Trust in Mass Media as Sources of Cancer Information: Findings from a Nationally Representative Cross-Sectional Survey in Japan

Trust is a major factor in effective public dissemination and use of relevant health information to guide important health decisions. To examine mass media as a communication channel for delivering cancer information among Japanese adults, we identified the level of trust in various types of mass media as sources of cancer information, and examined factors associated with trust, including exposure to mass media, sociodemographic factors, and cancer history. Data were analyzed for 3,109 Japanese adults who responded to a nationally representative cross-sectional mail survey. Data included trust in cancer information sources, sociodemographic variables, cancer history, and exposure to mass media. Logistic regression analysis was used. The prevalence of high trust in cancer information sources was highest for physicians (94.7%). Among mass media, Internet (47.2%) was the most trusted source of cancer-related information, followed by television (44.3%), newspapers/magazines (42.7%), and radio (32.7%). The high-exposure group for newspapers (AOR = 1.28, 95%CI = 1.07-1.54) was more likely to trust newspapers. Similarly, high-exposure groups for radio (1.22, 1.02-1.45), Internet (1.21, 1.01-1.45), and television (1.30, 1.10-1.53) were positively associated with trust in each media type. Although trust in mass media was lower than trust in physicians, the study found that a large group of respondents had high levels of trust in mass media sources. Trust in cancer information from each mass media type was mainly related to the level of exposure to each mass media type. Developing health communication strategies using mass media may be effective for disseminating relevant cancer information in Japan.

Chinese Americans' Information Sources on, Preferred Types of, and Satisfaction with COVID-19 Vaccination

According to the Centers for Disease Control and Prevention (CDC), about 87% of Asian Americans had received at least one dose of the COVID-19 vaccine as of July 2023. The purpose of this study is to identify the sources of information, preferred vaccine types, and levels of satisfaction related to COVID-19 vaccination among Chinese Americans, the largest subgroup of Asian immigrants living in the U.S. Our survey data were collected from 241 Chinese American early adopters of the COVID-19 vaccine, who completed at least one dose of the COVID-19 vaccine in June 2021. Our results indicated that their major information sources regarding COVID-19 vaccination included health officials and authorities, local news, family/friends/co-workers, social media platforms, and healthcare professionals. More than half of the participants expressed a preference for the Pfizer-BioNTech (New York, U.S.) vaccine based on the primary considerations of safety, efficacy, credibility of the developer, and availability. A majority of the participants felt satisfied with their experience of receiving the COVID-19 vaccination. Participants with higher levels of self-efficacy and subjective norms related to receiving the COVID-19 vaccine were more likely to express satisfaction with the vaccination. These findings provide valuable insights into Chinese Americans' information sources, vaccine preferences, and satisfaction levels regarding COVID-19 vaccination. This knowledge can help guide future vaccination interventions and campaigns.

Exploring communication apprehension in nursing and healthcare education: A scoping review

Communication among healthcare professionals is critical to optimizing patient outcomes, and communication education is incorporated into the educational programs of healthcare professions students. Communication can be a source of stress for new healthcare professionals, however, there is a lack of research on communication apprehension (CA) in healthcare students, especially in nursing education. This scoping review sought to explore CA and factors associated with CA among healthcare professions students. This scoping review report was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (Tricco et al., Annals of Internal Medicine, 2018, 169, 467-473). Twenty studies of healthcare professions students were included for analysis. The percentage of health professions students with high CA ranged from 0.7% to 27%. Five out of seven intervention studies demonstrated a significant decrease in CA after the intervention. This review identified inconsistent associations between CA and various individual and educational factors. More research is needed utilizing rigorous research designs, designs employing qualitative methodology, and studies to investigate the impact of language on CA in health professions students who speak English as a second language.

Identifying Mental Health Literacy as a Key Predictor of COVID-19 Vaccination Acceptance among American Indian/Alaska Native/Native American People

BACKGROUND

This study examines how health literacy and mental health literacy associate with the willingness to receive a COVID-19 vaccination among American Indian/Alaska Native/Native American (AI/AN) people.

METHODS

The data were collected with an online Qualtrics survey in February 2021 (n = 563). A purposive snowball sampling strategy was used by sending recruitment flyers to colleagues and organizations who work with AI/AN communities to share with appropriate potential respondents. We performed linear regression analyses examining the relationships between the willingness to receive a COVID-19 vaccination and socio-demographic characteristics such as age, gender, education, health literacy, mental health literacy, self-rated physical and mental health status, worry about getting COVID-19, perceived COVID-19 susceptibility, and perceived COVID-19 severity.

