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The Underlying Mechanisms of Active and Passive Cancer Information Behaviors: A Comparative Study Between Hong Kong and the United States
Health Communication
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Cancer is one of the most common causes of death in China and the United States. Past studies found that cancer risk perceptions, fatalistic beliefs, and worry were prominent predictors of health-related behaviors. Perceived cancer risks, fatalistic beliefs, and worry were associated with cancer information acquisition in the United States. However, little is known about whether these factors played comparable roles in China. This study investigates the psychological antecedents of cancer information acquisition using data from Health Information National Trends Surveys (HINTS) in both countries. Results showed that cancer worry was negatively related to cancer information avoidance in the U.S. but positively related to information avoidance in China. Also, whereas cancer fatalistic beliefs were negatively associated with cancer information seeking in the U.S., the relationships between fatalistic beliefs and cancer information seeking exhibited more complex patterns in China. Implications for cancer communication in different cultures are discussed.
Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.
Background
Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals’ mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients.
Objective
This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students.
Methods
Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university.
Results
The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information–seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM.
Conclusions
Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking.
Social media have recently gained attention as a potential health campaign tool. This study examines this line of expectation concerning the role social media may play in health campaigns by testing an integrated health campaign model that combines insights from research on social media-specific perceptions and communicative behaviors in order to predict health behaviors. Specifically, this study aims to (a) develop a more holistic social media campaign model for predicting health behaviors in the social media context, (b) investigate how social media channel-related perceptions affect preventive health behaviors, and (c) investigate how communicative behaviors mediate perceptions and behavioral intention. The study conducted an online survey of 498 females who followed the Purple Ribbon Twitter campaign (@pprb), a cervical cancer prevention campaign. The results indicated that information acquisition mediated perceived risk's effect on intention. Information acquisition also mediated the relationships between intention and information selection and information transmission. On the other hand, social media-related perceptions indirectly impacted behavioral intention through communicative behaviors. The findings' theoretical and practical implications are discussed.
Background
The Internet has increasingly become a popular source of health information by connecting individuals with health content, experts, and support. More and more, individuals turn to social media and Internet sites to share health information and experiences. Although online health information seeking occurs worldwide, limited empirical studies exist examining cross-cultural differences in perceptions about user-generated, experience-based information compared to expertise-based information sources.
Objective
To investigate if cultural variations exist in patterns of online health information seeking, specifically in perceptions of online health information sources. It was hypothesized that Koreans and Hongkongers, compared to Americans, would be more likely to trust and use experience-based knowledge shared in social Internet sites, such as social media and online support groups. Conversely, Americans, compared to Koreans and Hongkongers, would value expertise-based knowledge prepared and approved by doctors or professional health providers more.
Methods
Survey questionnaires were developed in English first and then translated into Korean and Chinese. The back-translation method ensured the standardization of questions. Surveys were administered using a standardized recruitment strategy and data collection methods.
Results
A total of 826 participants living in metropolitan areas from the United States (n=301), Korea (n=179), and Hong Kong (n=337) participated in the study. We found significant cultural differences in information processing preferences for online health information. A planned contrast test revealed that Koreans and Hongkongers showed more trust in experience-based health information sources (blogs: t 451.50=11.21, P<.001; online support group: t 455.71=9.30, P<.001; social networking sites [SNS]: t 466.75=11.36, P<.001) and also reported using blogs (t 515.31=6.67, P<.001) and SNS (t 529.22=4.51, P<.001) more frequently than Americans. Americans showed a stronger preference for using expertise-based information sources (eg, WebMD and CDC) compared to Koreans and Hongkongers (t 360.02=3.01, P=.003). Trust in expertise-based information sources was universal, demonstrating no cultural differences (Brown-Forsythe F 2,654=1.82, P=.16). Culture also contributed significantly to differences in searching information on behalf of family members (t 480.38=5.99, P<.001) as well as to the goals of information searching.
Conclusions
This research found significant cultural differences in information processing preferences for online health information. Further discussion is included regarding effective communication strategies in providing quality health information.
