The consumer-driven development and acceptability testing of a website designed to connect rural cancer patients and their families, carers and health professionals with appropriate information and psychosocial support

Meaningful consumer involvement in cancer care: a systematic review on co-design methods and processes

OBJECTIVE

Although the benefits of consumer involvement in research and health care initiatives are known, there is a need to optimize this for all people with cancer. This systematic review aimed to synthesize and evaluate the application of co-design in the oncology literature and develop recommendations to guide the application of optimal co-design processes and reporting in oncology research, practice, and policy.

METHODS

A systematic review of co-design studies in adults with cancer was conducted, searching MEDLINE, CINAHL, Embase, and PsycINFO databases and included studies focused on 2 concepts, co-design and oncology.

RESULTS

A total of 5652 titles and abstracts were screened, resulting in 66 eligible publications reporting on 51 unique studies. Four frameworks were applied to describe the co-design initiatives. Most co-design initiatives were designed for use in an outpatient setting (n = 38; 74%) and were predominantly digital resources (n = 14; 27%) or apps (n = 12; 23%). Most studies (n = 25; 49%) used a co-production approach to consumer engagement. Although some studies presented strong co-design methodology, most (n = 36; 70%) did not report the co-design approach, and 14% used no framework. Reporting was poor for the participant level of involvement, the frequency, and time commitment of co-design sessions. Consumer participation level was predominantly collaborate (n = 25; 49%).

CONCLUSIONS

There are opportunities to improve the application of co-design in oncology research. This review has generated recommendations to guide 1) methodology and frameworks, 2) recruitment and engagement of co-design participants, and 3) evaluation of the co-design process. These recommendations can help drive appropriate, meaningful, and equitable co-design, leading to better cancer research and care.

Exploring Web-Based Information and Resources That Support Adolescents and Young Adults With Cancer to Resume Study and Work: Environmental Scan Study

BACKGROUND

Adolescents and young adults (AYAs) diagnosed with cancer experience physical, cognitive, and psychosocial effects from cancer treatment that can negatively affect their ability to remain engaged in education or work through cancer treatment and in the long term. Disengagement from education or work can have lasting implications for AYAs' financial independence, psychosocial well-being, and quality of life. Australian AYAs with cancer lack access to adequate specialist support for their education and work needs and report a preference for web-based support that they can access from anywhere, in their own time. However, it remains unclear what web-based resources exist that are tailored to support AYAs with cancer in reaching their educational or work goals.

OBJECTIVE

This study aimed to determine what web-based resources exist for Australian AYAs with cancer to (1) support return to education or work and (2) identify the degree to which existing resources are age-specific, cancer-specific, culturally inclusive, and evidence-based; are co-designed with AYAs; use age-appropriate language; and are easy to find.

METHODS

We conducted an environmental scan by searching Google with English search terms in August 2022 to identify information resources about employment and education for AYAs ever diagnosed with cancer. Data extraction was conducted in Microsoft Excel, and the following were assessed: understandability and actionability (using the Patient Education and Materials Tool), readability (using the Sydney Health Literacy Laboratory Health Literacy Editor), and whether the resource was easy to locate, evidence-based, co-designed with AYAs, and culturally inclusive of Aboriginal and Torres Strait Islander peoples. The latter was assessed using 7 criteria previously developed by members of the research team.

RESULTS

We identified 24 web-based resources, comprising 22 written text resources and 12 video resources. Most resources (21/24, 88%) were published by nongovernmental organizations in Australia, Canada, the United States, and the United Kingdom. A total of 7 resources focused on education, 8 focused on work, and 9 focused on both education and work. The evaluation of resources demonstrated poor understandability and actionability. Resources were rarely evidence-based or co-designed by AYAs, difficult to locate on the internet, and largely not inclusive of Aboriginal and Torres Strait Islander populations.

CONCLUSIONS

Although web-based resources for AYAs with cancer are often available through the websites of hospitals or nongovernmental organizations, this environmental scan suggests they would benefit from more evidence-based and actionable resources that are available in multiple formats (eg, text and audio-visual) and tailored to be age-appropriate and culturally inclusive.

Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review

BACKGROUND

Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action.

OBJECTIVE

This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building.