RESULTS

Mental health literacy and health literacy predicted 30.90% and 4.65% of the variance (R2adjusted) in the willingness to receive a COVID-19 vaccine, respectively. After holding the self-rated physical/mental health status, worry about getting COVID-19, perceived susceptibility, perceived severity, health literacy, and socio-demographics constant, mental health literacy was still a strong predictor (b = 0.03, p < 0.001) for the willingness to receive a COVID-19 vaccine (model R2adjusted = 40.14%).

CONCLUSIONS

We identified mental health literacy as a substantial factor associated with the willingness to receive a COVID-19 vaccination among AI/AN respondents.

Age, gender and socioeconomic disparities in human papillomavirus (HPV) awareness and knowledge among Japanese adults after a 7-year suspension of proactive recommendation for the HPV vaccine: A nationally representative cross-sectional survey

The Japanese government's 2013 suspension of its proactive recommendation for Human papillomavirus (HPV) vaccination resulted in low HPV vaccination coverage and was unique. However, data on awareness and knowledge of HPV vaccines in the general population was limited. Here, to investigate more recent awareness and knowledge of HPV vaccines by age, gender, and socioeconomic status, we used data from the INFORM Study 2020, a nationally representative cross-sectional survey of self-administered questionnaires with 1,998 Japanese individuals aged 20 to 59 years. We found that 47.5% of females and 21.0% of males had heard of HPV, and 33.6% of females and 16.8% of males had knowledge of HPV vaccine efficacy. After adjusting for potential confounders, females aged 50-54 years were more likely to be aware of HPV than females aged 20-24 (AOR, 2.02, 95%CI: 1.12-3.65). Females (AOR, 2.13, 95%CI: 1.48-3.07) and males (AOR, 1.64, 95%CI: 1.03-2.59) with higher education had more awareness than those with less education. Females with higher education had more knowledge about HPV vaccine efficacy than those with less education (AOR, 1.70; 95%CI: 1.16-2.50). We found a generally low level of awareness and knowledge about HPV vaccines in Japan, which might be attributable to the suspension of proactive recommendations. Additionally, we identified disparities in awareness and knowledge by age, gender, socioeconomic status, and health literacy. Enhancing HPV awareness and understanding of HPV vaccines and implementing targeted efforts for specific subpopulations within Japan after the resumption of proactive recommendation for HPV vaccines, are imperative.

An Association between the Mosquito Nets and the Wealth Status: Public Health Promotion Planning and Intervention

The Government of Nepal (GoN) has approved the Malaria Strategic Plan with the aim of 'Malaria free Nepal by 2025'. This study aimed to determine the factors associated with the mosquito bed nets and its determinants of the ownership with reference to the households' wealth status in Nepal. The study used the secondary data from the Nepal Demographic and Health Survey 2016. The households' characteristics were considered independent variables and ownership of the mosquito nets as the dependent variable. We used IBM SPSS Statistics 22 to analyse the data. The data showed that three fourths of the total households had such nets, where 80 percent were urban households as compared to 68 percent rural households, 95 percent from the Terai region of Nepal as compared to 34 percent from the mountain region, 91 percent were of middle income, as compared to 39 percent the poorest wealth status of households, 84 percent of households that had TV as compared to 66 percent of the households with no TV used the nets. The poorest households were 52 percent less likely to own the nets as compared to the richest households (a OR = 0.48, 95% CI: 0.39-0.60, p<0.001). The wealth status of households, residence setting in terms of urban or rural area, and eco-belt migration history of the households, and households having radio and TV were significant predictors for the nets ownership. Special attention was paid by the government and policymakers to the poorest families, rural households, households in the mountain region of Nepal, and households having no radio and TV to meet the national target of the government plan with the use of public health promotion planning and intervention.

Trust in and Use of COVID-19 Information Sources Differs by Health Literacy among College Students

People’s health information-seeking behaviors differ by their health literacy levels. This study assessed the relationship between health literacy and college students’ levels of trust in and use of a range of health information sources of COVID-19. We collected data from August to December 2020 among college students (n = 763) through an online survey. We used a health literacy measure containing three self-reported survey questions, developed by the CDC. We assessed the extent to which participants trusted and used any of the sixteen different sources of information about COVID-19. Respondents reported high levels of trusting and using COVID-19 information from the CDC, health care providers, the WHO, state/county/city health departments, and official government websites when compared to other sources. After controlling for demographic characteristics (i.e., gender, age, race, ethnicity, and income), those who reported having lower health literacy were significantly less likely to trust and use COVID-19 information from these health authorities when compared to participants who reported having higher health literacy. Students with lower self-reported health literacy indicated not trusting or using official health authority sources for COVID-19 information. Relying on low-quality information sources could create and reinforce people’s misperceptions regarding the virus, leading to low compliance with COVID-19-related public health measures and poor health outcomes.

