The Knowledge Gap Hypothesis: Twenty-Five Years Later

Evolving policies, enduring impacts: Cross-sectional surveys of mental health, risk-related perceptions, and coping behaviors throughout China's U-turn in its stringent zero-COVID policy

OBJECTIVE

China's early encounter with COVID-19 and protracted prevention policies, presents an ideal case to study psychological changes during a prolonged and evolving crisis. This study aims to examine the shifts in mental health symptoms, risk-related perceptions, and associated coping behaviors within two large-scale samples of Chinese respondents, spanning from the pandemic's onset to the relaxation of the zero-COVID policy. Moreover, the study strives to identify protective factors that could potentially mitigate the pandemic's impact.

METHODS

Two online surveys were conducted during China's initial pandemic phase (February 25-28, 2020) and the relaxation of the zero-COVID policy (March 30-April 18, 2023). Participants' mental health indicators, risk-related perceptions, and coping behaviors were assessed using the Depression, Anxiety, and Stress Scale-21 Items, the 9-item Bergen Burnout Inventory, and other adopted scales. Multivariable linear models were employed to examine the enduring psychological impact of the pandemic and identify potential protective factors.

RESULTS

Analysis of two datasets comprising 1946 and 1878 participants from the onset and the remission of China's COVID-19 pandemic revealed an upward trend in various mental health indicators of Chinese respondents between 2020 and 2023. Similarly, risk-related perceptions, encompassing perceived severity, susceptibility, and self-efficacy, and risk-related information sharing witnessed an increase. Being female, single, residing in rural areas, having higher education, and lacking acquaintances with COVID-19 are protective factors against mental health risks. Additionally, being female, married, over 30, living in big cities, having higher education, and lacking personal or acquaintances' infection history are associated with engaging in protective behaviors and reduced information avoidance.

CONCLUSION

The study investigated the changes in mental health symptoms, risk-related perceptions, and coping behaviors of Chinese respondents between 2020 and 2023 and identified protective factors against the pandemic's impact, including demographic (gender, age), social (education, marital status, residence), and exposure (infection history) elements. Understanding these fluctuations and protective elements is crucial for policymakers, as it can inform the development of targeted strategies to alleviate negative psychological impacts while effectively managing future pandemics.

Extending the Knowledge Gap Hypothesis to Narrative Persuasion: Parents' Information-Seeking Intention and Learning About Adolescent Children's Covid-19 Vaccination

The gap in knowledge and information-seeking between high and low socioeconomic status (SES) has been well documented. This study extends this knowledge gap hypothesis to narrative persuasion in the context of parents' knowledge and information-seeking intention concerning adolescents' COVID-19 vaccination. It specifically tests if the gap is moderated by a message type (narrative vs. non-narrative). An online quasi-experiment, with a 2 (participants' education level: high vs. low) × 3 (message type: narrative vs. non-narrative vs. no-message) between-subject design, showed a main effect of education level (i.e., parents with a higher [vs. lower] education level rated a higher intention to seek information and provided more correct answers on questions about adolescents' COVID-19 vaccination) and an interaction between the two factors. The interaction showed that the gap between high- and low-education groups in information-seeking intention disappeared among those who read the narrative or non-narrative, and the gap in knowledge disappeared among those who read the narrative. Study findings suggest the utility of narratives in narrowing the gap in knowledge and information-seeking to improve parents' decisions on child vaccination.

A Cross-Sectional Study on the Knowledge and Awareness of Lung Cancer and Screening in Jazan Region, Saudi Arabia

BACKGROUND

Lung cancer (LC) is the most common cause of cancer-related deaths worldwide. With lung cancer often diagnosed at advanced stages, understanding the local population's awareness levels is crucial for designing effective preventive strategies. By identifying gaps in knowledge, the research aims to inform targeted health education efforts, optimize resource allocation, influence policy development, and contribute to the limited body of research on lung cancer awareness in the region, ultimately fostering improved public health outcomes.