METHODS

This study collected peer-reviewed materials published in 15-year period (2005-2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems).

RESULTS

The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%).

CONCLUSION

This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening.

Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment

OBJECTIVE

Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient-caregiver relationships can mitigate this distress during treatment, but this association is unclear pre-treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity.

METHODS

We recruited 55 breast cancer patient-caregiver dyads to complete a self-report survey after diagnosis but before treatment. We used a series of Actor-Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity.

RESULTS

Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient-reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain.

CONCLUSIONS

This study demonstrates that pre-treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.

Rapid systematic review on developing web-based interventions to support people affected by cancer

OBJECTIVE

To systematically identify and explore the existing evidence to inform the development of web-based interventions to support people affected by cancer (PABC).

DESIGN

A rapid review design was employed in accordance with the guidance produced by the Cochrane Rapid Reviews Methods Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A rapid review was chosen due to the need for a timely evidence synthesis to underpin the subsequent development of a digital resource (Shared Lives: Cancer) as part of an ongoing funded project.

METHODS AND OUTCOMES

Keyword searches were performed in MEDLINE to identify peer-reviewed literature that reported primary data on the development of web-based interventions designed to support PABC. The review included peer-reviewed studies published in English with no limits set on publication date or geography. Key outcomes included any primary data that reported on the design, usability, feasibility, acceptability, functionality and user experience of web-based resource development.

RESULTS

Ten studies were identified that met the pre-specified eligibility criteria. All studies employed an iterative, co-design approach underpinned by either quantitative, qualitative or mixed methods. The findings were grouped into the following overarching themes: (1) exploring current evidence, guidelines and theory, (2) identifying user needs and preferences and (3) evaluating the usability, feasibility and acceptability of resources. Resources should be informed by the experiences of a wide range of end-users taking into consideration current guidelines and theory early in the design process. Resource design and content should be developed around the user's needs and preferences and evaluated through usability, feasibility or acceptability testing using quantitative, qualitative or mixed methods.

CONCLUSION

The findings of this rapid review provide novel methodological insights into the approaches used to design web-based interventions to support PABC. Our findings have the potential to inform and guide researchers when considering the development of future digital health resources.

TRIAL REGISTRATION NUMBER

The review protocol was registered on the Open Science Framework (https://osf.io/ucvsz).

Optimizing Rural People's Access to Relevant Cancer Education and Support Using Peer-Led YouTube Films

Rural cancer patients have inferior cancer outcomes and unique unmet information needs. This paper explores the value of rural people affected by cancer delivering cancer-related education and support to their peers via 3-5 min online YouTube films. In part 1, 14 rural Australians affected by cancer (10 survivors, 4 carers), 50% (7/14) female, 55-79 years, "storytellers", were purposively invited to be filmed sharing their cancer-related experience and advice for others facing similar challenges. They then reflected on their storytelling experience during semi-structured interviews with an independent researcher. In part 2, 11 rural South Australians affected by cancer (8 survivors, 3 carers), 82% (9/11) female, 32-75 years, "viewers", who had watched at least three of the videos, were interviewed. When data saturation was reached, thematic analysis was employed. Storytellers were found to be highly satisfied with the film-making process and product. They valued rapport building prior to filming and the opportunity to help others. They also found storytelling cathartic and the films useful in communicating their cancer experience to family and friends. Rural viewers appreciated the honesty, authenticity, relatability and believability of the storytellers, the practical advice on rural-specific psychosocial issues, acknowledgment of the impact of isolation and the opportunity to understand others' cancer experiences. The film's short duration and professional film-making added appeal. Inclusion of younger storytellers and methods of delivery other than YouTube were suggested. This study highlights the value of this approach for storytellers and viewers. It may be particularly beneficial for isolated rural cancer survivors who feel that their unique challenges are not adequately addressed by mainstream cancer education resources However, further quantitative research to test acceptability and impact in representative rural samples is required.

Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review

BACKGROUND

Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development.

OBJECTIVE

This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given.

METHODS

A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach.

RESULTS

Recommendations include paying attention to the training of stakeholders' academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group.

CONCLUSIONS

This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach.

