professionals who were learning to teach with patients and caregivers as co-teachers in a post-graduate course.

METHODS

A focused ethnographic study involving 11 health professionals was conducted. Data were collected through participatory observation during the course, individual semi-structured interviews, and a follow-up focus group. Taxonomic analysis was performed.

RESULTS

Three categories were identified: 'group', 'role of narration' and 'applying co-teaching with patients and caregivers '. Specifically, heterogeneity, absence of hierarchies, and balanced relationships characterised the group dynamic and promoted partnership. Narration played a key role both in learning and in healthcare professionals' relationship with patients and caregivers and promoted emotional skills and self-awareness. Project planning and lessons simulations were essential aspects of the implementation process.

CONCLUSIONS

This focused ethnography helped further understanding of the context of a specific project involving patients and caregivers as co-teachers in healthcare professional education. The development of emotional skills and self-awareness are the main learning patterns of co-teaching, and interprofessionalism and balanced relationships are the basis of the behavioural patterns. These patterns facilitated the involvement of patients and caregivers in health education.

Emotional Shifts in Health Messages as a Strategy for Generating Talk and Behavior Change

Although talk generated by health messages can spread message content and promote positive behavior change, little is known about what message features may be more likely to prompt conversation. Given theoretical and research support for sequential emotional experiences to increase the intensity of emotion and the extent of engagement with the emotional content - both of which are expected to positively influence talk and persuasion - we examined whether shifts in emotion within a health message influenced these outcomes. In a longitudinal experiment, we compared the effects of two texting while driving prevention messages containing a shift in emotional valence (negative to positive and positive to negative) with two single-valence emotional messages (negative-only and positive-only) on talk and persuasion (N = 333). Results indicated that emotional shift messages generated more talk than single-valence messages because they elicited greater emotional intensity and deeper message processing. These variables also mediated the effect of emotional shift messages on persuasion both immediately following message exposure and one week later, though intentions to avoid texting while driving immediately after message exposure had a greater influence on beliefs and behavior at the one-week follow-up than talk. These findings suggest that talk may play a more important role in spreading message content and reinforcing message-generated change rather than creating change itself.

Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context

BACKGROUND

Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known.

OBJECTIVE

We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics.

METHODS

We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms "HPV" and "HPV vaccine" on YouTube.

RESULTS

In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term "HPV" was more frequently searched on YouTube compared with "HPV vaccine." Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine.

CONCLUSIONS

The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics.

Communication inequalities in the COVID-19 pandemic: socioeconomic differences and preventive behaviors in the United States and South Korea

BACKGROUND

Communication inequalities are important mechanisms linking socioeconomic backgrounds to health outcomes. Guided by the structural influence model of communication, this study examined the intermediate role of health communication in the relationship between education, income, and preventive behavioral intentions during the COVID-19 pandemic in the United States and South Korea.

METHODS

The data were collected through two online surveys conducted by two professional research firms in the US (April 1-3, 2020) and South Korea (April 9-16, 2020). To test the mediating role of health communication, as well as the hypothesized relationships in the proposed model, we performed a path analysis using Mplus 6.1.

RESULTS

In analyzing survey data from 1050 American and 1175 Korean adults, we found that one's socioeconomic positions were associated with their intentions to engage in COVID-19 preventive behaviors through affecting their health communication experiences and then efficacious beliefs. Differences in education and income were associated with willingness to engage in preventive behaviors by constraining health communication among people with low levels of education and income. The findings showed notable differences and some similarities between the US and South Korea. For example, while income was positively associated with health communication in both US and South Korea, education was only significantly related to health communication in US but not in South Korea.

CONCLUSIONS

This study suggests health communication strategies such as choice of communication channels and messages to promote intention for COVID-19 prevention behaviors in particular consideration of individual differences in socioeconomic positions in countries with different cultural features. Pubic policies and health campaigns can utilize the suggestions to promote efficacy and preventive behavioral intention during early pandemics.

How communicative environments affect college students' mental health help-seeking during COVID-19: a cross-sectional study

Objective: This study explores how interpersonal communication environments (eg family, patient-provider, and online communication environments) affect college students' mental help-seeking during COVID-19. Methods: Based on Social Cognitive Theory, we conducted a cross-sectional survey assessing participants' mental help-seeking attitudes, self-stigma, self-efficacy, and readiness, as well as their communication experiences with their families, healthcare providers, and online environments. Four hundred fifty-six student participants were recruited. Structural equation modeling was used to explore relationships among the assessed variables. Results: About one-third of the participants (N = 137) had signs of mental distress, and most of them (N = 71) did not intend to seek help soon. Patient-centered communication experiences with healthcare providers were associated with reduced help-seeking stigma, whereas online and family communication predicted help-seeking readiness through changes in attitude, self-stigma, and self-efficacy. Conclusions: This study's results help identify risk factors of help-seeking reluctance. It suggests that communicative environments affect help-seeking by influencing individual predictors. This study may inform interventions targeting college students' use of mental health services during health crises like COVID-19.