Exploring Factors Associated with Chinese-Americans' Willingness to Receive an Additional Hypothetical Annual Dose of the COVID-19 Vaccine

Chinese-Americans are one of the largest groups of Asian-Americans in the US with distinctive behavioral and cultural characteristics that influence health service use. Although Chinese-Americans have significantly higher COVID-19-related mortality rates, relative to other racial and ethnic groups, limited literature is available examining their willingness to accept the COVID-19 vaccine. With recent development of the combination influenza-COVID-19 vaccine by biotechnology companies to mitigate COVID-19 infection, we examined factors associated with Chinese-Americans' acceptance of hypothetical annual doses of COVID-19 vaccination before the vaccine rollout. A total of 241 Chinese-Americans who received at least one dose of the COVID-19 vaccine completed an online questionnaire developed and based on health behavior theories. Our results indicated that Chinese-American participants who were satisfied with their prior COVID-19 vaccination experience, who had more accurate knowledge and perceived higher susceptibility of getting COVID-19, were more willing to receive the annual COVID-19 vaccine in the future. The findings of our current study may be used to guide the development of strategic messages to promote uptake of the annual COVID-19 vaccine by Chinese-Americans in the U.S.

Trends and differences in perceptions of patient-centered communication among adults in the US

OBJECTIVE

Patient-centered communication (PCC) is a key indicator of healthcare quality and is critical to patient-centered care. The purpose of this study is to examine the trends in PCC over the past decade and determine if differences in PCC by subpopulation remain METHODS: We used nationally representative survey data from the Health Information National Trends Study (HINTS) to examine PCC. We conducted trend and multivariate regression analyses to understand the changes of PCC scores and differences in PCC by key sociodemographic groups.

RESULTS

PCC reported among adults minimally increased with the largest increases in participants involved in making decisions regarding their healthcare. Participants who were non-Hispanic Black, older, had less than a high school education, or rural residents reported more positive perceptions of PCC CONCLUSION: Our findings indicate improvements to PCC over time. These findings also indicate that differences in patients' perceptions of PCC continue to persist and it's possible that personal expectations may influence a person's perception of the quality of PCC experienced PRACTICE IMPLICATIONS: This study highlights the continued need for provider education in patient emotional support and providing patients with the skills and resources to engage in high quality PCC.

School Health Service Provider Perceptions on Facilitated Interactive Role-Play Around HPV Vaccine Recommendation

The purpose of this study was to evaluate a facilitated interactive role-playing activity on increasing human papillomavirus (HPV) vaccine recommendation skills for school nurses and school-based health center staff. A 1-day workshop was implemented for school-based clinicians focused on improving HPV vaccination rates in schools. The workshop included a facilitated interactive role-playing activity involving five scenarios related to recommending the HPV vaccine to parents. Participants completed a usability survey with open-ended questions assessing their experience. A general inductive approach was used to examine responses. Sixteen participants completed the usability survey. The major strength identified specific to the activity included opportunity to practice evidence-based recommendation skills (n = 10). Weaknesses of the activity identified included lack of diversity (n = 4) and complexity within the scenarios (n = 2). Results could shift current educational and clinical paradigms through the implementation of hands-on education strategies to effectively train school-based clinicians to strongly recommend the HPV vaccine.

Expanding the Health Information National Trends Survey Research Program Internationally to Examine Global Health Communication Trends: Comparing Health Information Seeking Behaviors in the U.S. and Germany

The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds.

Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal

This study was conducted from a behaviour change perspective to assess the association between the constructs of Health Belief Model and enrolment in health insurance (HI). A cross-sectional study was conducted among 810 households in Kailali and Baglung districts. The study used personal interviews to collect data. Perceived susceptibility, severity of diseases, benefits of enrolment, causes of non-enrolment, interaction with peers/neighbours, and family member's approval to enrol were independent variables and enrolment in HI served as dependent variable. More than half (52%) of the respondents evaluated themselves as not susceptible to health problems. The severity of the health problem was perceived as an economic burden. General treatment and reduction of financial load were perceived as the main benefits of enrolment. Economic status was described as the main barrier to enrol. A vast majority of the respondents had been invited to enrol, and 73% agreed to enrol. Perceived susceptibility and severity of health problems were significantly associated with HI enrolment but were not significant predictors. However, peers' requests to register in HI, discussion with relatives, and family members' approval to enrol were the most significant predictors enrolment. These factors could be incorporated into future intervention plans for increasing enrolment in HI.

Double burden of COVID-19 knowledge deficit: low health literacy and high information avoidance

OBJECTIVE

People with lower levels of health literacy are likely to report engaging in information avoidance. However, health information avoidance has been overlooked in previous research on responses to viral outbreaks. The purpose of this cross-sectional survey study was to assess the relationship between health literacy and COVID-19 information avoidance. Students (n = 561) at a university in the south central region of the U.S. completed our online survey conducted from April to June 2020 using simple random sampling. We measured information avoidance and the degree to which people opt not to learn about COVID-19 when given the choice. We assessed participants' health literacy level using the Newest Vital Sign (NVS), eHealth Literacy Scale (eHEALS), and All Aspect of Health Literacy Scale (AAHLS).