Caring for someone with cancer in rural Australia

PURPOSE

To explore the experiences of people caring for someone with cancer, while living in rural Australia, and the impact of the cancer-caring role on their well-being.

METHOD

Eighteen adults in regional or remote ('rural') Australia who cared for a person with cancer took part in semi-structured telephone interviews. Participants were aged 32-77 years and mainly female (66%). Data were analysed using thematic analysis and an essentialist approach.

RESULTS

Eight themes were identified: (1) travel is hard, but supports are available; (2) frustration with systems that do not demonstrate understanding of the rural context; (3) the importance of lay and peer support; (4) the impact of access to trusted, local health care services; (5) the importance of access to rurally relevant information (particularly on relevant services and what to expect); (6) living with uncertainty and balancing loss with hope; (7) reluctance to seek or accept psychological support; and (8) the gendered nature of care.

CONCLUSION

Rural cancer carers' roles can be made easier by improving health systems and coordination to ease the burden of travel, providing information about available support and what to expect throughout cancer treatment that is relevant to the rural context, and increasing access to quality health, community, and support services, including palliative care, in rural areas. More training on the specific needs of rural patients and their carers is needed for urban health care professionals. Peer support groups may have particular value for cancer carers in rural settings, where there are known to be multiple barriers to accessing professional sources of psychosocial support.

Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination

OBJECTIVE

This study aimed to understand how cancer survivors in rural Queensland seek and receive information, as well as their preferences regarding the content and delivery of health-related information.

METHODS

This study explored cancer survivors' experiences in seeking and comprehending health information using a qualitative descriptive approach. Semi-structured interviews were conducted with 24 participants. Data were analysed using reflexive thematic analysis.

RESULTS

Two major themes and six sub-themes were identified including 1) information content and gaps - a) information about diagnosis and treatment, b) survivorship information gaps and c) practical support needs and 2) delivery and acceptance of information - a) sources of information, b) personalised information needs and c) information seeking or avoidance. Findings suggested that health information provision was inconsistent; survivors' attitudes towards seeking information varied greatly; and survivors' had difficulty processing information due to emotional distress.

CONCLUSION

The role of the health professional is critical in providing information and support to rural cancer survivors. Information provided should be tailored to meet the needs and preferences of individuals taking into consideration demographic factors and attitudes. Implications for public health: The current findings imply that quality information provision after cancer treatment would facilitate improvements in satisfaction among rural cancer survivors.

Codesigning a supportive online resource for Australian cancer carers: a thematic analysis of informal carers' and healthcare professionals' perspectives about carers' responsibilities and content needs

OBJECTIVE

To gather preliminary qualitative data that will assist in the codesign and development of a new informational and supportive website to assist informal cancer carers in Australia.

DESIGN AND SETTING

Utilising a previously tested codesign process, informal carers' experiences and perspectives, including those of healthcare professionals', were examined via focus groups and/or interviews. Data were analysed via thematic analysis.

PARTICIPANTS

Rural (n=9) and urban (n=11) carers', and healthcare professionals' (n=8) perspectives were collected. Carers participated in a focus group (n=9) or telephone interview (n=11). Healthcare professionals completed an interview (n=6) or online survey (n=2).

RESULTS

Rural and urban carers typically felt ill prepared for their multitudinal caregiving responsibilities. Supporting patient-to-healthcare professional liaisons could especially challenge. Carers' biopsychosocial and fiscal strains were affected by patients' hardships and available informal supports. Rural carers described greater social support than urban carers. Both rural and urban carers also described discontentment related to a carer neglecting healthcare system. Both carers and healthcare professionals endorsed the need for a user-friendly, carer-specific website encompassing practical information and resources, peer-driven advice and evidence-based illness information, tailored to the Australian context.

CONCLUSIONS

Carers and healthcare professionals recognise the pressing need for an Australian, cancer carer-specific online resource. Findings will inform the next phase, where a resource will be designed, developed and tested.

The role of digital health technology in rural cancer care delivery: A systematic review

PURPOSE

Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care.

METHODS

PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality.

FINDINGS

Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41).

CONCLUSIONS

Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.

The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies

OBJECTIVE

This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information.

METHODS

We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out.

RESULTS

118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users.