METHODS

This was a cross-sectional observational study conducted in Jazan region, Saudi Arabia, from July 2022 to June 2023, 671 participants over 18 years old, encompassing both genders, were gsurveyed. Data was collected through a questionnaire covering sociodemographic characteristics and LC-related awareness. SPSS 23 was used for analysis. Factors associated with knowledge scores were explored using independent t-tests and ANOVA, with the Tukey post-hoc test identifying specific group differences.

RESULTS

The study included 671 participants, most participants were between 18 and 35 years (73.5%), with 38.5% males and 61.5% females. Lung cancer (LC) awareness was high (95.1%), with 4.9% reporting a family history. Knowledge assessment revealed a mean score of 14.66, with 41.6% having low, 49.5% moderate, and 8.9% high knowledge levels. Correct responses were notable for recognizing LC as a common cancer, a leading cause of death, and associating smoking and shisha with risk. Symptoms were well identified. Screening awareness was at 63.5%, with 78.8% willing to undergo tests if at risk. Age, marital status, and occupation were associated with knowledge, while factors like gender, nationality, residency, education, income, and smoking status showed no significant associations.

CONCLUSION

The findings indicate that there are knowledge gaps related to LC and its screening in Jazan region in Saudi Arabia. Effective awareness programs targeting specific sociodemographic groups are needed to improve the early detection and outcomes.

Knowledge Gaps, Cognition and Media Learning: Designing Tailored Messages to Address COVID-19 Communication Inequalities

Various health and crisis studies have demonstrated support for the existence of knowledge gaps-a hypothesis suggesting that information will reach those in the lower socioeconomic status last, worsening health disparities. At the point at which COVID-19 vaccines were becoming widely accessible, the present study surveyed 651 Black Americans to understand vaccine hesitancy, intentions, and media learning variations after exposure to different types of social media posts about the COVID-19 vaccine. Although exposure to any of the message conditions in our study resulted in a decrease in vaccine hesitancy, we found mixed support for the knowledge gap hypothesis. Results show that lack of knowledge because of socioeconomic status is not a key factor driving vaccine hesitancy among Black Americans. Instead, public communication (government) campaigns may consider focusing on strategies to target Black American communities by age to improve media learning, and consider increasing social control and communal message functions to increase cognitive processing of pro-vaccine messages, and over the longer term, influence COVID-19 vaccine hesitancy and uptake.

Health Insurance Ad Messages Targeted to English- and Spanish-Speaking Populations in a Period of Limited Federal Investment in Marketplace Outreach

Federal funding cuts to enrollment outreach and marketing of the Affordable Care Act (ACA) marketplace options in 2017 has raised questions about the adequacy of the information the public has received, especially among populations vulnerable to uninsurance. Using health insurance ads aired from January 1, 2018, through December 21, 2018, we conducted a content analysis focused on (a) the messaging differences by ad language (English vs. Spanish) and (b) the messaging appeals used by nonfederally sponsored health insurance ads in 2018. The results reveal that privately sponsored ads focused on benefit appeals (e.g., prescription drugs), while publicly sponsored ads emphasized financial assistance subsidies. Few ads, regardless of language, referenced the ACA explicitly and privately sponsored Spanish-language ads emphasized benefits (e.g., choice of doctor) over enrollment-relevant details. This study emphasizes that private-sponsored television marketing may not provide specific and actionable health insurance information to the public, especially for the Spanish-speaking populations.

It's the platform, stupid (-; the elitist nature of sport podcast listeners

Purpose

Despite the ability of podcasts to bring free quality content to the masses, studies found that podcast consumption have been identified mostly with the elite class, thus increasing knowledge gaps and digital divides. This study aims to examine whether this trend extends to non-elitist podcast genres by providing the first analysis of sport podcast demographics and uses and gratifications.

Design/methodology/approach

A survey was conducted among Israel’s three most popular sport podcast listeners (N = 503), examining the listeners’ demographics, consumption patterns and uses and gratifications driving them to listen to the podcast.

Findings

The analysis reveals that most listeners are secular millennials males with above average income, highlighting the elitist nature of sport podcast consumers. The analysis further revealed that information-rich groups were more likely to tune in for information acquisition whereas other groups used it more for entertainment and escapist purposes.