RESULTS

Those with lower health literacy were more likely to avoid information about COVID-19. This negative association between health literacy and information avoidance was consistent across all types of health literacy measures: NVS scores (b = - 0.47, p = 0.033), eHEALS scores (b = - 0.12, p = 0.003), functional health literacy (b = - 0.66, p = 0.001), communicative health literacy (b = - 0.94, p < 0.001), information appraisal (b = - 0.36, p = 0.004), and empowerment (b = - 0.62, p = 0.027). The double burden of low health literacy and high information avoidance is likely to lead to a lack of knowledge about COVID-19.

Evaluation of HPV Vaccine: Same Way, Same DayTM: A Pilot Study

Missed clinical opportunities and the lack of strong and consistent vaccine recommendations are key reasons for low HPV vaccination rates. The purpose of this study was to conduct a pilot evaluation of a web-based training's impact on knowledge, attitudes, and self-efficacy related to providing evidence-based HPV vaccine recommendations. Participants completed three online interactive learning modules and the HPV Vaccine: Same Way, Same Day™ smartphone application (app). Participants completed a pre-training survey, immediate post-training survey, and two-month post-survey. Participants demonstrated a statistically significant increase in knowledge scores from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for female patients increased from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for male patients increased from T1 to T2 and T1 to T3. Mean self-efficacy scores increased from T1 to T2 and T1 to T3. The HPV Vaccine: Same Way, Same Day™ app is a promising strategy for improving HPV vaccine recommendations among physicians. Future research should explore long-term effects and enroll attending and community physicians to examine its efficacy in other physician populations.

Does exposure of mass media associate with utilisation of ANC services? A trend analysis from Nepal demographic and health surveys

The study analysed antenatal care (ANC) services usage trends related to exposure to mass media based upon data from three Nepal Demographic and Health Surveys [NDHS] conducted in 2006, 2011, and 2016. Total 12,212 women aged 15-49 having live births within five years preceding each survey included in the study. Most independent variables were found to be associated with utilisation of ANC services. For example, exposure to TV illustrated an increasing services trend. Seventy-three percent of the women had exposure to Radio followed by TV (65%), and newspaper (25%). All three media were significantly associated with ANC services in all surveys (p < 0.05). High exposure to Newspapers were (2.5 times, 95%CI: 1.93-3.19), Radio (1.3 times, 95%CI: 1.13-1.46), and TV (1.6 times, 95%CI: 1.36-1.76) more likely to result in adequate (≥4) ANC visits. Age and age at marriage; caste and educational status of women; place of residence; wealth status; and women's decision-making autonomy were significant predictors for adequate ANC visits. ANC services utilisation trends increased gradually, but not satisfactory. Most socio-demographic variables were also significant predictors for utilizing ANC services. All these predictors should be used to guide ANC services promotion policies and interventions.

An Analysis of Government Communication in the United States During the COVID-19 Pandemic: Recommendations for Effective Government Health Risk Communication

Governments throughout the world can learn many critical lessons from examining instances of ineffective communication with the public during the global coronavirus disease (COVID‐19) pandemic. Ineffective government communication has resulted in a great deal of public confusion and misunderstanding, as well as serious errors in responding to this evolving health threat, leading to disastrous health and social outcomes for the public and prolonging the pandemic, especially within the United States. This article uses systems theory as a template for analyzing government communication in the United States during the COVID‐19 pandemic, providing governments with recommendations for establishing effective health risk communication strategies for use with the public. The communication strategies offered here promote the delivery of relevant, accurate, and sensitive information to key public groups, minimizing communication noise to guide desirable coordinated actions. These communication strategies can be applied locally, nationally, and internationally.

Promoting Convergence Between Health Literacy and Health Communication

Health communication and health literacy are complementary areas of study and application. However, the important connections between the work conducted in these two related areas of inquiry do not appear to have always been well understood, nor appreciated, leading to limited integration and coordination between health communication and health literacy inquiry. Part of the problem may be that these two related areas developed from different professional trajectories, with health communication developing primarily from a social science orientation, and health literacy emerging primarily from a health professional application perspective. While health literacy grew out of the professional disciplines of medicine and education, health communication was undergirded by communication and social science research. Due to these different initial starting points, a lack of understanding has grown between these two areas of inquiry, resulting in a lack of appreciation for how well these fields fit together and how they can be mutually supportive in both research and applications. While there are many scholars who study both health communication and health literacy, some researchers are not well-versed in both areas, and do not understand how they can contribute to one another. In this chapter, the authors examine the parallel development of these two interdependent areas of study, trace their inter-connections, and propose strategies to enhance collaboration and integration within health literacy as well as health communication research and applications.