CONCLUSION

Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria.

PRACTICE IMPLICATIONS

With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.

Descriptive Review of Online Information Resources for People With Stroke: Protocol for a Scoping Review

Background

People with stroke and their caregivers experience numerous information needs; internet-based resources may offer cost-effective ways to improve access to information about this condition and its management, including the availability of resources and support. The quality of online health information is, therefore, an important consideration for both developers and consumers of these online resources.

Objective

This study aims to map and evaluate the content, readability, understandability, design, and quality characteristics of freely available online information resources (ie, websites) that empower people with stroke and their caregivers with information and self-help strategies poststroke.

Methods

This descriptive review will follow the five systematic and rigorous methodological steps that are recommended for scoping reviews, which include the following: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarizing, and reporting the results. Data will then be synthesized and analyzed thematically.

Results

As of February 2021, the scoping review is in the data extraction stage. Data will be synthesized, and the first results are expected to be submitted for publication in an open-access peer-reviewed journal in August 2021. In addition, we will develop an accessible summary of the results for stakeholder meetings. Ethical approval is not required for this review, as it will only include publicly available information.

Conclusions

This study is novel and will evaluate the typology, content, and design-related criteria, including accessibility, aesthetics, navigability, interactivity, privacy, and data protection, of online information resources for stroke. The review will be limited to online resources published in English.

International Registered Report Identifier (IRRID)

DERR1-10.2196/23174

Understanding the strategies rural cancer patients and survivors use to manage financial toxicity and the broader implications on their lives

PURPOSE

To explore strategies rural Australians use to cope with the financial consequences of their cancer diagnosis and how that impacts on their lives.

METHODS

Twenty adult cancer patients/survivors residing in regional-remote areas of Australia were purposively sampled and participated in audio-recorded, semi-structured interviews. When data saturation was reached, thematic analysis was employed to analyse the data.

RESULTS

Participants were 20-78 years (M=60), 70% female, 35% were undergoing treatment and the remaining 65% had finished treatment within the past 5 years. Three themes provide context to rural financial toxicity-related experiences (travelling to access cancer treatment away from home is expensive, being single or lacking family support exacerbates the financial strain, and no choice other than to adopt cost-saving strategies if wanted to access treatment). Strategies commonly employed to minimise financial toxicity include: accessing travel-related support, changes to lifestyle (buying cheaper food, saving on utilities), accessing savings and retirement funds, missing holidays and social activities, reduced car use and not taking a companion to cancer-related appointments at metropolitan treatment areas. Although cost-saving strategies can effectively increase the ability of rural people to cover cancer treatment-related and other costs, most have broader negative psychological, social and practical consequences for them and their families.

CONCLUSIONS

Increasing rural cancer patients' and survivors' awareness of various cost-saving strategies and their impact (positive and negative) may decrease their risk of experiencing financial toxicity and unexpected unintended consequences of adopting cost-saving measures.

The psychosocial experiences and supportive care preferences of organ transplant recipients and their carers who live in regional Australia

BACKGROUND

There is no evidence that being a rural or regional organ transplant recipient has adverse physical health outcomes post-surgery compared with those experienced by people living in cities, but the impact of living remotely from transplant centres on psychosocial outcomes has not been explored.

OBJECTIVE

To identify the social, emotional, psychological, spiritual, informational and practical issues associated with being a regionally based organ transplant recipient or carer and determine how support services could be improved for this group.

DESIGN/ SETTING/ PARTICIPANTS

Twenty-two purposively sampled adult Australians who lived outside metropolitan centres and had received an organ transplant (n = 15) or were the primary carer of someone who had received one (n = 7), participated in semi-structured, telephone interviews. Qualitative data were collected until data saturation was reached and were analysed using thematic analysis.

RESULTS

Five key themes (plus subthemes) were identified: (a) travelling for specialist transplant care takes a toll, (b) unique transplant-related psychological and emotional issues experienced before and after transplants, (c) caring for transplant recipients is a demanding role, (d) lay, peer and professional support, including rural general practitioners and accommodation facilities, help ease the burden, but (e) significant barriers to accessing transplant-focused psychosocial support exist.