Practical implications

For policy makers and educators who wish to promote podcast-based initiatives to narrow social gaps, the analysis strengthens the notion that the podcast platform mostly attracts those who are already information rich and thus increase knowledge gaps and digital divides. For sport broadcasters, the analysis illuminates sport podcasts audiences’ demographics and their uses of the platform.

Social implications

The study reflects that the podcast platform is identified with elitist listening even in non-elitist genres; thus it further increases the already wide knowledge gap and digital divides promoted by the advent of the podcast platform.

Originality/value

The study is the first to highlight the elitist nature of sport podcast listeners’ demographics, indicating that the podcast platform increases the knowledge gap also even across non-elitist content genres such as sport content.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-12-2021-0684

Can High Exposure Help to Close Gaps? The Influence of COVID-19 Preventive Messages on Behavioral Intentions by Educational Attainment in Chile

The literature in the field of health communication has shown the existence of gaps between groups of different socioeconomic levels both in exposure to health campaign messages and in the influence these messages exert on individuals' health decisions. In this article, we examine the association between educational attainment and exposure to messages promoting COVID-19 preventive behaviors, namely, physical distancing, handwashing, and masks wearing in Chile. In addition, we model the association between exposure to these messages and the intentions to carry out the behaviors, as well as the differences attributable to educational attainment in the influence of exposure. A cross-sectional population survey combining online and telephone techniques was conducted among 3,592 adults in Chile. Regression analysis revealed that lower educational level and frequency of television use were positively associated with greater exposure to preventive messages. Exposure to preventive messages, in turn, was positively associated with intentions to maintain the three behaviors examined. Individuals in the lower educational attainment group had lower intentions to engage in two of the three behaviors, but those in these segments who were more exposed to preventive messages were as likely as their more educated counterparts to intend wearing masks and adhering to physical distance. The findings of this study underscore the importance of reaching the least educated segments with campaign messages in the context of public health crisis, since these messages can close gaps between the more and less educated group in their intentions to engage in preventive behaviors.

Framing Disaster Risk Perception and Vulnerability in Social Media Communication: A Literature Review

The paper presents the results of a literature review on how social media can impact on disaster risk perception and vulnerability and how these two aspects are interconnected, trying to understand what factors have consequences especially on informational vulnerability. The paper answers to the increasing requests at an international level to move from a technocratic approach to disaster risk management and reduction to a holistic one, where social perspective is integrated. The paper states that this change of paradigm is relevant, especially considering the role that new technologies in communication and information systems are acquiring in disaster risk management and reduction. What emerges from the literature review is that there is a limited scientific production on the topic and further works are desired, to improve knowledge on how new communication and information technologies can impact on vulnerability and risk perception. Furthermore, the two topics are usually discussed separately. However, the role that risk perception can have in increasing or reducing vulnerability deserves to be better discussed.

Factors Influencing the Knowledge Gap regarding Influenza and Influenza Vaccination in the Context of COVID-19 Pandemic: A Cross-Sectional Survey in China

In the context of the COVID-19 global pandemic, promoting influenza knowledge and vaccine helps reduce the risk of dual pandemics and relieve the pressure on healthcare systems. Due to the low rate of influenza vaccination in China, we conducted a cross-sectional survey to investigate whether a knowledge gap regarding influenza and influenza vaccine exists between Chinese groups of different socioeconomic statuses and then explore the possible factors influencing knowledge level. A total of 951 valid questionnaires were collected online in this study. Variance analysis shows a knowledge gap regarding influenza and influenza vaccination between different socioeconomic status groups. Correlation analysis shows that internet media, social media, public communication, and interpersonal communication are positively associated with the knowledge level. Multilevel regression analysis shows a significant interaction between internet media and educational level. This study finds that internet media use helps narrow the knowledge gap between groups with different education levels. This article recommends a multi-channel promotion of influenza and vaccine knowledge and better pertinence between contents and readers.

