Neuhauser, L, & Kreps, G.L. (2008). Online cancer communication: Meeting the literacy, cultural and linguistic needs of diverse audiences. Patient Education and Counseling, 71, 365-377.

• Those with more limited access to information about cancer are more likely to develop it.
• Some possible influences:
  • literacy
  • race/ethnicity
  • language
• African American men - more likely to die from lung, colon, prostate cancer
• African American woment - colon and breast cancer
• cancer leading cause of death among Asian American women
• Vietnamese women - higher rates of cervical cancer
• Human factors are the biggest predictors of cancer
  • risk factors primarily behavioral - smoking, diet and exercise
  • how do we develop successful interventions that target our populations?
• communication considered a powerful weapon
  • uses selected media
  • aimed towards targeted audiences
  • documented that this often results in behavior change
  • multiple methods of communication are considered to be the most effective
  • community-based outreach is also a factor
• traditional communication methods are often not as effective for minority populations
  • construct better models that better reflect the complexity of social dynamics and culture
  • more contextually relevant materials
  • can reach many individuals but on a more personal level
  • use multiple and interactive means reaching the masses
• online communication - seen as having quite a bit of potential
  • reaches a broad audience
  • 24/7/365
  • interactive
  • social networking
  • multimedia
  • can be anonymous
  • can target and tailor groups
• more people have access to information
  • evidence - can empower and improve knowledge, behavior (and outcomes?)\
• does online information meet the needs of linguistically and culturally diverse audiences?
• Current paper - literauture search on online cancer support (THERE IS A LOT OF LITERATURE ON CANCER)
  • keyword searches did not seem as effective as grandfathering
  • 300 papers considered that were on-topic
• Use of online cancer communication
  • all literature was based upon US sites
  • Health Information national trends survey (HINTS) - people often go to the internet before consulting books magazines, etc...
• Literacy factors related to health information
  • 2003 - 43% of  American adults had a literacy level measured as basic or below basic
  • low literacy worldwide
  • recommends making sure that text readability is matched to literacy levels (between 7th and 9th grade)
  • 20% of Americans - below the 5th grade level
  • health information - typically complex and full of jargon
    • concept: "health literacy"
    • low literacy - prevents understanding prevention, screening, and treatment
    • lower health literacy - more likely to be diagnosed with cancer
  • very few tools exist to measure health literacy levels
  • more likely to be low for older adults (70% of all cancer diagnosis)
• Readability and usability of online cancer communication
  • 800 studies - most literature is written above high school
  • only 1% of the literature is considered to be usable
  • most require at least a high school reading level in both English and Spanish
    • 12.9 and 10.7 grade level when subjected to SMOG and Flesch-Kincaid tests
    • most scored difficult to read
  • Additional literacy demands
    • search terms
    • spelling
    • navigation
    • following links
  • referred to as usability
    • US - http://www.usability.gov
  • little research on usability and cancer
  • what is available seems to state that usability is not good
  • little information about whether steps to increase readability and usability result in positive outcomes
• Language factors in online cancer communication
  • 2007 - 30.1% of internet users were English speakers (does not say to what level)
  • most websites are in English
  • number of users that speak other languages is growing
  • no analyses of language content and the Internet
  • most websites did not translate their content (IS THIS A GOOD IDEA, ANYWAY?)
  • more likely to use content in the local language
  • most information about language factors came from inferred sources
  • literal translation - too simplistic and may not motivate behavior change
• Cultural factors in online cancer communication
  • racial and ethnic disparities - is information culturally and ethnically appropriate?
  • people from different racial and ethnic groups may be coming to the internet looking for different information
• Online cancer communication among minority populations
  • "digital divide" - has been an issue
  • some accessibility gaps have narrowed over the years, but it is still a concern
  • most studies about racial/ethnic groups' use of the internet comes from the US
  • African Americans, Hispanic and non-Hispanic other groups reported to have preferred to receive information from a healthcare provider instead of the internet
  • not as confident that they would get the advice that they needed
  • Spanish speakers especially reported preferring written information over digital
    • used the internet for entertainment as opposed to information seeking
    • although less likely to use internet, those who did had positive outcomes with regard to social support
  • Asians - less likely to use the internet
  • lower computer ownership among Hispanics when compared with Whites
  • However, results are somewhat mixed
    • CHESS - low income AA women used online cancer communication as often as their white counterparts
• Cultural Relevance of online cancer communication
  •  very little research on cultural relevance
  • e.g., foods for people with different ethnic or cultural backgrounds
  • while some were culturally relevant, literacy levels might have prevented access (I'M SORRY IF THAT SOUNDS RACIST - COMES FROM THE REVIEW)
  • Cultural Sensitivity Assessment Tool used for one study - not a validated measure - found that cancer decision websites were "culturally sensitive"
    • however, developed for AA
• Discussion and Conclusion
  • communciation barriers - literacy culture, language
  • too generic
  • too passive
  • not tailored to diverse needs
  • people are missing out on information