Social Distancing during the COVID-19 Pandemic in Switzerland: Health Protective Behavior in the Context of Communication and Perceptions of Efficacy, Norms, and Threat

The success of health protection measures depends on public compliance. This paper aims to understand the influence of three different types of communication (i.e., news media, social media, and interpersonal communication) on people's engagement in health protective behavior during a public health crisis. Our C-ENT model of health protective behavior proposes that communication raises perceptions of efficacy, norms, and threat, which in turn influence health protective behavior (communication → efficacy, norms, threat: C-ENT). We test the model for the case of social distancing during the COVID-19 pandemic, based on a representative online survey during the first week of the lockdown in Switzerland (N = 1005). The results support the C-ENT model and illustrate the important role of communication engagement during a public health crisis. News media use was associated with perceptions of behavior-related efficacy and norms and disease-related threat, and these perceptions were positively associated with compliance with social distancing. Social media use and interpersonal communication were related with perceived norms. Social media use was negatively and interpersonal communication positively associated with health behavior-supporting normative perceptions. Our findings suggest taking the distinct pattern among communication types (i.e., news media, social media, and interpersonal communication), perceptions, and behavior into account in order to understand existing dependencies and design respective communication strategies.

Addressing social inequity through improving relational care: A social-ecological model based on the experiences of migrant women and midwives in South Wales

BACKGROUND

Migrant and ethnic inequalities in maternal and perinatal mortality persist across high-income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence-based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed.

METHODS

An inductive modelling approach was used to develop a new evidence-based conceptual model of woman-midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social-ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman-midwife relationship.

RESULTS

Three key concepts influencing the woman-midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented.

CONCLUSIONS

The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research.

PATIENT OR PUBLIC CONTRIBUTION

At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees.

Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis

OBJECTIVE

To investigate gender differences of health literacy in individuals with a migration background.

DESIGN

Systematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020.

SETTING

Studies had to provide health literacy data for adult women and men with a migration background, collected with a standardised instrument, or report results that demonstrated the collection of such data. Health literacy data were extracted from eligible studies or requested from the respective authors. Using a random-effects model, a meta-analysis was conducted to assess standardised mean differences (SMDs) of health literacy in men and women. Two researchers independently assessed risk of bias for each included study using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

Twenty-four studies were included in this systematic review. Thereof, 22 studies (8012 female and 5380 male participants) were included in the meta-analyses. In six studies, gender-specific health literacy scores were reported. The authors of additional 15 studies provided their data upon request and for one further study data were available online. Women achieved higher health literacy scores than men: SMD=0.08, 95% CI 0.002 to 0.159, p=0.04, I2=65%. Another 27 studies reported data on female participants only and could not be included due to a lack of comparable studies with male participants only. Authors of 56 other eligible studies were asked for data, but without success.

CONCLUSION

Men with a migration background-while being much less frequently examined-may have lower health literacy than women. As heterogeneity between studies was high and the difference became statistically insignificant when excluding studies with a high risk of bias, this result must be interpreted with caution. There is a paucity of research on the social and relational aspects of gender in relation to health literacy among people with a migration background, especially for men.

PROSPERO REGISTRATION NUMBER

CRD42018085555.

Power and Privilege: A Critical Analysis of Interpersonal Communication in Health Care as a Guide for Oncology Patient Navigation in Breast Cancer Care

Despite advances in cancer care, inequalities in race, ethnicity, and social class in breast cancer outcomes still exist. Interpersonal communication is a critical piece to addressing health disparities and it is a core component of the oncology patient navigator role. While widely used, the concept of interpersonal communication is vague, understudied, and requires better clarification to promote equity in health communication. The aim of this article is to investigate the concept of interpersonal communication through a critical lens. Findings from this critical analysis identified a gap in the current literature addressing the intersections of race, gender, and social class.

Characterizing the impact of verbal communication and health literacy in the patient-surgeon encounter

BACKGROUND

Patients with limited health literacy (HL) have difficulty understanding written/verbal information. The quality of verbal communication is not well understood. Therefore, our aim was to characterize patient-surgeon conversations and identify opportunities for improvement.

METHODS

New colorectal patient-surgeon encounters were audio-recorded and transcribed. HL was measured. Primary outcomes were rates-of-speech, understandability of words, patient-reported understanding, and usage of medical jargon/statistics. Secondary outcomes included length-of-visit (LOV), conversation possession time, patient-surgeon exchanges, and speech interruptions.

RESULTS

Significant variations existed between surgeons in rates-of-speech and understandability of words (p < 0.05). Faster rates-of-speech were associated with significantly less understandable words (p < 0.05). Patient-reported understanding varied by HL and by surgeon. Conversation possession time and usage of medical jargon/statistics varied significantly by surgeon (p < 0.05) in addition to patient-surgeon exchanges and interruptions. Patients with limited HL had shorter LOV.

CONCLUSIONS

Significant variations exist in how surgeons talk to patients. Opportunities to improve verbal communication include slowing speech and using more understandable words.

Beyond Educating the Masses: The Role of Public Health Communication in Addressing Socioeconomic- and Residence-based Disparities in Tobacco Risk Perception

Public health communication has long been a key component of tobacco control efforts. However, little is known whether and how such an effort could address disparities in tobacco risk perceptions among population subgroups. In this study, using data from the Global Adult Tobacco Survey of Ethiopia, we examined if tobacco risk perceptions varied across socioeconomic and urban vs. rural population subgroups, and whether and how exposure to anti-smoking message was associated with disparities in risk perceptions across socioeconomic and urban-rural subgroups. The results indicated that health risk perceptions of smoking and secondhand smoke exposure were significantly lower among rural, less educated and less affluent population subgroups. Controlling for age, gender, education, wealth, place of residence, and pro-smoking message exposure, anti-smoking message exposure was associated with greater risk perceptions of smoking. Moreover, anti-smoking message exposure moderated the associations of place of residence and education with risk perceptions of smoking and secondhand smoke exposure, respectively. The probability of risk perception of smoking associated with anti-smoking message exposure was higher among the rural populace compared to urbanites. Similarly, the probability of risk perception of secondhand smoke exposure associated with anti-smoking message exposure was the highest among individuals without formal education compared to those with primary, secondary, and college-level education. The findings suggest that efforts should be made to make sure adequate anti-smoking message exposure among less educated and rural audiences so as to reduce disparities in tobacco risk perceptions.