CONCLUSION

Novel methods of delivering targeted, transplant-specific information and psychosocial care to rural transplant recipients and their carers, employers and rural health professionals require development and evaluation. Strategies might be delivered by peers or professionals via telehealth, telephone, social media or websites for example, depending on preferences and level of need.

Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population?

OBJECTIVE

Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material.

METHODS

Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured.

RESULTS

Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%).

CONCLUSIONS

Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.

E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey

Background

Chronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia.

Methods

Institutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05.

Result

In total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level.

Conclusion

Besides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.

Rural cancer survivors' health information needs post-treatment

OBJECTIVE

This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs.

METHODS

Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics.

RESULTS

Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs.

CONCLUSIONS

Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support.

PRACTICE IMPLICATIONS

The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.

Organizing Online Health Content: Developing Hashtag Collections for Healthier Internet-Based People and Communities

Twitter use has increased among patients with cancer, advocates, and oncology professionals. Hashtags, a form of metadata, can be used to share content, organize health information, and create virtual communities of interest. Cancer-specific hashtags modeled on a breast cancer community, #bcsm, led to the development of a structured set of hashtags called the cancer tag ontology. In this article, we review how these hashtags have worked with the aim of describing our experience from 2011 to 2017. We discuss useful guidelines for the development and maintenance of health-oriented communities on Twitter, including possible challenges to community sustainability and opportunities for future improvement and research.

What quality factors matter in enhancing the perceived benefits of online health information sites? Application of the updated DeLone and McLean Information Systems Success Model

BACKGROUND

Despite a growing need for designing and monitoring health information sites through comprehensive examination of the various elements of website quality, there is little research that systematically models and presents such examinations.

OBJECTIVES

Applying the updated DeLone and McLean Model of Information Systems Success, this research aimed to examine how health information sites' information quality, system quality, and service quality lead to user satisfaction and perceived benefits.

METHODS

This research was conducted in a specific context of the National Health Information Portal (NHIP), a governmental health information site in South Korea. We conducted online survey in 2017, with 506 adults from the NHIP consumer panel. Data were analyzed using a confirmatory factor analysis, hierarchical ordinary least squares regression, and bootstrapping approach for a mediation test.

RESULTS

Of the three quality factors, information quality had significant associations with all outcome variables: user satisfaction, intention to reuse the site, and perceived benefits of site use in health settings. There were also indirect paths from information quality to perceived benefits, one mediated through intention and the other mediated through satisfaction and then intention. Service quality had a significant association with user satisfaction, and its impact on perceived benefits occurred indirectly through user satisfaction and intention in serial. By contrast, the role of system quality received no empirical support.

IMPLICATIONS

The results offer theoretical and practical implications for how to enhance the effectiveness of online health information sites.

Participatory Methods to Engage Health Service Users in the Development of Electronic Health Resources: Systematic Review

Background

When health service providers (HSP) plan to develop electronic health (eHealth) resources for health service users (HSU), the latter’s involvement is essential. Typically, however, HSP, HSU, and technology developers engaged to produce the resources lack expertise in participatory design methodologies suited to the eHealth context. Furthermore, it can be difficult to identify an established method to use, or determine how to work stepwise through any particular process.

Objective

We sought to summarize the evidence about participatory methods and frameworks used to engage HSU in the development of eHealth resources from the beginning of the design process.

Methods

We searched for studies reporting participatory processes in initial development of eHealth resources from 2006 to 2016 in 9 bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Emcare, Cochrane Library, Web of Science, ACM Guide to Computing Literature, and IEEE Xplore. From 15,117 records initially screened on title and abstract for relevance to eHealth and early participatory design, 603 studies were assessed for eligibility on full text. The remaining 90 studies were rated by 2 reviewers using the Mixed Methods Appraisal Tool Version 2011 (Pluye et al; MMAT) and analyzed with respect to health area, purpose, technology type, and country of study. The 30 studies scoring 90% or higher on MMAT were included in a detailed qualitative synthesis.