Cancer-related affect and cognition, such as cancer fear, cancer worry, and cancer risk perception, are important predictors of cancer prevention and communication behaviors. However, they have not been clearly conceptualized in cancer communication literature, and in particular, the role of affect (i.e., cancer fear) in cancer prevention and communication has not been fully investigated. The present study developed a 3-factor cancer-related mental condition model encompassing affective (cancer fear), cognitive (cancer risk perception), and affective-cognitive (cancer worry) conditions. Two studies were conducted. Study 1 developed the model with Sample 1 (U.S. undergraduates, N = 309), and subsequently validated the model with Sample 2 (Korean general population, ages 40 years or older, N = 1,130). Study 2, using Sample 2, tested the model's relationship with cancer information use, cancer information avoidance, and screening intention. While Sample 1 participants were asked about cancer in general, Sample 2 participants were asked specifically about stomach cancer. Thus, the model derived from the specific sample in a general context was confirmed via the general sample in a specific context. The results showed that both cancer worry and cancer risk perception are positively associated with cancer information use and screening intention, but they are negatively associated with cancer information avoidance. Cancer fear was positively associated with cancer information use, but it was also positively related to cancer information avoidance. Moreover, cancer fear was negatively associated with screening intention. Although the three components of the model are positively related to one another, they function differently in the cancer context.
This paper provides a history and overview of the field of human information behavior, including recent advances in the field and multidisciplinary perspectives.
The present study aimed to examine the public reaction to the death of Steve Jobs, focusing on general and cancer-specific information seeking and interpersonal communication. Shortly after Jobs's death, employees from a large university in the Southeastern United States (N = 1,398) completed a web-based survey. Every employee had heard about Steve Jobs's death, and 97% correctly identified pancreatic cancer as the cause of his death. General (50%) and pancreatic cancer-specific (7%) information seeking, as well as general (74%) and pancreatic cancer-specific (17%) interpersonal communication, took place in response to Steve Jobs's death. In multivariate logistic regression analyses controlling for demographics and several cancer-oriented variables, both identification with Steve Jobs and cancer worry in response to Steve Jobs's death significantly (p < .05) predicted pancreatic cancer information seeking as well as interpersonal communication about pancreatic cancer. Additional analyses revealed that cancer worry partially mediated the effects of identification on these outcome variables. Implications of these results for future research as well as cancer prevention and communication efforts are discussed.
This study tests an expanded Structural Influence Model (SIM) to gain a greater understanding of the social and cognitive factors that contribute to disparities in cancer risk knowledge and information seeking. At the core of this expansion is the planned risk information seeking model (PRISM). This study employed an online sample (N = 1,007) of African American, Hispanic, and non-Hispanic White adults. The addition of four cognitive predictors to the SIM substantially increased variance explained in cancer risk knowledge (R (2) = .29) and information seeking (R (2) = .56). Health literacy mediated the effects of social determinants (socioeconomic status [SES] and race/ethnicity) on cancer risk knowledge, while subjective norms mediated their effects on cancer risk information seeking. Social capital and perceived seeking control were also shown to be important mediators of the relationships between SES and cancer communication outcomes. Our results illustrate the social and cognitive mechanisms by which social determinants impact cancer communication outcomes, as well as several points of intervention to reduce communication disparities.
This study draws a nexus between heuristic-systematic information processing and the theory of planned behavior through a model of risk information seeking and processing. The model proposes that the form of information processing individuals apply to risk information from the media and other sources affects beliefs, evaluations, and attitudes considered important to making judgments about performing risk-reducing behaviors. This study found that deeper, more systematic processing of risk information is positively related to evaluation strength, attitude strength, and the number of strongly held behavioral beliefs actively considered by respondents when thinking about environmental hazards. The relationships were consistent, appearing across two communities and three risks (two health risks and one ecological risk), and held up under multiple statistical controls.