Educational Status of Female Youth in Nepal: A Foundation for Health and Well-being. Where Should Programmes Focus?

Youth are important change agents for social, political and economic issues. However, research evidence suggests that many youth, especially females, face many challenges in Nepal in reaching their social potential due to serious problems with educational access and attainment. This study examines the influence of educational attainment on achieving the social potential of Nepalese female youth through a secondary analysis of data from the Nepal Demographic and Health Survey 2016. Results from this analysis show that one out of 10 female youth are illiterate and do not receive a formal education. Socio-demographic variables, such as marital status, caste, place of residence and wealth status were found to be major predictors for literacy status and educational attainment of female youth in Nepal. The findings from this study suggest that special attention should be paid to these critical variables for guiding educational and interventional planning by concerned authorities including stakeholders for improving the social potential, as well as the health and well-being of female youth in Nepal.

A COMPREHENSIVE DIGITAL SELF-CARE SUPPORT SYSTEM FOR OLDER ADULTS: A MULTIDISCIPLINARY FRAMEWORK

This paper presents an innovative conceptual framework for designing a Comprehensive Digital Self-care Support System (CDSSS) to meet the health needs -physical, mental and social health needs of older adults and their caregivers. Older adults deal with multiple co-morbidities, medications and their side effects, fragmented care and often have poor understanding of their own health and treatments. These challenges call for solutions that lead to better empowerment and pro-active engagement and for support systems that focus on wellness and preventive care. The conceptual model we offer draws on diverse disciplines including health care management and medicine, information systems, communication, consumer behavior, and sociology to identify a set of key design principles for CDSSS. A review and analysis of the literature in the different fields led to the identification of 6 CDSSS design principles: (1) Systems approach; (2) User experience; (3) Ecosystem perspective for shared resources 4) Social and contextual learning; (5) Accessible design; (6) Designing for trust and empathy. The model clarifies how these design principles (or approaches) inform the development of the three main components of a CDSSS (data integration, communication, and resource integration) and enable the key CDSSS deliverables (learning, social & emotional support and care integration). The conceptual model also helps to lay out an agenda for future research on self-care support systems for older adults.

A content analysis of HPV vaccine online continuing medical education purpose statements and learning objectives

Numerous online HPV vaccine education interventions for clinicians have been created to improve HPV vaccinations rates. The aims for this study were to (1) assess the content of the purpose statements and learning objectives of online HPV vaccine continuing medical education (CME) activities developed for clinicians and (2) identify themes and gaps in the purpose statements and learning objectives. A content analysis was conducted of the purpose statements and learning objectives for each HPV vaccine online CME activity. Open coding identified the following purpose statements topics: 1) delivering recommendations, 2) HPV epidemiology, 3) HPV vaccine, 4) guidelines, and 5) medical news. The following topics for learning objectives were identified: 1) delivering recommendations, 2) strategies, 3) HPV epidemiology, 4) HPV vaccine, 5) guidelines, 6) prevention services, 7) HPV vaccination advocacy, and 8) disparities. Phrases about guidelines for vaccine administration and vaccine recommendation guidelines were the most common for purpose statements and learning objectives, respectively. One learning objective focused on behavior/skill change, which is concerning considering clinicians do not feel well prepared to provide strong vaccine recommendations. Clear and intentional purpose statements and learning objectives must be used to guide the development of effective CME activities.

Promoting patient comprehension of relevant health information

Patient understanding of health care recommendations provided by health care professionals is essential to enabling active and informed patient participation in care. Unfortunately, evidence suggests that patients often seriously misunderstand relevant health information provided to them, leading to errant patient decisions about their care. This commentary examines key communication factors that influence patient understanding and argues for a comprehensive approach to assessing and promoting patient comprehension.

A content analysis of depression-related discourses on Sina Weibo: attribution, efficacy, and information sources

BACKGROUND

Depression is a mood disorder that may lead to severe outcomes including mental breakdown, self-injury, and suicide. Potential causes of depression include genetic, sociocultural, and individual-level factors. However, public understandings of depression guided by a complex interplay of media and other societal discourses might not be congruent with the scientific knowledge. Misunderstandings of depression can lead to under-treatment and stigmatization of depression. Against this backdrop, this study aims to achieve a holistic understanding of the patterns and dynamics in discourses about depression from various information sources in China by looking at related posts on social media.

METHOD

A content analysis was conducted with 902 posts about depression randomly selected within a three-year period (2014 to 2016) on the mainstream social media platform in China, Sina Weibo. Posts were analyzed with a focus on attributions of and solutions to depression, attitudes towards depression, and efficacy indicated by the posts across various information sources.