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.

Web-Based Health Information Seeking Among African American and Hispanic Men Living With Chronic Conditions: Cross-sectional Survey Study

Background

Previous research has identified disparities in seeking and using web-based health information to inform health-related behaviors. Relatively few studies however have examined the correlations between web-based health information seeking and use based on race, gender, age, and the presence of chronic health conditions.

Objective

In this study, we identify factors associated with seeking and using web-based health information among a uniquely vulnerable and intersectional population—middle-aged and older (40 years and older) African American and Hispanic men living with one or more chronic conditions.

Methods

Survey responses were collected from a purposive sample of African American and Hispanic men using Qualtrics web-based survey management software. To qualify for inclusion in the study, respondents had to identify as African American or Hispanic men, report having at least one chronic condition, and be aged 40 years and older. A series of binary logistic regression models was created using backward elimination. Statistical significance was determined at P<.05 for all analyses.

Results

Web-based health information seeking among African American and Hispanic men is a function of education, the presence of multiple chronic conditions, frustration with health care providers, internet use, and the perceived reliability of web-based health information. The use of web-based health information to inform interactions with health care providers was more common among African American and Hispanic men, who rated their health as relatively good, perceived barriers to care, used technology regularly, and took more daily medications.

Conclusions

Understanding the factors that influence African American and Hispanic men seeking web-based health information may help improve the care and treatment of chronic conditions. African American and Hispanic men seek web-based health information as a substitute for routine care and to inform their discussions with health care providers.

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points Persistent communication inequalities limit racial/ethnic minority access to life-saving health information and make them more vulnerable to the effects of misinformation.  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue. Public investments and support for minority-serving media and community outlets are needed to close persistent gaps in access to credible health information.

Racial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents

CONTEXT

Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented.

OBJECTIVES

We sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain.

METHODS

We used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups.

RESULTS

Vocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPR_Black: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPR_Black: 0.87; 95% CI: 0.86-0.88; aPR_Hispanics: 0.87; 95% CI: 0.84-0.89).

CONCLUSION

Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.

Perceived susceptibility to developing cancer and screening for colorectal and prostate cancer: A longitudinal analysis of Alberta's Tomorrow Project

INTRODUCTION

To assess the association between perceived susceptibility of developing cancer and being screened via sigmoidoscopy/colonoscopy and prostate-specific antigen, respectively.

METHODS

Participants aged 35-69, who resided in Alberta, Canada, were enrolled into the study between 2000 and 2008. We used general linear mixed models, adjusted for age, marital status, work status, education, family history and place of residence, to explore the association.

RESULTS

Perceived susceptibility of developing cancer was associated with both screening tests at baseline and a maximum of 14-year follow-up: (i) colorectal cancer screening - adjusted odds ratios were 1.97 (95% CI = 1.52-2.55) per one-unit increase in participants' personal belief in susceptibility to cancer, and 1.03 (95% CI = 1.00-1.04) per one-percent increase in participants' estimate of their own chance of developing cancer; (ii) prostate cancer screening - adjusted odds ratios were 1.36 times greater (95% CI = 1.07-1.72), and 1.02 times higher (95% CI = 1.01-1.03), for each respective perceived susceptibility measure.

CONCLUSION

Health promotion can focus on targeting and heightening personal perceived susceptibility of developing cancer in jurisdictions with low screening rates for colorectal or prostate cancer.

Interpersonal Diffusion of Health Information: Health Information Mavenism among People Age 65 and over in Japan

Health information mavens are those who provide and share health information with others via interpersonal communication. We investigated the characteristics of health information mavens among Japanese elderly and whether those who share health information with others via interpersonal communication behave more healthily or report better health status compared to their peers. Data come from a cross-sectional analysis of 27,414 participants in the Japanese Gerontological Evaluation Study (JAGES) (mean age = 74 years). Mavenism is associated with being female, younger age, higher educational status, and perceived financial condition, as well as larger social networks, higher social support, and media exposure. A higher mavenism score was associated with healthier dietary, and exercise behaviors, but not associated with smoking or alcohol consumption. Mavens were more likely to have a disease and/or report disease symptoms. Health information mavens have the potential to facilitate word-of-mouth communication among older adults, who tend to be more disadvantaged in terms of health information access compared to younger populations.

Information Sources on Healthy Eating Among Community Living Older Adults

Information about nutrition and health are important to empower older adults on what their food choice is concerned. The present research aims to study the perceived need and preferences regarding sources of information about healthy eating among older adults and to relate them with sociodemographic characteristics. A sample of 602 older adults (≥65 years old) living in the community (Vila Nova de Gaia, Portugal) was assessed by trained nutritionists using a structured questionnaire developed within the Pronutrisenior project. Most participants (87.5%) are concerned about healthy eating, and 69.3% would like to receive more information about the subject, mainly as audiovisual material (49.8%). Women prefer to receive information through practical cooking sessions and audiovisual material. Highly educated individuals prefer leaflets with text as well as audiovisual material, while more independent individuals prefer a wide range of media, such as booklets with pictures, informational posters, and food education and practical cooking sessions. Those with an adequate social support network prefer booklets with text. Age was not related to these preferences. These results can inform stakeholders about the most effective means of transmitting information on food and nutrition to older adults and are therefore useful in tailoring community and clinical interventions.