Factor analysis, path analysis, structural equation modeling, and related multivariate statistical methods are based on maximum likelihood or generalized least squares estimation developed for covariance structure models (CSMs). Large-sample theory provides a chi-square goodness-of-fit test for comparing a model (M) against a general alternative M based on correlated variables. It is suggested that this comparison is insufficient for M evaluation. A general null M based on modified independence among variables is proposed as an additional reference point for the statistical and scientific evaluation of CSMs. Use of the null M in the context of a procedure that sequentially evaluates the statistical necessity of various sets of parameters places statistical methods in covariance structure analysis into a more complete framework. The concepts of ideal Ms and pseudo chi-square tests are introduced, and their roles in hypothesis testing are developed. The importance of supplementing statistical evaluation with incremental fit indices associated with the comparison of hierarchical Ms is also emphasized. Normed and nonnormed fit indices are developed and illustrated. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In Exp I, 183 undergraduates read a persuasive message from a likable or unlikable communicator who presented 6 or 2 arguments on 1 of 2 topics. High involvement (HI) Ss anticipated discussing the message topic at a future experimental session, whereas low-involvement (LI) Ss anticipated discussing a different topic. For HI Ss, opinion change was significantly greater given 6 arguments but was unaffected by communicator likability. For LI Ss, opinion change was significantly greater given a likable communicator but was unaffected by the argument's manipulation. In Exp II with 80 similar Ss, HI Ss showed slightly greater opinion change when exposed to 5 arguments from an unlikable (vs 1 argument from a likable) communicator, whereas LI Ss exhibited significantly greater persuasion in response to 1 argument from a likable (vs 5 arguments from an unlikable) communicator. Findings support the idea that HI leads message recipients to employ a systematic information processing strategy in which message-based cognitions mediate persuasion, whereas LI leads recipients to use a heuristic processing strategy in which simple decision rules mediate persuasion. Support was also obtained for the hypothesis that content- vs source-mediated opinion change would result in greater persistence. (37 ref) (PsycINFO Database Record (c) 2004 APA, all rights reserved)
In this study, we apply the concept of "ambiguity," as developed in the decision theory literature, to an analysis of potential psychological consequences of uncertainty about cancer prevention recommendations. We used Health Information National Trends Survey (HINTS) 2003 data to examine how perceived ambiguity about cancer prevention recommendations relates to three other cognitive variables known to influence cancer-protective behavior: perceived cancer preventability, perceived cancer risk, and cancer-related worry. Using logistic regression analyses, we tested several predictions derived from a review of literature on the effects of ambiguity perceptions on decision making, cognitions, and emotions. We found perceived ambiguity to have a strong negative relationship with perceived cancer preventability, consistent with "ambiguity aversion"-a pessimistic bias in the interpretation of ambiguity. Cancer worry moderated this relationship; ambiguity aversion increased with higher levels of worry. At the same time, perceived ambiguity was positively related to both perceived cancer risk and cancer worry. Furthermore, perceived risk partially mediated the relationship between perceived ambiguity and worry. These findings suggest that perceived ambiguity about cancer prevention recommendations may have broad and important effects on other health cognitions. We discuss ethical implications of these findings for health communication efforts, and propose a tentative causal model to guide future research.
Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse.
Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.
To examine how cancer fatalism, stigma, and risk perception influence information seeking and avoidance among Chinese adults in Hong Kong.
We administered an online survey to 616 Hong Kong Chinese adults using quota sampling and analyzed the data using structural equation modeling.
Fatalism was positively associated with susceptibility (β = .25, p < .001), severity (β = .11, p = .03), and fear (β = .17, p < .001), while stigma was negatively associated with severity (β = -.22, p < .001). Severity (β = -.19, p < .001) was negatively associated but fear was positively associated with cancer information avoidance (β = .14, p = .01).
Public health communication and education on cancer risks among ethnic Chinese communities in Hong Kong should be sensitive and address underlying cultural beliefs and views that may impede active information seeking.
Online health information, as an emerging field in health communication research, has attracted close attention from researchers. To identify major determinants of why individuals seek health information online, we conducted a meta-analysis that systematically accumulates the existing research findings. To that end, by integrating three theories or models for examining information-seeking behavior, we developed a theoretical framework for the current meta-analysis that emphasizing psychosocial, instrumental, contextual, and demographic factors. By analyzing the effect sizes from 44 articles representing 54 empirical samples, we found that the quality, trustworthiness, and utility of online health information were the dominant predictors of seeking it and that instrumental factors were more important than psychological ones in determining whether individuals did so. Moreover, the development of information and communication technology, the sampling method, and the type of information sought significantly moderated pairwise relationships between determinants and seeking behavior, whereas culture did not. Herein, we discuss the theoretical implications of our findings as well as directions for future research.