Postcolonial pandemic publics: examining social media health promotion in India during the COVID-19 crisis

Affordances offered by new media platforms are perceived as revolutionary instruments for removing the inequities of access to health promotion and communication. However, the production and dissemination of health promotional material on digital platforms does not necessarily translate into uniform access across diverse demographics. This article addresses the lacuna when it comes to analyzing Health Promotion initiatives in India, with a specific focus on the governmental publicity carried out on social media during the four phases of COVID-19 national lockdown between 24 March and 31 May 2020. Our intervention examines how governmental social media health promotion in India played a key role in shaping the 'outbreak narrative' during the lockdown across different levels of social and economic privilege. Through a combination of quantitative data analysis and qualitative interview methods, this article analyzes the circulation and impact of official publicity in online and offline spaces, during the COVID-19 lockdown in India. Resultant findings allow for a comprehensive assessment of whether such publicity contributed to democratized citizen science discourses: enabling social protection measures for vulnerable majorities or potentially reified the existing privileges of the economically and socially affluent minority. We find that health promotion campaigns during a pandemic must focus on reaching the widest possible audience in the most efficient manner. Specifically, in the Indian context, health promotion through mass-media like Television and Radio, and participatory media platforms needed to be implemented in tandem with new media platforms, to achieve required engagement with vulnerable communities on key health issues.

Bridging Academics’ Roles in Knowledge Diffusion in Sustainability-Driven Public–Private Partnerships: A Case Study of the SDGs Workshop in Central Japan

This article discusses the role of academics in knowledge diffusion among various stakeholders using a case study of a sustainability-oriented workshop to address issues of a local forest in central Japan. This research employs thematic analysis through interpreted data from documents, minutes of meetings, workshop interactions among stakeholders, debriefing sessions, questionnaires, and fieldwork findings of participants in a regional business school. The findings show that Bridging Academics (BAs) have effectively facilitated knowledge diffusion amongst global, national and local stakeholder clusters. The interactions among workshop stakeholders resulted in outcomes that enhanced awareness of knowledge gaps, fostered effective communication, enabled knowledge extension, and created shared values. The study contributes towards the understanding of academics’ roles in collaborative settings for sustainability and suggests a multi-node knowledge link model as a collaborative mechanism for knowledge diffusion. The study suggests implications for stakeholders and provides a use case relevant to sustainability-based regional development.

Knowledge gap exists among caregivers of adults compared to caregivers of children with epilepsy: a comparative analysis from a low resource setting

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We compared knowledge, attitude, behavior, belief and seizure recognition among CG-A and CG-C.

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Overall performance of caregivers of adults and children in tested domains was good.

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Knowledge-behavior, knowledge-faith and knowledge-seizure recognition gaps existed in CG-A.

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Lack of formal education in CG-A lead to inadequate factual knowledge and the knowledge gaps.

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CG-A need focused education to improve seizure recognition and response and dispel epilepsy myths.

Caregivers of adults (CG-A) and caregivers of children (CG-C) may differ in their knowledge, attitude and behavior and hence their education requirements during epilepsy counseling could vary. This study compares the current knowledge, attitudes, behavior during a seizure, presence of myths surrounding epilepsy and ability to recognize seizures among a sample of CG-A and CG-C. Caregivers of children and adult patients with minimum 6 months history of epilepsy were enrolled. Information was collected using a questionnaire about clinical and demographic details and five domains (KAP-plus); knowledge, attitude, behavior, presence of myths and a video data for identification of focal impaired awareness seizures (FIAS) and generalized tonic-clonic seizures (GTCS). There were 132 CG-A and 127 CG-C. CG-C were younger and better educated compared to CG-A (formal education of 64.6% vs 44.7% p = 0.001). CG-A and CG-C were comparable in the knowledge and attitude domains. CG-A scored less than CG-C in the domains of behavior (15.5 vs 16.8 p = <0.001), myths (15.4 vs 16.2 p = 0.002), video recognition of FIAS and GTCS (0.7 vs 0.94 p = 0.001) and KAP-plus score (22.9 vs 24.6 p = 0.017). The knowledge-behavior or knowing-doing gap, knowledge-faith gap and knowledge-recognition gaps existed more among CG-A compared to CG-C. Focused education strategies are required to bridge the gap among CG-A.