RESULTS

Results suggested that depression was most often attributed to individual-level factors. Across all the sources, individual-level attributions were often adopted by state-owned media whereas health and academic experts and organizations most often mentioned biological causes of depression. Citizen journalists and unofficial social groups tended to make societal-level attributions. Overall, traditional media posts suggested the lowest efficacy in coping with depression and the most severe negative outcomes as compared with other sources.

CONCLUSIONS

The dominance of individual-level attributions and solutions regarding depression on Chinese social media on one hand manifests the public's limited understanding of depression and on the other hand, may further constrain adoption of scientific explanations about depression and exacerbate stigmatization towards depressed individuals. Mass media's posts centered on description of severe outcomes of depression without suggestions of solutions' effectiveness, which may induce more anxiety among depressed individuals. Campaigns promoting comprehensive understandings about depression and popular works translating scientific findings on depression to the public are called for.

Perceptions About Disseminating Health Information Among Mommy Bloggers: Quantitative Study

Background

Social media are potentially powerful channels for communicating relevant health information in culturally sensitive and influential ways to key audiences. Moreover, these channels hold promise for promoting awareness and knowledge of health risks, prevention, and treatment by utilizing opinion leaders for message dissemination. Despite limited empirical evidence to-date, early promising results suggest that blogs are a form of social media that should be examined as worthy channels for health communication.

Objectives

This formative study explored mommy bloggers’ perceptions about sharing health-related information on their blogs with their readers. It also sought to analyze which topics would be of most interest to mommy bloggers, what motivates them to write about health issues, and how they perceive interest in these topics among their readers.

Methods

This study employed survey methodology, including the use of open-ended questions, the responses to which were coded for analysis. Specifically, a 14-item survey was fielded with mommy bloggers between October 1 and October 28, 2016. Bloggers were recruited through The Motherhood network. A total of 461 mommy bloggers responded to the survey; 163 were removed for low quality responses and incomplete data. As a result, 298 eligible participants completed the survey. For open-ended questions in the survey, a sample of responses were coded and analyzed.

Results

The majority of the respondents (87.2%, 260/298) reported that they have written about health issues in the past; 97.3% (290/298) of the respondents reported that they would consider writing about health issues sometime in the future, and 96.3% (287/298) of the respondents reported that their readers like to read about health issues on their blogs. In terms of content priorities for this sample of bloggers, Nutrition and Physical Activity dominate the current conversation and similarly, Physical Activity and Nutrition remain top content priorities for these bloggers for the future. Moreover, 21.3% of the respondents reported that their readers would be interested in these topics. Finally, having a personal connection with a health issue was found to be positively associated with likeliness to write about health issues on their blog (P<.001).

Conclusions

This study illustrates that there are potentially rich opportunities for working with mommy bloggers to communicate with key health decision makers (moms) on important health issues. There is a great support among mommy bloggers for health information dissemination as well as interest for accessing relevant health information from their readers. This presents an opportunity for public health research and communication campaigns to more broadly promote their messages, thereby contributing to their behavior change objectives. Limitations included overrepresentation of white, higher-educated, and younger women. It suggests a need for more targeted engagement of a diverse sample for future work.

Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment

BACKGROUND

Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination.

OBJECTIVE

The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions.

METHODS

Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions' content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models.

RESULTS

A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention.

CONCLUSIONS

This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians.

The Relevance of Health Literacy to mHealth

This chapter examines the importance of health literacy to the design and use of mobile digital health information technology (mHealth) applications. Over the past two decades mHealth has evolved to become a major health communication channel for delivering health care, promoting health, and tracking health behaviors. Yet, there are serious communication challenges that must be addressed concerning the best way to design and utilize mHealth application to achieve key health promotion goals, including assuring the appropriateness and effectiveness of mHealth messaging for audiences with different communication competencies, styles, and health literacy levels, to ensure that mHealth applications are truly effective tools for health promotion. Health literacy is one of the major communication issues relevant to the effective use of mHealth. To be effective, mHealth applications need to match the messages conveyed via these mobile media to the specific health communication needs, orientations, and competencies of intended audience members. Unfortunately, current evidence suggests that many mHealth applications are difficult for audiences to utilize because they provide health information that is not easy for many consumers to understand and apply. Health literacy refers to the ability of participants within the health care system to accurately interpret and utilize relevant health information and resources to achieve their health goals. Evidence suggests that many consumers possess limited levels of health literacy to adequately understand health information, especially when they are feeling ill, since health literacy is both a trait (limited education, language facility, etc.), and a state condition (based on how their current physical and mental states influence their abilities to communicate effectively). Therefore, it is incumbent upon mHealth developers to design and utilize message systems. Strategies for designing and implementing mHealth applications to meet the health literacy levels of different audiences are described in this chapter.