This study aimed to examine a theoretical model to predict publics’ communicative actions to take and transmit information from the Centers for Disease Control and Prevention (CDC), as well as their behavioral intentions to follow the CDC’s instructions in the context of infectious disease outbreaks. Using the framework of the situational theory of problem-solving (STOPS), this study tested the roles of fear and positive organization-public relationship (OPR), linking STOPS and behavioral intentions to follow CDC instructions. The results of this study suggest that fear and positive OPR variables play vital roles in predicting individuals’ information acquisition, information transmission, and willingness to follow the CDC’s instructions to cope with infectious diseases.
Uncertainty in the context of cancer involves a complex and conflicting decision-making process. Individual preferences of seeking or avoiding information in the decisions of maintaining, reducing, or increasing uncertainty often depend on key cancer-related beliefs. The present study investigates whether cancer worry (CW), information overload (CIO), or fatalism (CF) can predict four constructs of uncertainty management preferences – avoid to maintain hope, avoid insufficient information, seek to increase uncertainty, and seek to reduce uncertainty. A hybrid model with structural and measurement components was specified and tested. The model analysis shows that cancer-related beliefs influenced individuals’ needs and preferences for uncertainty management through seeking or avoiding information. CW was positively related to all but avoiding insufficient information. CIO was positively associated with all four preferences. CF was only associated with avoiding to maintain uncertainty. Theoretical and practical implications were discussed.
Stigma against people living with HIV in China is common, not only among the general public but also among Chinese health-care providers, impacting their ability to provide quality HIV treatment and care. HIV stigma may be particularly common in rural areas of China, where village doctors (i.e., “barefoot doctors”) have limited medical training yet are charged with providing frontline care for much of China’s rural population. Therefore, the present study aims to use communication and behavioral theory to better understand Chinese village doctors’ beliefs about HIV, including their willingness to become involved in HIV treatment and care. In collaboration with the Behai Centers for Disease Control, we surveyed 228 village doctors in rural China to learn about their experiences in providing HIV treatment and care. We then applied a hybrid theoretical model, combining variables from the Situational Theory of Publics and the Theory of Reasoned Action, to explain providers’ communication, attitudes, and behaviors. Findings suggest that enhanced information activity about HIV may increase providers’ self-efficacy in caring for HIV patients and yield more positive attitudes towards caring for people living with HIV. Theoretical and practical implications are discussed.
Informed by the Situational Theory of Problem Solving (STOPS), this study used data from the Health Information National Trends Survey, a large and representative national sample, to examine predictors of information seeking and information accessing of health information, including cancer-related information. We found that the independent variables in STOPS—problem recognition, involvement recognition, and referent criterion— well predicted people’s information seeking of cancer-related information and accessing of health information on line. However, the impact of trust in online health information was more complicated than anticipated. Our study demonstrated the utility of the STOPS in the health information context. Theoretical and practical implications are discussed.
This study investigated the determinants of health information sharing behaviors of Chinese older adults living in rural areas. Drawing upon a widely used categorization of social support, we tested the effect of social embeddedness and perceived social support on health information sharing behavior, which is conceptualized as a type of enacted social support—informational support. Data were collected between June and August 2014 from 387 older Chinese adults aged 60–79 years in Linxi County of northern China. The results of hierarchical ordinary least squares regression analyses revealed that Chinese older adults’ perceived social support from families and social embeddedness were positively associated with health information sharing behavior, net of the influence of social demographic controls and health information seeking and scanning behaviors. Furthermore, health information sharing behavior was also found to be positively associated with health information seeking and scanning behaviors. Overall, this study enriched the existing literature on health information sharing behavior by taking a social support perspective. A number of practical implications were also discussed.
Despite the concerns raised about the impact of online health information on users, research has not specifically explored different types of information behaviors people exhibit during the communicative process. In this article, we address this research gap by combining the Situational Theory of Problem Solving with considerations of multiple dimensions of risk perception, such as affective and deliberative. This study constructs a hypothetical model to explore how online users’ risk perceptions and information behaviors (information seeking, forefending, and forwarding) influence their health behavioral intention. A survey collected data from 1,463 participants at two healthcare centers in China. Based on the structural equation modeling, multiple dimensions of risk perception play a distinctive role in communicating online health information and forming health behavioral intention. Furthermore, information forwarding, an essential information behavior, influences deliberative risk perception more than information forefending, and it is a much better predictor of individuals’ health intention than information seeking. Implications and suggestions for health communication research are discussed.