Improving iron folic acid consumption through interpersonal communication: Findings from the Reduction in Anemia through Normative Innovations (RANI) project

OBJECTIVE

More than half of Indian women of reproductive age are anemic. Regular iron folic acid uptake can prevent and treat anemia. This study investigated the effect of interpersonal communication on improving IFA use among women of reproductive age.

METHODS

The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized trial that collected longitudinal data from control (n = 1896) and intervention (n = 1898) communities in Odisha, India at Time 1 and six months later at Time 2. Structural equation models assessed the effect of the intervention on iron folic acid use via multiple interpersonal communication pathways.

RESULTS

Compared to the control arm, iron folic acid use significantly increased in the intervention arm. Both, general health interpersonal communication and anemia-specific interpersonal communication were augmented in the intervention communities. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication.

CONCLUSION

The RANI Project increased interpersonal communication among participants, resulting in increased iron folic acid use for anemia reduction.

PRACTICE IMPLICATIONS

Strategic use of targeted interpersonal communication to promote behavior change appears to be a viable strategy to increase iron folic acid use to reduce anemia.

Factors influencing COVID-19 knowledge-gap: a cross-sectional study in China

Background

In the face of a sudden outbreak of COVID-19, it is essential to promote health communication, especially to reduce communication inequality. The paper targeted China to investigate whether social structural factors (education level and urban-rural differences) lead to the knowledge gap of COVID-19. Also, this paper examined whether media use, interpersonal communication, public communication, and perceived salience of information can influence the knowledge gap of COVID-19. Furthermore, this paper explored the strategies to promote communication equality.

Methods

An online survey on COVID-19 knowledge and its influencing factors was conducted in February 2020, with a valid sample of 981 participants. The dependent variable was the total score of knowledge related to COVID-19. In addition to demographic variables such as education level and residence, the main explanatory variables include four independent variables: the use of different media (print media, radio, television, Internet), interpersonal communication, public communication, and perceived salience of information. This paper utilized descriptive statistics, correlation analysis, and hierarchical multiple regression analysis for data processing.

Results

Descriptive statistics indicated that the Internet was the most frequent source of information for participants to obtain COVID-19 knowledge (M = 6.28, SD = 1.022). Bi-variate analysis and regression analysis presented that education level, Internet media use, and perceived salience of information predicted the difference in knowledge level. Hierarchical multiple regression showed that Internet media use significantly predicted differences in the level of knowledge related to COVID-19 among groups with different education levels.

Conclusions

This study found a COVID-19 knowledge gap among the Chinese public, especially the digital knowledge gap. Education level, perceived salience of information, and internet media use can significantly predict the difference in COVID-19 knowledge level. In contrast, the use of traditional media such as newspaper, radio, and television, public communication, and interpersonal communication did not improve knowledge level. Internet media use and education level have an interactive effect on the formation of a COVID-19 knowledge gap. That is, online media use will expand the COVID-19 knowledge gap between groups with different education levels.

A national pilot program for chronic diseases and health inequalities in South Korea

BACKGROUND

To achieve the health equity, it is important to reduce socioeconomic inequalities when managing chronic diseases. In South Korea, a pilot program for chronic diseases was implemented at the national level. This study aimed to examine its effect on socioeconomic inequalities in chronic disease management at the individual and regional levels.

METHODS

Korean National Health Insurance data from September 2016 to October 2017 were used. Study subjects in the national pilot program for chronic diseases included 31,765 participants and 5,741,922 non-participants. The dependent variable was continuity of prescription medication. Socioeconomic position indicators were health insurance contribution level and the area deprivation index. Covariates were gender, age, and the Charlson Comorbidity Index (CCI). A multilevel logistic regression model was used to address the effects at both the individual and regional levels. This is a cross-sectional study.

RESULTS

Unlike the group of non-participants, the participants showed no inequality in prescription medication continuity according to individual-level socioeconomic position. However, continuity of prescription medication was higher among those in less deprived areas compared to those in more deprived areas in both the participation and non-participation groups.

CONCLUSIONS

This study found that the pilot program for chronic diseases at the least did not contribute to the worsening of health inequalities at the individual level in South Korea. However, there was a trend showing health inequalities based on the socioeconomic level of the area. These findings suggest that additional policy measures are needed to attain equality in the management of chronic diseases regardless of the regional socioeconomic position.

Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study

Background

eHealth literacy can potentially facilitate web-based information seeking and taking informed measures.

Objective

This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors.

Methods

The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated.

Results

The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score.

Conclusions

Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.

We Need the Lens of Equity in COVID-19 Communication

The ongoing COVID-19 pandemic has brought forward the centrality of public communication as a force for information, and in highlighting the differential impact on diverse segments of the society. Information and communication technologies-led developments including social media have previously been discussed as instruments of democratization of knowledge. However, the evidence so far shows that the promise remains unfulfilled as upper socioeconomic groups acquire information at a faster rate than others. The communication inequalities have only reinforced the existing societal fault lines of race, class and place. As the first pandemic of the social media age, COVID-19 has also given rise to an "infodemic", providing fertile ground for the spread of information, misinformation and disinformation. With limited gatekeeping, an immense amount of unprocessed scientific information is being put forward to publics not trained in science. In this commentary, we offer some propositions on how disinformation on COVID-19 has become mainstreamed through social media's spiral of amplification and what role public communication has in an emergency from a lens of equity. We raise the question of whether the tremendous flow of scientific information during the COVID-19 pandemic has a differential impact on different socioeconomic groups. We propose that more systematic research is urgently needed to understand how mis/disinformation originate, spread and what their consequences are. In our view, research in health communication inequalities is foundational to mitigating the current off-line and online ravages of the pandemic.

Low Health Literacy and Health Information Avoidance but Not Satisficing Help Explain "Don't Know" Responses to Questions Assessing Perceived Risk

BACKGROUND

People who say they don't know (DK) their disease risk are less likely to engage in protective behavior.

PURPOSE

This study examined possible mechanisms underlying not knowing one's risk for common diseases.

METHODS

Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs.

RESULTS

Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01).

LIMITATIONS

The data were cross-sectional; therefore, directionality of the pathways cannot be assumed.

CONCLUSIONS

DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.

Differences in Rural and Urban Health Information Access and Use

PURPOSE

Rural residents may have lower access to and use of certain health information sources relative to urban residents. We investigated differences in information source access and use between rural and urban US adults and whether having low health literacy might exacerbate rural disparities in access to and use of health information.

METHODS

Six hundred participants (50% rural) completed an online survey about access and use of 25 health information sources. We used logistic regression models to test associations between rurality and access to and use of health information sources and whether rurality interacted with health literacy to predict the access and use.

FINDINGS

Compared to urban residents, rural residents had lower access to health information from sources including primary care providers, specialist doctors, blogs, and magazines, and less use of search engines. After accounting for sociodemographics, rural residents only had lower access to specialist doctors than urban residents. Rural residents with limited health literacy had lower access to mass media and scientific literature but higher use of corporations/companies than rural residents with adequate health literacy and urban residents regardless of health literacy level.

CONCLUSIONS

Some differences in access to and use of health information sources may be accounted for by sociodemographic differences between rural and urban populations. There may be structural barriers such as shortage of specialist doctors and limited media exposure that make it harder for rural residents to access health information, especially those with limited health literacy.

Digital disparities and vulnerability: mobile phone use, information behaviour, and disaster preparedness in Southeast Asia

This paper proposes an ecological view to investigate how disparities in mobile technology use reflect vulnerabilities in communities vis-à-vis disaster preparedness. Data (n=1,603) were collected through a multi-country survey conducted equally in rural and urban areas of Indonesia, Myanmar, Philippines, and Vietnam, where mobile technology has become a dominant and ubiquitous communication and information medium. The findings show that smartphone users' routinised use of mobile technology and their risk perception are significantly associated with disaster preparedness behaviour indirectly through disaster-related information sharing. In addition to disaster-specific social support, smartphone users' disaster-related information repertoires are another strong influencing factor. In contrast, non-smartphone users are likely to rely solely on receipt of disaster-specific social support as the motivator of disaster preparedness. The results also reveal demographic and rural-urban differences in disaster information behaviour and preparedness. Given the increasing shift from basic mobile phone models to smartphones, the theoretical and policy-oriented implications of digital disparities and vulnerability are discussed.