Social Capital and Health Communication in Singapore: An Examination of the Relationships between Community Participation, Perceived Neighborliness and Health Communication Behaviors

Social capital is a collective characteristic of communities that determines the health and well-being of populations. There is ample evidence supporting the link between social capital and health; however, less is known about the relationship between social capital and health communication behaviors. Our study aimed to investigate the relationships between social capital and health communication in Singaporean adults aged 21 years and above. Cross-sectional data (N = 1,012) were collected from the Singapore Population Health Studies (SPHS) Online Panel. Three main outcome variables assessing health communication behaviors in the past 12 months were (1) health information-seeking; health information-sharing (2) with family members and (3) with friends and coworkers. Two components of social capital were assessed: structural component (i.e., community participation) and cognitive component (i.e., perceived neighborliness). Regression analyses found that community participation and perceived neighborliness were significantly associated with health information-seeking. The analyses also found that perceived cohesion was a significant correlate of health information-sharing with family members. Finally, moderation tests indicated that perceived neighborliness moderated the relationships between trust in information sources and health communication (health information-seeking and health information-sharing with friends/coworkers). Findings have implications for community-based health interventions and social policies to strengthen community participation and cohesion.

Promoting access to health information

Purpose

Describe the design of a health information and technology educational intervention that promotes health information sharing and technology use for older adult African Americans to support access to health information. The paper aims to discuss this issue.

Design/methodology/approach

The study team developed a novel method to design the intervention. It drew upon three approaches: intergenerational technology transfer, participatory design and community-based participatory research.

Findings

Older adult African Americans (55+) with diabetes and young adults (18–54) connected to them via familial or naturally occurring social networks designed the intervention, which was conducted in the two study sites in Michigan, USA. In total, 29 participants helped design the intervention. Four themes emerged concerning factors that promote intergenerational information exchange in the context of technology and health. First, focus on one technology skill. Second, working together in small groups is preferred. Third, patience is essential. Last, physical capabilities (i.e., eyesight, operating on relatively small screens) and literacy levels should be considered.

Originality/value

This novel method of having participants from the sample population select the health information materials and technology exercises serves as a guide for implementing health information and education interventions aimed at technology use to support self-management for vulnerable patient populations.

A "fitness" Theme May Mitigate Regional Prevalence of Overweight and Obesity: Evidence from Google Search and Tweets

Taking ecological perspectives to overweight and obesity, the current study applies data mining approach to examine the association between information and social environments and regional prevalence of overweight and obesity. In particular, we focus on online search and social media data since the increasing popularity of location-based geo-targeting could be an influential source of regional differences in health information and social environment. In Study 1, we calculated the correlation between regional overweight and obesity rates with regional Google searches for a time period of 12 years (2004 to 2016). The findings showed that in regions with high overweight and obesity rates, people were looking for and obtaining information on weight-loss and diet;, but in regions with low overweight and obesity rates, people were looking for and obtaining information on fitness services and facilities. In Study 2, we analyzed and compared 4010 tweets from Houston, a city with a high overweight and obesity rate, and 3281 tweets from San Diego, a city with a low overweight and obesity rate. The tweets were collected from August 2015 to August of 2016. We analyzed the textual content of tweets by word frequency analysis and topic modeling. The findings suggest that San Diego has a social environment that focuses on fitness and combining exercising with dieting. In contrast, Houston's social environment emphasizes dieting. The implication of these findings is that health practitioners should push a paradigm shift to a stronger focus on "healthy life" (combining exercising and dieting) in regions with high overweight and obesity rates.

Online Health-Information Seeking Among Older Populations: Family Influences and the Role of the Medical Professional

There are myriad technological devices, computer programs, and online information sources available for people to manage their health and the health of others. However, people must be technologically and health literate and capable of accessing, analyzing, and sharing the information they encounter. The authors interviewed middle-aged and older adults about their online health information seeking behavior and discovered that technology and health literacy are influenced by a collective ability to manage the health and technological needs of a family. We used information management theory to frame participants' experiences of their self-efficacy using technology to manage the health of loved ones. Findings suggest that health can be co-managed if at least one person in a family unit is technologically "savvy" and able to effectively share health information. However, individuals' confidence in their own literacy often depends on others, usually family members who tend to "do" instead of "teach."

"He would never let me just give up": Communicatively Constructing Dyadic Resilience in the Experience of Breast Cancer

A breast cancer diagnosis is a significant stressor that impacts both survivors' and their partners' psychological adjustment and well-being. Communication patterns and strategies utilized by survivors and partners are the key determinants of how some couples adjust to a cancer diagnosis. This study employs the Communicative theory of resilience (CTR)(Buzzanell, 2010) to examine the dyadic communicative processes couples enact that contribute to their resilience. Researchers conducted semi-structured interviews with 27 breast cancer survivors concerning communication with their partners. All interviews were transcribed and independently coded using thematic analysis. Findings support and extend the presence of the five communicative processes of resilience outlined by Buzzanell (2010), demonstrating how these processes interact with one another. Results also suggest that couples' communication both promotes and interferes with resilience. Practical and theoretical implications are discussed.