Results

Of the 90 MMAT-rated studies, the highest reported (1) health areas were cancer and mental disorders, (2) eHealth technologies were websites and mobile apps, (3) targeted populations were youth and women, and (4) countries of study were the United States, the United Kingdom, and the Netherlands. Of the top 30 studies the highest reported participatory frameworks were User-Centered Design, Participatory Action Research Framework, and the Center for eHealth Research and Disease Management (CeHRes) Roadmap, and the highest reported model underpinning development and engagement was Social Cognitive Theory. Of the 30 studies, 4 reported on all the 5 stages of the CeHRes Roadmap.

Conclusions

The top 30 studies yielded 24 participatory frameworks. Many studies referred to using participatory design methods without reference to a framework. The application of a structured framework such as the CeHRes Roadmap and a model such as Social Cognitive Theory creates a foundation for a well-designed eHealth initiative that ensures clarity and enables replication across participatory design projects. The framework and model need to be clearly articulated and address issues that include resource availability, responsiveness to change, and the criteria for good practice. This review creates an information resource for future eHealth developers, to guide the design of their eHealth resource with a framework that can support further evaluation and development.

Trial Registration

PROSPERO CRD42017053838; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53838

If You Build It, Who Will Come? A Description of User Characteristics and Experiences With the McMaster Optimal Aging Portal

Objectives: The McMaster Optimal Aging Portal (the Portal) aims to increase access to evidence-based health information. We would now like to understand who uses the Portal, why, and for what, and elicit feedback and suggestions for future initiatives. Methods: An online survey of users collected data on demographics, eHealth literacy, Internet use, information-seeking behavior, site acceptability and perceived impact on health behaviors, participant satisfaction, and suggestions for improvements using mixed methods. Results: Participants (n = 163, age 69.8 ± 8.6 years) were predominantly female (76%), married (67%), retired (80%), and well-educated with very good/excellent health (55%). The Portal was easy to use (83%) and relevant (80%), with 68% intending to, and 48% having changed behavior after using the Portal. A number of suggestions for improvement were obtained. Discussion: A better understanding of users' characteristics, needs, and preferences will allow us to improve content, target groups who are not engaging with the Portal, and plan future directions.

An evaluation of social work services in a cancer accommodation facility for rural South Australians

PURPOSE

The purpose of this investigation was to evaluate the social work service at an accommodation facility for people receiving cancer treatment away from home with a focus on distress, impact of support, and type of assistance received from the social work service.

METHOD

Guests who stayed at the Cancer Council Lodge during June 2015 were mailed a questionnaire collecting information about level of distress upon arrival and departure, impact of support in several areas, and what the service assisted them with specifically.

RESULTS

The sample comprised 149 guests. Social work contact (n = 19) was associated with greater reduction in distress between arrival and departure compared with no contact (n = 56). Contact with a social worker was associated with greater odds of agreeing or strongly agreeing that guests felt supported in 6 out of 10 areas assessed. These areas were managing the challenges related to cancer, approaching support services, asking questions of healthcare teams, accessing support services, coping with strong emotions, and understanding reactions of family and friends. The most common types of support received were emotional and informational support.

CONCLUSIONS

This study describes some of benefits of providing social work services to people receiving cancer treatment away from home and has implications for provision of social work service resources in similar settings. Further research could investigate the impact of this service in similar settings using randomised controlled trials to better account for potential biases. Research in this area has potential to inform program development and policy.

Cancer control-A global perspective

Disparities in cancer control exist in low- and middle-income countries (LMICs). Many countries do not have cancer registries to record incidence, mortality and prevalence and are reliant on Globocan estimates of their cancer burden. Poorer cancer control within and between countries occurs in those living remotely from urban centres, those in a low socioeconomic group and some ethnic groups who have lifestyle and belief systems which impact on cancer control. High-income countries generally have population screening programmes for cervix, breast and bowel cancer. However, simpler forms of screening for cancer of the cervix like visual inspection with acetic acid have been shown to be feasible in developing nations. The widespread use of vaccines to prevent cancer has been achieved with the Hepatitis B vaccine but the human papilloma virus vaccine to prevent cancer of the cervix is largely only available in high-income countries. Access to and training of oncological surgeons in LMICs is limited, while 70% of patients in these countries cannot access radiotherapy. The World Health Organization has developed a list of essential medicines although access remains poor in LMICs. The United Nations has set targets for the control of non-communicable diseases to improve global cancer control.