Making Air Pollution Visible: A Tool for Promoting Environmental Health Literacy

BACKGROUND

Digital maps are instrumental in conveying information about environmental hazards geographically. For laypersons, computer-based maps can serve as tools to promote environmental health literacy about invisible traffic-related air pollution and ultrafine particles. Concentrations of these pollutants are higher near major roadways and increasingly linked to adverse health effects. Interactive computer maps provide visualizations that can allow users to build mental models of the spatial distribution of ultrafine particles in a community and learn about the risk of exposure in a geographic context.

OBJECTIVE

The objective of this work was to develop a new software tool appropriate for educating members of the Boston Chinatown community (Boston, MA, USA) about the nature and potential health risks of traffic-related air pollution. The tool, the Interactive Map of Chinatown Traffic Pollution ("Air Pollution Map" hereafter), is a prototype that can be adapted for the purpose of educating community members across a range of socioeconomic contexts.

METHODS

We built the educational visualization tool on the open source Weave software platform. We designed the tool as the centerpiece of a multimodal and intergenerational educational intervention about the health risk of traffic-related air pollution. We used a previously published fine resolution (20 m) hourly land-use regression model of ultrafine particles as the algorithm for predicting pollution levels and applied it to one neighborhood, Boston Chinatown. In designing the map, we consulted community experts to help customize the user interface to communication styles prevalent in the target community.

RESULTS

The product is a map that displays ultrafine particulate concentrations averaged across census blocks using a color gradation from white to dark red. The interactive features allow users to explore and learn how changing meteorological conditions and traffic volume influence ultrafine particle concentrations. Users can also select from multiple map layers, such as a street map or satellite view. The map legends and labels are available in both Chinese and English, and are thus accessible to immigrants and residents with proficiency in either language. The map can be either Web or desktop based.

CONCLUSIONS

The Air Pollution Map incorporates relevant language and landmarks to make complex scientific information about ultrafine particles accessible to members of the Boston Chinatown community. In future work, we will test the map in an educational intervention that features intergenerational colearning and the use of supplementary multimedia presentations.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Exploring Factors Influencing Smokers' Information Seeking for Smoking Cessation

This study addressed the factors influencing smokers' information seeking pertaining to the health risks of smoking. In particular, this study aimed to extend the risk information seeking and processing model by taking into account the role of autonomous motivations used to stimulate smokers' information-seeking behavior. The results of a Web-based survey indicated that information insufficiency was positively associated with health information-seeking behavior and that negative affective responses were positively associated with information insufficiency and health information-seeking behavior. In addition, autonomous motivations were positively associated with information insufficiency and information-seeking behavior. The results indicated that risk perception was positively related to autonomous motivations and negative affective response. Finally, informational subjective norm was positively related to autonomous motivations and negative affective responses. The implications of this study for future research are discussed.

The influence of graphic warning labels on efficacy beliefs and risk perceptions: a qualitative study with low-income, urban smokers

Background

Health communication theories indicate that messages depicting efficacy and threat might promote behavior change by enhancing individuals’ efficacy beliefs and risk perceptions, but this has received little attention in graphic warning label research. We explored low socioeconomic status (SES) smokers’ perceptions of theory-based graphic warning labels to inform the development of labels to promote smoking cessation.

Methods

Twelve graphic warning labels were developed with self-efficacy and response efficacy messages paired with messages portraying high, low, or no threat from smoking. Self-efficacy messages were designed to promote confidence in ability to quit, while response efficacy messages were designed to promote confidence in the ability of the Quitline to aid cessation. From January – February 2014, we conducted in-depth interviews with 25 low SES adult men and women smokers in Baltimore, Maryland, U.S. Participants discussed the labels’ role in their self-efficacy beliefs, response efficacy beliefs about the Quitline, and risk perceptions (including perceived severity of and susceptibility to disease). Data were analyzed through framework analysis, a type of thematic analysis.