Social inequalities in health information seeking among young adults in Montreal

Over their lifecourse, young adults develop different skills and preferences in relationship to the information sources they seek when having questions about health. Health information seeking behaviour (HISB) includes multiple, unequally accessed sources; yet most studies have focused on single sources and did not examine HISB's association with social inequalities. This study explores 'multiple-source' profiles and their association with socioeconomic characteristics. We analyzed cross-sectional data from the Interdisciplinary Study of Inequalities in Smoking involving 2093 young adults recruited in Montreal, Canada, in 2011-2012. We used latent class analysis to create profiles based on responses to questions regarding whether participants sought health professionals, family, friends or the Internet when having questions about health. Using multinomial logistic regression, we examined the associations between profiles and economic, social and cultural capital indicators: financial difficulties and transportation means, friend satisfaction and network size, and individual, mother's, and father's education. Five profiles were found: 'all sources' (42%), 'health professional centred' (29%), 'family only' (14%), 'Internet centred' (14%) and 'no sources' (2%). Participants with a larger social network and higher friend satisfaction were more likely to be in the 'all sources' group. Participants who experienced financial difficulties and completed college/university were less likely to be in the 'family only' group; those whose mother had completed college/university were more likely to be in this group. Our findings point to the importance of considering multiple sources to study HISB, especially when the capacity to seek multiple sources is unequally distributed. Scholars should acknowledge HISB's implications for health inequalities.

Chronic Conditions May Be More Important Than Race or Ethnicity in Relation to Health Information Seeking and Use

OBJECTIVE

This research examines health information (HI) seeking and use among middle-aged and older adults with chronic health conditions.

METHOD

We used logistic regression models to analyze HI seeking ( N = 7,822) and use (N = 4,541-4,547) among participants (aged 45+ years) with chronic conditions from the nationally-representative Health Tracking Household Survey.

RESULTS

Adults aged 45+ years with chronic conditions were significantly more likely to seek and use HI; however, these results varied based on the age and education. Compared with Whites, Latinos were less likely to seek HI but more likely to use HI to treat illness, and African Americans were more likely to use HI to maintain health.

CONCLUSION

Middle-aged and older adults with chronic conditions are prominent HI seekers and users. Proficient HI seeking and use may have the potential to enhance control over one's own health, maintain independence in the community, and reduce the impact of negative health consequences on the health care system.

Why Do Smokers Talk About Antismoking Campaigns? Predictors of the Occurrence and Content of Campaign-Generated Conversations

Smokers often talk about antismoking campaigns, and these conversations can contribute to campaign effectiveness. However, little is known about the predictors and content of naturally occurring campaign-generated conversations. In two studies (Study 1, N = 480; Study 2, N = 232), we systematically examined whether the occurrence and content of smokers' conversations after exposure to one of eight antismoking television advertisements were predicted by characteristics of (a) the message, (b) intrapersonal responses to the message, (c) the individual, and (d) the social context in which exposure occurred. In multivariable models, we found that conversations were more likely to occur when advertisement exposure occurred in the presence of others, and as the amount of anxiety elicited by the advertisement increased. Conversations were more likely to contain a favorable appraisal of the advertisement when the message elicited higher levels of sadness, and less likely to contain favorable appraisals when the respondent had finished secondary education (vs. lower levels of education). Stronger feelings of guilt reduced the likelihood that conversations contained unfavorable appraisals, and increased the likelihood that they contained quitting talk. These findings suggest several promising avenues for future investigations into why smokers talk and talk in particular ways.

Telehealth Protocol to Prevent Readmission Among High-Risk Patients With Congestive Heart Failure

BACKGROUND

Congestive heart failure is the leading cause of hospital readmissions. We aimed to assess adherence to and effectiveness of a telehealth protocol designed to prevent hospital admissions for congestive heart failure.

METHODS

We recruited a random sample of 50 patients with congestive heart failure (mean age 61 years) from a managed care organization. We developed a telehealth platform allowing for daily, real-time reporting of health status and video conferencing. We defined adherence as the percentage of days on which the patient completed the daily check-in protocol. To assess efficacy, we compared admission and readmission rates between the 6-month intervention period and the prior 6 months. Primary outcomes were admissions and readmissions due to congestive heart failure, and secondary outcomes were admissions and readmissions due to any cause.

RESULTS

Forty-eight patients (96%) completed the protocol. Approximately half (46%) were at high risk for readmission according to standardized measures. Median 120-day adherence was 96% (interquartile range, 92%-98%), and adherence did not significantly differ across sex, race, age, living situation, depression, cognitive ability, or risk for readmission. Approximately equal proportions of patients were admitted for all causes during the 6-month intervention period versus the comparison period (37% vs 43%; P = .32). Half as many patients were admitted for congestive heart failure during the 6-month intervention period compared with the comparison period (12% vs 25%; P = .11).

CONCLUSION

Adherence to this telehealth protocol was excellent and consistent, even among high-risk patients. Future research should test the protocol using a more rigorous randomized design.

Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey

Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive.Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest.Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs.Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study.Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26(12); 1804-11. ©2017 AACR.

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

PURPOSE

Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge.

METHODS

We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software.

RESULTS

Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time.

