| Background: The incidence of cancer keeps rising in recent years in China,causing serious threat to people's health.Cancer patients are experiencing various unmet supportive needs.Both cancer patients and family members are in need of convenient approach to get access to health care.The development of mobile health service provides a platform for continuous cancer care.Nevertheless,cancer patients do not make full use of the mobile health and there is limited popularization of the innovative service.Literature review shows that the patient's m-health information-seeking behavior(MHISB)was influenced by both subjective and objective factors,including electronic health literacy,information needs and information environment.Literature review indicates a research gap understanding Chinese cancer patients' MHISB and factors influencing MHISB.Objective: The first aim of this study is to develop a tool for measuring MHISB among cancer patients.The second aim is to explore cancer patients' e-health literacy,information demands,MHISB,and information seeking environment,and to analyze factors influencing MHISB.This study is significant to develop targeted intervention to promote the development of m-health among cancer patients,thereby improving the level of cancer care.Method: A hybrid approach was applied in this study,combining both qualitative and quantitative research methods.There were two stages in the study.The first stage was the development of MHISB questionnaire,including literature review,semi-structured interviews,expert consultation,cognitive interviews and pilot study.Purposive sampling method was adopted in semi-structured interviews and cognitive interviews.Nvivo11.0 was used to encode and analyze the data,and content analysis method was used to to extract the interview themes.The second stage was the exploration of factors influencing MHISB.Using MHISB questionnaire and information environment questionnaire which developed in the first stage,and INQ-SF,E-heals as key instruments for the second stage,a cross-sectional survey was conducted.Convenience sampling method was adopted to collect data.SPSS 20.0 was used for simple and multiple factor analysis to explore factors influencing four dimensions of MHISB,and AMOS 22.0 for structural equation model(SEM)analysis,was applied to explore the interaction mechanism among e-health literacy,information demands,information seeking environment and four dimensions of MHISB.Result: In this study,the results were described from four aspects: development of the questionnaire,the status of information need,e-health literacy and information environment in cancer patients,the score and influencing factors of MHISB among cancer patients.(1)In stage one,we conducted a semi-structured interview with 15 cancer patients,two rounds of expert consultation with 6 experts,cognitive interview with 10 patients,and a pilot study with 287 participants to improve the questionnaire step by step.The final questionnaire includes 25 items.Four dimensions were extracted by the exploratory factor analysis,i.e.m-health information seeking frequency(1~10),mhealth information seeking willingness(11~14),m-health information seeking selfefficacy(15~21)and m-health information evaluation(22~25).Cronbach's ? for each dimensions were 0.896,0.815,0.690 and 0.682 respectively.Besides,the questionnaire includes 9 items with multiple choices which measures patients' information seeking approach,experiences and preferences particularly.CFA shows that the goodness of fit index are as follows: x~2/ df = 1.295,RMSEA = 0.052,IFI = 0.962,CFI = 0.961,the questionnaire has good fitting.(2)The overall score of cancer patients' information needs was 78.98±27.44.The average score of physical health and daily life,social psychology,interpersonal communication,providing care and support,health information dimensions were 2.26±1.00,2.33±1.15,2.17±1.05,2.70±0.96,3.08±1.00 respectively.It revealed that patients had the highest demands for health information domain,followed by care provision and support,social psychology,physical health and daily life,and interpersonal communication needs were the lowest need.The overall score of cancer patients' e-health literacy was 26.54±7.85,the average score of electronic information application ability,judgment ability and decisionmaking ability dimension were 3.39±1.06,3.16±1.00,3.27±1.06 respectively.It showed that the application ability score was higher while judgment ability score was relatively low.The overall score of cancer patients' seeking environment was 7.99±2.86,and the score of each item was 2.17±0.85,2.10±0.85,1.92±0.87,1.81±0.87 respectively,the score of "commercial advertisement" and "network instability" were higher.(3)Total points of MHISB in cancer patients was 60.52±9.64.Score of information seeking frequency,information seeking willingness,information seeking self-efficacy and information evaluation dimensions were 2.08±0.55,3.06±0.50,2.41±0.50,2.74±0.43 respectively.It showed that the patients have higher score in information seeking willingness and information evaluation,while lower score in information seeking frequency and seeking self-efficacy.Data analysis showed that patients varied in MHISB total and dimension scores by the age,occupation,working status,treatment,education level,income and tumor type.(4)Using four dimensions of MHISB(cancer patients' seeking frequency,seeking willingness,self-efficacy and information evaluation score)as dependent variables,significant variables from t-test and variance analysis as independent variable,four multiple linear regression analyses were conducted.Results showed that cancer patients' seeking frequency was influenced by their age,occupation,educational level,income,information demands,e-health literacy and information environment.The seeking willingness was significantly related to occupation,income,information demands and e-health literacy.The information seeking self-efficacy were influenced by the status of chemotherapy,tumor type,information demands,e-health literacy and information environment.The information evaluation was influenced by the working condition,marriage status and e-health literacy.A structural equation model was established based on the results of regression analysis and theoretical framework.The SEM showed that cancer patients' e-health literacy was the mediated variable between their information demands,seeking frequency,seeking willingness,seeking self-efficacy and information evaluation,its normalized effect value were 0.083,0.060,0.014 and 0.070 respectively;cancer patients' information demands can positively influence their seeking willingness,and normalized effect value was 0.12;cancer patients' seeking environment was mediated variable between information demands and seeking frequency,self-efficacy,and information evaluation,its normalized effect value was 0.083,0.177 and 0.052 respectively.Conclusion: The study indicated that the newly developed cancer patients' MHISB questionnaire has good validity and reliability,and it can be used to evaluate information-seeking frequency,seeking willingness,self-efficacy and information evaluation among cancer patients.The results of current study shows that cancer patients have strong information needs.However,the high information seeking willingness for health information was not paralled with high seeking frequency and seeking self-efficacy,indicating a lack of seeking confidence and ability.Regression analysis and SEM showed the importance of improving patients' MHISB from the perspective of subjective and objective aspects.That is,patients should enhance their e-health literacy;meanwhile,mobile information environment should be improved,thereby increasing patients' seeking frequency and improving their ability to evaluate information. |
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