Measuring Health Literacy Levels of a Patient Portal Using the CDC's Clear Communication Index

Once promised to revolutionize health care, patient portals have yet to fully achieve their potential of improving communication between patients and clinicians. In fact, their use can be detrimental to many consumers due to their limited literacy and numeracy skills. This study demonstrates how applying the Centers for Disease Control and Prevention's Clear Communication Index to a patient portal can be used to identify opportunities for better patient communication and engagement. The Clear Communication Index contains 20 scored items grounded in communication science to enhance patients' understanding of health information. The Index was applied to one portal used by over 80,000 patients in 12 primary care practices: MyPreventiveCare. This portal was selected because of its ability to personalize preventive and chronic care information by internally using content featuring health literacy principles and linking patients' externally to trusted materials. Thirty-seven frequently visited portal pages (17 internal and 20 external) were evaluated based on the Index's four main variables. The overall score for the portal was 72%, which falls below the 90% threshold to be considered clear communication. Internal content scored higher than external (75% vs. 69%). Specific changes to improve the score include simpler language, more specific examples, and clearer numerical explanations.

Testing a Relational Model for Health Communication Competence among Caregivers for Individuals with Alzheimer's Disease

The Relational Model of Health Communication Competence suggests that health-care participants' level of communication competence is positively related to their achieving desired physiological and psychological health outcomes. This article provides a partial test of the model by examining the relationships between communication competence, social support and cognitive depression among lay caregivers of patients with Alzheimer's disease. The study provides validation for the model by demonstrating that the communication competence of the caregivers is positively related to important psychological health outcomes, such as high levels of social support, and decreases in cognitive depression. Implications of these findings and directions for future inquiry are examined.

Promoting a Consumer Orientation to Health Care and Health Promotion

There is a compelling need to establish a consumer orientation to health care to address the troubling imbalance of power between providers and consumers in the modem health-care system. This power imbalance has systematically disenfranchised and marginalized health-care consumers. Adoption of a consumer orientation that focuses institutional attention and resources specifically on fulfilling the physical and psychological needs of the consumer, equalizing influence and control between health-care providers and consumers, and empowering consumers to make informed decisions about their health care will help promote social justice within the modem health-care system. Strategies are suggested to help providers and consumers develop and promote a consumer orientation in modem health care.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications

BACKGROUND

Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G).

MATERIALS AND METHODS

In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework.

RESULTS

Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%).

CONCLUSIONS

Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology.

Applying Multiple Methods to Comprehensively Evaluate a Patient Portal's Effectiveness to Convey Information to Patients

BACKGROUND

Patient portals have yet to achieve their full potential for enhancing health communication and improving health outcomes. Although the Patient Protection and Affordable Care Act in the United States mandates the utilization of patient portals, and usage continues to rise, their impact has not been as profound as anticipated.

OBJECTIVE

The objective of our case study was to evaluate how well portals convey information to patients. To demonstrate how multiple methodologies could be used to evaluate and improve the design of patient-centered portals, we conducted an in-depth evaluation of an exemplar patient-centered portal designed to promote preventive care to consumers.

METHODS

We used 31 critical incident patient interviews, 2 clinician focus groups, and a thematic content analysis to understand patients' and clinicians' perspectives, as well as theoretical understandings of the portal's use.

RESULTS

We gathered over 140 critical incidents, 71.8% (102/142) negative and 28.2% (40/142) positive. Positive incident categories were (1) instant medical information access, (2) clear health information, and (3) patient vigilance. Negative incident categories were (1) standardized content, (2) desire for direct communication, (3) website functionality, and (4) difficulty interpreting laboratory data. Thematic analysis of the portal's immediacy resulted in high scores in the attributes enhances understanding (18/23, 78%), personalization (18/24, 75%), and motivates behavior (17/24, 71%), but low levels of interactivity (7/24, 29%) and engagement (2/24, 8%). Two overarching themes emerged to guide portal refinements: (1) communication can be improved with directness and interactivity and (2) perceived personalization must be greater to engage patients.

CONCLUSIONS

Results suggest that simple modifications, such as increased interactivity and personalized messages, can make portals customized, robust, easily accessible, and trusted information sources.

Age-Related Use and Perceptions of eHealth in Men With Prostate Cancer: A Web-Based Survey

Background

Men with prostate cancer require ample information and support along the continuum of care, and eHealth is one way to meet such critical information and support needs. Currently, evidence about how age influences use and perceptions about prostate cancer eHealth information and support is lacking.

Objective

The aim of this paper is to explore use and perceptions about eHealth among men living with prostate cancer. Specifically, we aimed to analyze men with prostate cancer by age-specific cohorts to identify potential age-related differences in use and perceptions about prostate cancer eHealth information.