CONCLUSION

Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults

BACKGROUND

In 2012, the U.S. Food and Drug Administration proposed nine graphic health warnings (GHWs) on cigarette packaging that were rated equally effective across racial/ethnic, education, or income groups of adult smokers. However, data on GHW effectiveness among sexual and gender minority (SGM) adults, who have higher smoking prevalence, are currently lacking. This study analyzed whether perceived effectiveness of GHWs differed by gender and sexual orientation.

METHODS

Data came from a randomized experiment among 1,200 adults with an oversample from low socioeconomic status groups, conducted between 2013 and 2014 in three Massachusetts communities. Participants viewed and rated the effectiveness of nine GHWs. Mixed effects regression models predicted perceived effectiveness with gender and sexual orientation, adjusting for repeated measurements, GHWs viewed, age, race, ethnicity, smoking status, and health status.

RESULTS

Female heterosexuals rated GHWs as more effective than male heterosexual, lesbian, and transgender and other gender respondents. There was no significant difference between female and male heterosexuals versus gay, male bisexual, or female bisexual respondents. Differences by gender and sexual orientation were consistent across all nine GHWs. Significant correlates of higher perceived effectiveness included certain GHWs, older age, being African-American (vs white), being Hispanic (vs non-Hispanic), having less than high school education (vs associate degree or higher), and being current smokers (vs non-smokers).

CONCLUSIONS

Perceived effectiveness of GHWs was lower in certain SGM groups. We recommend further studies to understand the underlying mechanisms for these findings and investments in research and policy to communicate anti-smoking messages more effectively to SGM populations.

Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology

Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.

An Interactive, Mobile-Based Tool for Personal Social Network Data Collection and Visualization Among a Geographically Isolated and Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study With Qualitative User Feedback

BACKGROUND

Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural Appalachian Kentucky.

OBJECTIVE

We explored the early-stage feasibility (Acceptability, Demand, Implementation, and Practicality) of using innovative, interactive, tablet-based network data collection and visualization software (OpenEddi) in field collection of personal network data in Appalachian Kentucky.

METHODS

A total of 168 rural Appalachian women who had previously participated in a study on the use of a self-collected vaginal swab (SCVS) for human papillomavirus testing were recruited by community-based nurse interviewers between September 2013 and August 2014. Participants completed egocentric network surveys via OpenEddi, which captured social and communication network influences on participation in, and recruitment to, the SCVS study. After study completion, we conducted a qualitative group interview with four nurse interviewers and two participants in the network study. Using this qualitative data, and quantitative data from the network study, we applied guidelines from Bowen et al to assess feasibility in four areas of early-stage development of OpenEddi: Acceptability, Demand, Implementation, and Practicality. Basic descriptive network statistics (size, edges, density) were analyzed using RStudio.

RESULTS

OpenEddi was perceived as fun, novel, and superior to other data collection methods or tools. Respondents enjoyed the social network survey component, and visualizing social networks produced thoughtful responses from participants about leveraging or changing network content and structure for specific health-promoting purposes. Areas for improved literacy and functionality of the tool were identified. However, technical issues led to substantial (50%) data loss, limiting the success of its implementation from a researcher's perspective, and hindering practicality in the field.

CONCLUSIONS

OpenEddi is a promising data collection tool for use in geographically isolated and socioeconomically disadvantaged populations. Future development will mitigate technical problems, improve usability and literacy, and test new methods of data collection. These changes will support goals for use of this tool in the delivery of network-based health communication and social support interventions to socioeconomically disadvantaged populations.

With Some Help From My Network: Supplementing eHealth Literacy With Social Ties

Background

eHealth literacy is defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply knowledge gained to addressing or solving a health problem. Previous research has shown high reliance on both online and face-to-face interpersonal sources when sharing and receiving health information.

Objective

In this paper, we examine these interpersonal sources and their interplay with respondents’ eHealth literacy and perceived health outcomes. Specifically, we look at how the relationship between eHealth literacy and health outcomes is moderated by (1) finding help while performing online activities, (2) finding others with similar health concerns online, and (3) the importance of finding others with similar health concerns for people from ethnic minorities, specifically Palestinian citizens of Israel versus Israeli Jews.

Methods

We used a nationally representative random-digit dial telephone household survey of an Israeli adult population (age ≥21 years, N=819). The collected data were analyzed using two regression models. The first examined how the correlation between eHealth literacy and perceived outcomes was moderated by the availability of help. The second examined how the correlation between eHealth literacy and perceived outcomes was moderated by finding others with similar health concerns and by ethnicity.

Results

Respondents with low eHealth literacy who were able to recruit help when performing online activities demonstrated higher perceived health outcomes compared to similar respondents who did not find help. Respondents with low eHealth literacy, who were able to find others with similar health concerns (online), demonstrated higher perceived health outcomes when compared to similar respondents who did not find others with similar health concerns. Finally, finding similar others online was more helpful in enhancing health outcomes for ethnic minorities; Palestinian citizens of Israel gained more health benefits by finding similar others compared to Israeli Jews.

Conclusions

Although the availability of help and the notion of ethnicity have been discussed extensively within the context of social capital and health, our findings offer initial evidence for the relevancy of these concepts when studying individuals’ eHealth literacy. Specifically, our findings enable a better understanding of the role of social ties and ethnicity in moderating the interplay between eHealth literacy and perceived health outcomes. Given the increased importance of eHealth information, our findings enhance understanding of how social ties can potentially compensate for low eHealth literacy.

Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position

RATIONALE

Graphic health warnings (GHWs) on cigarette packages present an important tobacco control opportunity, particularly for vulnerable populations suffering a disproportionate tobacco burden. One mechanism by which GHWs may influence smoking outcomes is by prompting interpersonal discussions within health discussion networks (the set of personal contacts with whom an individual discusses health issues).

OBJECTIVE

The study examined the association between GHW-prompted conversations within health discussion networks and key tobacco-related outcomes, with attention to valence and content of the discussions.

METHOD

Between August 2013 and April 2014, we recruited 1200 individuals from three communities in Massachusetts, emphasizing recruitment of individuals of low socioeconomic position (SEP) and members of other selected vulnerable groups. Respondents were exposed to the nine GHWs proposed by the FDA in 2011, asked a series of questions, and assessed at follow-up a few weeks later.

RESULTS

A total of 806 individuals were included in this analysis. About 51% of respondents reported having a health discussion network, with significantly lower reports among African-Americans and Hispanics compared to Whites. Around 70% of respondents (smokers and nonsmokers) with health discussion networks reported having one or more conversations about the GHWs with network members, the bulk of which were negative and focused on warning others about smoking. For smokers, we found a small but positive association between the percentage of network conversations that were negative and reports of quit attempts.

CONCLUSION

The results point to a potential mechanism by which GHWs may impact tobacco-related outcomes, prompting further inquiry into the role of health discussion networks (and discussion networks, more broadly) in tobacco control among low SEP individuals.

Sources of Information During the 2014 West Virginia Water Crisis: A Cross-Sectional Survey

Objective

On January 9, 2014, a faulty storage tank leaked 10,000 gallons of an industrial coal-processing liquid into the Elk River in West Virginia, contaminating the drinking water of 9 counties collectively known as the Kanawha Valley. In the context of this event, we explored the relationship between social determinants and (1) the timeliness with which residents learned about the crisis, (2) the source of information, (3) opinions on the source of information, (4) information-seeking behaviors, and (5) knowledge acquired.

Methods

Between February 7 and 26, 2014, we conducted a survey of 690 adult residents of West Virginia. Descriptive statistics and multivariable statistical models were performed.

Results

Information about water contamination spread quickly, with 88% of respondents from the affected counties hearing about the incident on the same day it occurred. Most people received the information from local television news (73%); social media users had 120% increased odds of knowing about the recommended behaviors. People who had a favorable opinion of the source of information demonstrated better knowledge of recommended behaviors.

Conclusions

The use of local television news during a crisis is important for timely dissemination of information. Information exposure across segments of the population differed on the basis of the population’s background characteristics. (Disaster Med Public Health Preparedness. 2017;11:196–206)

Dikir Farmasi: folk songs for health education

In an effort to enhance public awareness, we develop Dikir Farmasi as an innovative approach to deliver health information. Dikir Farmasi combines the elements of dikir barat (a type of traditional folk song rhythm) and traditional sketches which are popular in the state of Kelantan, Malaysia. These sketches and dikir barat rhythmic songs, with lyrics touch on issues such as drug abuse and regulation are presented in an entertaining and humorous way. Health promotion messages are disseminated using Dikir Farmasi in the form of compact disks, video compact disks, stage performance, exhibition, social media, printed media (signboard, brochure and flyer).

Latino Civic Group Participation, Social Networks, and Physical Activity

OBJECTIVES

We examined whether social networks and resource awareness for physical activity may mediate the relationship between civic group participation and physical activity.

METHODS

This is a cross-sectional study of a randomly selected sample of 335 Latinos (mean age 42.1 ± 16.4 years) participating in the San Diego Prevention Research Center's 2009 Household Community Survey. Serial multiple mediation analysis tested the hypothesis that civic group participation is associated with meeting physical activity recommendations through an indirect mechanism of larger social networks followed by greater knowledge of physical activity community resources.

RESULTS

The indirect effects of level of civic group participation as well as religious, health, neighborhood, or arts group participation on meeting national physical activity recommendations were significant in models testing pathways through social network size and physical activity resource awareness. The direct effect was only significant for health group indicating that participating in a health group predicted physical activity independent of social network size and awareness of physical activity resources.

CONCLUSION

Belonging to civic groups may promote physical activity engagement through social network diffusion of information on community physical activity resources which has implications for health.

Contextual Influences and Campaign Awareness Among Young Adults: Evidence from the National truth® Campaign

Mass media campaigns have been found to shape the public's knowledge, attitudes, beliefs, and behavior around tobacco. This study examines the influence of contextual factors with respect to awareness of the national truth® campaign, a mass media, branded tobacco use prevention campaign, among a sample of young adults (n = 2,804) aged 24-34 years old; these respondents were within the age range for both the primary and secondary targets of the campaign during the period (2000-2007) when the campaign was airing television advertising at consistently high levels. Mulitvariable models reveal lower educational attainment and Hispanic ethnicity as significant contextual factors predictive of lower campaign awareness, controlling for media use. In contrast, gender, state tobacco control policy, sensation-seeking, current smoking status, and community-level SES variables were not significantly associated with campaign awareness. Further research is needed to identify the mechanisms through which public education campaigns operate, particularly among disadvantaged communities.