We combined insights from various theories and models of media learning, and advanced an indirect model accounting for the mechanisms underlying the media influences on knowledge acquisition. Our model was largely supported by the data from a two-wave longitudinal panel survey with a nationwide sample of Korean adults. It was found that both personal cancer history and cancer worry were positively associated with exposure to stomach cancer information from the media. In turn, exposure to media information was positively related to reflective integration of that information, which ultimately leads to stomach cancer knowledge only among people with high levels of social capital. These findings suggest that media uses and effects are not only an individual but also a contextually dependent experience.
This study applied the comprehensive model of information seeking (CMIS) to online cancer information and extended the model by incorporating an exogenous variable: interest in online health information exchange with health providers. A nationally representative sample from the Health Information National Trends Survey 4 Cycle 4 was analyzed to examine the extended CMIS in predicting online cancer information seeking. Findings from a structural equation model supported most of the hypotheses derived from the CMIS, as well as the extension of the model related to interest in online health information exchange. In particular, socioeconomic status, beliefs, and interest in online health information exchange predicted utility. Utility, in turn, predicted online cancer information seeking, as did information-carrier characteristics. An unexpected but important finding from the study was the significant, direct relationship between cancer worry and online cancer information seeking. Theoretical and practical implications are discussed.
The last few decades have seen growing concerns among parents regarding the safety of childhood vaccines, arguably leading to the rise of the anti-vaccine movement. This study is an effort to understand situational and cross-situational factors that influence individuals’ negative attitudes toward vaccines, referred to as vaccine negativity. In doing so, this study elucidated how situational and cross-situational factors influence vaccine negativity. Specifically, this study tested how knowledge deficiency, or acceptance of scientifically inaccurate data about vaccines, and institutional trust influenced negative attitudes toward vaccines. Using the situational theory of problem solving as the theoretical framework, this study also identified and tested a knowledge–attitude–motivation–behavior framework of vaccine negative individuals’ cognitions and behaviors about the issue.
The statistical tests used in the analysis of structural equation models with unobservable variables and measurement error are examined. A drawback of the commonly applied chi square test, in addition to the known problems related to sample size and power, is that it may indicate an increasing correspondence between the hypothesized model and the observed data as both the measurement properties and the relationship between constructs decline. Further, and contrary to common assertion, the risk of making a Type II error can be substantial even when the sample size is large. Moreover, the present testing methods are unable to assess a model's explanatory power. To overcome these problems, the authors develop and apply a testing system based on measures of shared variance within the structural model, measurement model, and overall model.
This study examined proposed direct and mediating relationships in the Structural Influence Model (SIM) of Communication within the chronic disease context. Using data from the Annenberg National Health Communication Survey (N = 14,472), we tested the potential mediating roles of information seeking, information scanning, and social capital between social determinants of health and four chronic disease risk behaviors: exercise level, fruit and vegetable intake, cigarette smoking, and excessive alcohol use. Information seeking, information scanning, and social capital received support as potential mediators. Our results are largely consistent with predictions of the SIM and highlight the important role of communication in reducing health risks and increasing healthy behaviors.
Although cancer information avoidance (CIA) is detrimental to public health, predictors of CIA have not been fully investigated. Based on uncertainty management theory, this study viewed CIA as a response to uncertainty related to the distress associated with cancer information and illustrated the psychological process leading to CIA. Given the current information context, it was hypothesized that cancer information overload (CIO), accompanied by confusion and stress about cancer information, causes CIA. As trait anxiety is a strong predictor of CIO, it was also hypothesized that trait anxiety has an indirect effect on CIA through CIO. Study 1 tested this relationship in a U.S. sample (N = 384); the results showed that CIO was positively associated with CIA and that trait anxiety indirectly influenced CIA through CIO. Whereas Study 1 tested the relationship with cross-sectional data in the general cancer context, Study 2 replicated Study 1 with 3-wave longitudinal data in the context of a specific cancer (i.e., stomach cancer) in South Korea (N = 1,130 at Wave 1, 813 at Wave 2, and 582 at Wave 3). Trait anxiety at Wave 1 predicted CIO at Wave 2, which in turn increased CIA at Wave 3, suggesting that some people are inherently inclined to avoid cancer information due to their trait anxiety, which results in confusion about cancer information.