Methods

We used survey methodology to examine how men under 65 years old with prostate cancer differ from those aged 65 years old or older in use and perceptions about prostate cancer eHealth information and support (n=289).

Results

We found that men in the younger cohort used the Internet more often to be informed about treatment options (P=.04) and to learn more about staging/grading (P=.01) than men in the older cohort. Results also showed comparatively greater use of online prostate cancer information for emotional support and encouragement by the younger as compared to the older cohort (P=.001). Furthermore, the older cohort reported more negative psychosocial effects of eHealth (eg, more anxious, depressed) than younger men (P=.002). We also found that as a result of more frequent Internet use, younger men experienced more positive psychosocial effects (eg, more informed, in control) from accessing information about prostate cancer through eHealth channels (b=-0.10, 95% CI -0.28 to 0).

Conclusions

Men with prostate cancer have different information and support needs; our findings suggest that these needs might vary by age. Future research is needed to unravel age-related factors underlying these differences to be better able to tailor prostate cancer eHealth information to men’s information and support needs.

Cancer Information Seeking Behaviors of Korean American Women: A Mixed-Methods Study Using Surveys and Focus Group Interviews

Despite the high risk of cancer to the population, Korean Americans are known to have lower knowledge about cancer related information and a lower level of adherence to cancer prevention guidelines. This indicates the necessity of cancer interventions targeting the Korean American population. To reach this population effectively, it is imperative to understand Korean Americans' cancer information seeking behaviors. This study (a) identified cancer information sources that are trusted and used by Korean American women and (b) examined how general media exposure and trust in cancer information sources are related to the use of these sources. It also (c) explored perceived usefulness and limitations of cancer information sources. A mixed methods study using seven focus group interviews with 34 Korean American women and surveys with 152 Korean American women was conducted in the Washington, DC, metropolitan area from 2011 to 2012. The results indicate that Korean American women viewed health care professionals as the most trusted cancer information source but used the Internet and Korean ethnic media more often for cancer information seeking because of language, cultural, and economic barriers. Korean American women were most likely to obtain cancer information from media they used frequently for general purposes. Correlations between usage frequency and trust in doctor/health providers and the Internet as cancer information sources were negligible. When seeking cancer information, important factors for Korean American women were accessibility, affordability, and language proficiency, cultural sensitivity, meeting immediate needs, understandability, convenience, and reliability of cancer information sources. Findings from this study support developing interventions using Korean language media, including print, television and the Internet for health promotion and cancer prevention targeting Korean American women.

Cancer information seekers in china: a preliminary profile

Cancer is now the leading cause of death in China. Effective communication about cancer risk and prevention is an important component of cancer control. Yet, research in this area is very limited in China. This study used probability sample survey data from 2 Chinese cities (Beijing and Hefei, Anhui Province) to investigate potential predictors of self-initiated cancer information seeking. Analysis showed that cancer information seekers in China were likely to be married, relatively educated, earning modest incomes, living in rural areas, smoking occasionally, having a family cancer history, relatively trusting of the media for health information, somewhat knowledgeable about cancer, having nonfatalistic attitudes about cancer, and seeing a personal need for more cancer information. The pattern of results, particularly the lack of influence of personal health and risk perception factors, highlights the possibility that seeking for others might be more prevalent than seeking for self in China. Overall, findings suggest that emphasizing family need and mobilizing family support might be a productive approach to cancer communication interventions in China.

The NLM evaluation lecture series: introduction to the special section on evaluating health communication programs

This article introduces the Journal of Health Communication's special section, Evaluating Health Communication Programs. This special section is based on a public lecture series supported by the National Library of Medicine titled "Better Health: Evaluating Health Communication Programs" designed to share best practices for using evaluation research to develop, implement, refine, and institutionalize the best health communication programs for promoting public health. This introduction provides an overview to the series, summarizes the major presentations in the series, and describe implications from the series for translational health communication research, interventions, and programs that can enhance health outcomes.

Epilogue: lessons learned about evaluating health communication programs

Systematic evaluation research is needed to develop, implement, refine, and sustain effective health communication programs. Yet, evaluation research is not always well integrated into health communication intervention activities or even budgeted as part of health promotion efforts. If included in health promotion programs, evaluation research is often conducted superficially, after the fact, and does not provide the strategic information needed to make sure that health communication programs achieve their important goals. To rectify this problem, it is important to reassert and institutionalize the value of evaluation research in health promotion efforts. It is important to mandate that all major health communication programs are guided by robust evaluation research data. It is also important to help health promotion experts to conduct rigorous and revealing evaluation research as well as help them use evaluation research data to guide the development, refinement, and implementation of health communication programs. This Epilogue to this special section on Evaluating Health Communication Programs presents specific propositions that charts the course for using evaluation research to promote public health and recommends next steps for achieving this goal.