Beyond Race and Ethnicity: Exploring the Effects of Ethnic Identity and Its Implications for Cancer Communication Efforts

Within the health communication literature there has been an increased focus on the use of cultural and identity-based message tailoring to enhance the effectiveness of messages and interventions, particularly among minority and underserved populations. Although this approach may be promising, little is known about the effect of ethnic identity on health behaviors and beliefs or how the effects of ethnic identity differ from those of race or ethnicity. This study is among the first to explore relationships between ethnic identity and cancer-related risk factors, knowledge characteristics, and cognitive and affective appraisals. This study utilized a national online sample of Whites, Blacks, and Hispanics (N = 1,452). Higher ethnic identity was associated with increased physical activity and fruit and vegetable intake and decreased body mass index among Whites (p < .05). Higher ethnic identity was also associated with increased cancer risk knowledge (p < .05) but not cancer risk perceptions or self-efficacy (p > .05). Hispanics and Blacks with higher ethnic identity had greater cancer worry. Our results suggest that the effect of ethnic identity is often distinct from that of race/ethnicity and that health communication interventions based solely on race/ethnicity may not be as effective as those that also take ethnic identity into account.

Assessing opinions in community leadership networks to address health inequalities: a case study from Project IMPACT

This study demonstrates a novel approach that those engaged in promoting social change in health can use to analyze community power, mobilize it and enhance community capacity to reduce health inequalities. We used community reconnaissance methods to select and interview 33 participants from six leadership sectors in 'Milltown', the New England city where the study was conducted. We used UCINET network analysis software to assess the structure of local leadership and NVivo qualitative software to analyze leaders' views on public health and health inequalities. Our main analyses showed that community power is distributed unequally in Milltown, with our network of 33 divided into an older, largely male and more powerful group, and a younger, largely female group with many 'grassroots' sector leaders who focus on reducing health inequalities. Ancillary network analyses showed that grassroots leaders comprise a self-referential cluster that could benefit from greater affiliation with leaders from other sectors and identified leaders who may serve as leverage points in our overall program of public agenda change to address health inequalities. Our innovative approach provides public health practitioners with a method for assessing community leaders' views, understanding subgroup divides and mobilizing leaders who may be helpful in reducing health inequalities.

Communicative social capital and collective efficacy as determinants of access to health-enhancing resources in residential communities

This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents' access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital-that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media-plays a significant role in access to health resources. This relationship is complicated by individuals' health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research.

eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults

BACKGROUND

Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information.

OBJECTIVE

The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults.

METHODS

A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information.

RESULTS

Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t217.60=-2.98, P=.003. Younger age (b=-0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R(2) =.17, R(2)adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information.

CONCLUSIONS

Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.

E-health use in african american internet users: can new tools address old disparities?

OBJECTIVE

Web-based health information may be of particular value among the African American population due to its potential to reduce communication inequalities and empower minority groups. This study explores predictors of e-health behaviors and activities for African American Internet users.

MATERIALS AND METHODS

We used the 2010 Pew Internet and American Life Health Tracking Survey to examine sociodemographic and health status predictors of e-health use behaviors among African Americans. E-health use behaviors included searching for e-health information, conducting interactive health-related activities, and tracking health information online.

RESULTS

In the African American subsample, 55% (n=395) were at least "occasional" Internet users. Our model suggests that searching for health information online was positively associated with being helped/knowing someone helped by online information (odds ratio [OR]=5.169) and negatively associated with lower income (OR=0.312). Interactive health activities were associated with having a college education (OR=3.264), being 65 years of age or older (OR=0.188), having a family member living with chronic conditions (OR=2.191), having a recent medical crisis (OR=2.863), and being helped/knowing someone helped by online information (OR=8.335). E-tracking behaviors were significantly stronger among African Americans who had health insurance (OR=3.907), were helped/knowing someone helped by online information (OR=4.931), and were social media users (OR=4.799).

CONCLUSIONS

Findings suggest significant differences in e-health information-seeking behaviors among African American Internet users-these differences are mostly related to personal and family health concerns and experiences. Targeted online e-health resources and interventions can educate and empower a significant subset of the population.

YouTube as a tool for pain management with informal caregivers of cancer patients: a systematic review

CONTEXT

Cancer caregivers have information and support needs, especially about cancer pain management. With high Internet use reported among caregivers, YouTube may be an accessible option when looking for information on cancer pain management.

OBJECTIVES

The purpose of this study was to explore the availability and characteristics of instructional cancer pain management videos on YouTube and determine to what extent these videos addressed the role of informal caregivers in cancer pain management.

METHODS

A systematic review of videos on YouTube resulting from search terms "pain and cancer," "pain and hospice," and "pain and palliative care" was conducted in May 2013. If the video addressed pain management, was in English, and was instructional, it was coded for the scope and design of instructional content that included caregivers.

RESULTS

The search terms yielded 1118 unique videos, and 43 videos met the inclusion criteria. Overall, 63% of videos were viewed 500 times or less, and half of the videos received "like" ratings by viewers. Video instruction was primarily talk without any onscreen action (65%), user-generated amateur video (79%), and had poor quality sources of information. Videos were mainly clinician centered (77%). Although most videos addressed the need for caregiver pain assessment (35%) and caregiver education (23%), few actually addressed specific caregiver pain management barriers.

CONCLUSION

Most videos were primarily directed toward a clinical audience. Future research is necessary to determine if the platform is feasible and beneficial as a support tool for oncology caregivers.

Gendered communicative construction of patients in consultation settings

This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.