Results

Efficacy messages in which participants vicariously experienced the characters’ quit successes were reported as most influential to self-efficacy beliefs. Labels portraying a high threat were reported as most influential to participants’ perceived severity of and susceptibility to smoking risks. Self-efficacy messages alone and paired with high threat were seen as most influential on self-efficacy beliefs. Labels portraying the threat from smoking were most motivational for calling the Quitline, followed by labels showing healthy role models who had successfully quit using the Quitline.

Conclusions

Role model-based efficacy messages might enhance the effectiveness of labels by making smokers’ self-efficacy beliefs about quitting most salient and enhancing the perceived efficacy of the Quitline. Threatening messages play an important role in enhancing risk perceptions, but findings suggest that efficacy messages are also important in the impact of labels on beliefs and motivation. Our findings could aid in the development of labels to address smoking disparities among low SES populations in the U.S.

Computer use, internet access, and online health searching among Harlem adults

PURPOSE

Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion.

DESIGN

Cross-sectional random digit dial landline phone survey.

SETTING

Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City.

SUBJECTS

Adults 18 years and older (N=646).

MEASURES

Demographic characteristics, computer use, Internet access, and online searching for health information.

ANALYSIS

Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods.

RESULTS

Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p<.01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%).

CONCLUSIONS

Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups.

Different strategies contribute to community physical activity program participation in rural versus metropolitan settings

PURPOSE

Determine if recruitment methods are differentially related to the reach of a physical activity program in metro/urban vs. rural settings.

DESIGN

Cross-sectional survey.

SETTING

Kansas counties.

SUBJECTS

Ninety-four Cooperative Extension agents responsible for 102 counties.

MEASURES

Promotional score, task force activity, and years of program delivery were assessed using a self-report survey. Reach was assessed for each county by dividing the number of participants by intended population using census data.

ANALYSIS

Rural/urban comparisons on reach were completed using a Mann-Whitney test. Multiple linear regression models were used to determine the relationship between independent variables and participation rate by setting type.

RESULTS

Metro/urban counties had lower mean participation rates than rural counties (z = -4.5; p < .001). In metro/urban counties, the regression on participation rate was significant (R(2) = .19; F = 4.09; p = .011), but only promotional score significantly contributed to the model (p = .003). In rural counties, the regression was also significant (R(2) = .34; F = 6.64; p = .001), with task force activity and years of delivery making significant contributions (p = .001 and p = .017, respectively).

CONCLUSION

Interpersonal methods may be more effective in recruiting physical activity program participants in rural settings, whereas using a greater variety of promotional methods may be more effective in metro/urban settings.

Attributions in explanations of risk estimates

In the spring of 1993, nearly 40 percent of Milwaukee-area residents experienced a nationally publicized outbreak of cryptosporidium, a parasite that infested the metropolitan drinking water supply. Using open-ended survey data gathered from 610 adult residents in the wake of that outbreak, this study looks at factors related to the ways in which people make sense of their quantitative personal risk estimates. The concepts of informal reasoning and attribution aided this endeavor. Analysis of open-ended comments about the risk of getting ill from a waterborne parasite indicated that explanations of personal risk were consistent with predictions made by attribution theory. Good outcomes, which included having remained healthy during the outbreak, were associated with a greater likelihood that respondents would attribute causation to themselves, while one specific bad outcome, having experienced the illness, was associated with a greater likelihood that respondents would attribute causation externally. This study also examined predictors of whether respondents employed probabilistic language in those attributions. Analysis indicated that income was positively related to the use of probability-oriented language, while age and race were negatively related to the use of such language (i.e., persons of color and older individuals were less likely to use such language).

Biotechnology in Switzerland: high on the public agenda, but only moderate support

In Switzerland, there have been intensive public debates about biotechnology because of the specific Swiss political system of direct democracy that led, in 1992 and 1998, to two national referenda on biotechnology regulation. As a result, the Swiss population is well informed but skeptical about this technology. These findings contrast with the deficit model of public understanding of science, which predicts a positive correlation between knowledge of, and support for, a specific technology. What role did the media play in the development of public opinion? This question is discussed because of a content analysis (time series) of national newspapers. In addition, representative surveys and focus groups yield insights into the public perception of biotechnology and the influence of mass communication for opinion formation.