This study was carried out to understand how and why worry motivates health-related information seeking, and whether worry decreases after obtaining health-related information. It was proposed that worry influences health-related information-seeking behavior indirectly through cancer patients' desire for obtaining additional information. It was further expected that perceived knowledge about cancer could be increased after 2 months of searching for health information over the Internet, which would subsequently affect levels of worry. Using panel data collected from 224 women diagnosed with breast cancer, worry was found to predict patients' health information seeking via the perceived need for additional information. The results further showed significant increases in patients' perceived knowledge about breast cancer and decreased levels of worry after the seeking of health information for 2 months. Theoretical and practical implications of the findings are discussed.
The purposes of this study are to explore the role of negative emotions in the framework of the situational theory of problem solving (STOPS). First, we tested the validity of the original STOPS model with a sex crime issue in the context of Korea. Second, we tested the mediating role of negative emotions in the relationship between situational recognition and communicative action. The result suggests that STOPS is a useful model with a crime problem in the Korean context. Also, our proposed model shows that negative emotions serve as another aspect of motivation, and emotional experiences might precede subsequent cognitive activities. Especially, negative emotions show a stronger effect on situational motivation than communicative action. This study also found that negative emotions people feel about sex crimes directly influence their communicative action. Among different types of publics, the active and aware publics show stronger emotional responses than do the latent publics and nonpublics.
The persuasive effects of emotions have been the focus of burgeoning interest in recent years. Rather than considering how emotions function within traditional paradigms of attitude change, this research explores the possibility that emotions serve as frames for issues, privileging certain information in terms of accessibility and thus guiding subsequent decision making. This study's results offer evidence that fear and anger can differentially affect information accessibility, desired information seeking, and policy preference, though these effects may be contingent on schema development. These findings support not only the relationship between emotions and frames but also the importance of the discrete emotion perspective in persuasive contexts.
Worry and risk perceptions are generally found to be independently associated with health-promoting behaviors, although it is unknown whether they interact in ways that potentially dampen the effect of either construct on behavior. In this hypothesis-generating study, cancer-related worry and risk perception, and their interaction, were used to predict odds of meeting 5-a-day fruit and vegetable consumption guidelines and engaging in any exercise using data from a nationally representative sample (N = 10,230). Risk perception was not associated with either behavior; worry was associated only with exercise (OR = 1.77, 95% CI: 1.16, 2.70, p < .01). More important, their interaction was associated with these behaviors in a counterintuitive manner; among those higher in worry, higher levels of risk perception were associated with lower vegetable consumption (OR = 0.79, 95% CI: 0.62, 1.00, p < .05) and exercise (OR = 0.77, 95% CI: 0.63, 0.95, p = .01). These results suggest the hypothesis that, among people high in worry, attempts to increase risk perception could be counterproductive. These and related findings suggest the importance of distinguishing worry from risk perception, and future research is necessary to determine the causal nature of these associations.
Measurement invariance is usually tested using Multigroup Confirmatory Factor Analysis, which examines the change in the goodness-of-fit index (GFI) when cross-group constraints are imposed on a measurement model. Although many studies have examined the properties of GFI as indicators of overall model fit for single-group data, there have been none to date that examine how GFIs change when between-group constraints are added to a measurement model. The lack of a consensus about what constitutes significant GFI differences places limits on measurement invariance testing. We examine 20 GFIs based on the minimum fit function. A simulation under the two-group situation was used to examine changes in the GFIs (ΔGFIs) when invariance constraints were added. Based on the results, we recommend using Δcomparative fit index, ΔGamma hat, and ΔMcDonald's Noncentrality Index to evaluate measurement invariance. These three ΔGFIs are independent of both model complexity and sample size, and are not correlated with the overall fit measures. We propose critical values of these ΔGFIs that indicate measurement invariance.
Two Monte Carlo studies were conducted to examine the sensitivity of goodness of fit indexes to lack of measurement invariance at 3 commonly tested levels: factor loadings, intercepts, and residual variances. Standardized root mean square residual (SRMR) appears to be more sensitive to lack of invariance in factor loadings than in intercepts or residual variances. Comparative fit index (CFI) and root mean square error of approximation (RMSEA) appear to be equally sensitive to all 3 types of lack of invariance. The most intriguing finding is that changes in fit statistics are affected by the interaction between the pattern of invariance and the proportion of invariant items: when the pattern of lack of invariance is uniform, the relation is nonmonotonic, whereas when the pattern of lack of invariance is mixed, the relation is monotonic. Unequal sample sizes affect changes across all 3 levels of invariance: Changes are bigger when sample sizes are equal rather than when they are unequal. Cutoff points for testing invariance at different levels are recommended.
This article introduces the situational theory of problem solving (theory of problem solving) as an extended and generalized version of the situational theory of publics (theory of publics). The theory of problem solving introduces a new concept, communicative action in problem solving, as its dependent variable. To explain communicative action, the theory of problem solving refines the independent variables of the theory of publics: problem recognition, constraint recognition, involvement recognition, and referent criterion. Finally, it introduces a new variable: situational motivation in problem solving. The new motivational variable mediates the effects of antecedent perceptual variables on communicative behavior. We report the supporting evidence for theoretical propositions of the new theory based on structural equation modeling (SEM) testing using survey data.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
Several concepts are introduced and defined: measurement invariance, structural bias, weak measurement invariance, strong factorial invariance, and strict factorial invariance. It is shown that factorial invariance has implications for (weak) measurement invariance. Definitions of fairness in employment/admissions testing and salary equity are provided and it is argued that strict factorial invariance is required for fairness/equity to exist. Implications for item and test bias are developed and it is argued that item or test bias probably depends on the existence of latent variables that are irrelevant to the primary goal of test constructers.
This study investigated the role of willingness to communicate about health (WTCH) among older patients in a state-of-the-art cancer center. Specifically, relationships were examined between patients' WTCH and their information seeking, perceptions of coping activities the center offered, and satisfaction with the center. The study also explored how those relationships may be mediated by patients' perceptions of the health-care environment and their health status. The results indicated that WTCH may play an important role in predicting information-seeking behaviors, perceived helpfulness of center-sponsored activities, and overall satisfaction with care received at the center. Evidence also was found that perceptions of the health-care environment mediated cancer patients' WTCH. The implications of these findings for communication theory and application, as well as limitations and future directions for research, are discussed.
The present paper reports two questionnaire studies and an experimental investigation of worrying. Worry correlated more highly than general tension reports with a variety of affect scales and was characterized by: (a) feelings of anxiety, tension and apprehension; (b) moderate awareness of somatic cues including muscle tension and upset stomach; and (c) concerns over future rather than past or present situations. Self-labeled worriers were most distinguished from non-worriers by their reported uncontrollability of cognitive intrusions once worrying was initiated. In the experimental study, worriers and non-worriers were assessed for their ability to focus their attention on a monotonous (breathing) stimulus before and after 0, 15 or 30 min of worrying. Worriers reported significantly higher anxiety. depression and hostility, a lower frequency of focused attention and a greater frequency of negative thought intrusions than did non-worriers prior to the worry period. For both worriers and non-worriers. 15 min of worry resulted in an apparent incubation of negative cognitive intrusions on the subsequent attention-focusing task.
• This article discusses issues relating to information arising from a qualitative study of the experiences of informal carers of terminally ill cancer patients.
• Qualitative data analysis, drawing on methods of literary criticism, revealed that information was a key area in carers' experience.
• The findings are presented in the context of needing to provide individualized care to every family and deal with information needs relating to the illness and prognosis.
• The question of who is in possession of what information is raised, and the effect that this can have on couples is discussed, together with the issue of false information which carers may receive.
• The discussion centres on the complexity of understanding carers' information needs and considers how these are affected by the context within which carers operate.
• The work of Glaser and Strauss on awareness contexts is discussed in this respect.
• Finally, the importance of the nurse's role as a sensitive mediator of information is considered.
Leading causes of death
- Cdc
Can we provide better aftercare services to blacks? Questioning the efficacy and cultural relevance of prevailing models and approaches of aftercare
- R K Barrett
- Barrett R. K.
Death, dying, and bereavement in the United States of America
- C A Corr
- D M Corr
- Corr C. A.
Dying, death, and grief: Glimpses in Hong Kong and Taiwan
- I Martinson
- C.-S C Chao
- L Chung
- Martinson I.