From Online to Offline: How Different Sources of Online Health Information Seeking Affect Patient-Centered Communication in Chinese Older Adults? The Roles of Patient Activation and Patient-Provider Discussion of Online Health Information.

Despite the increasing prevalence of online health information seeking (OHIS) among older adults, its impact on patient-centered communication (PCC) outcomes remains unclear. Drawing from Street's ecological framework of communication in medical encounters, the present study examined the mediation role of patient activation in the relationship between OHIS across three media channels - social media, search engines, and mobile health applications (mHealth apps) - and PCC. Furthermore, it examines the moderation effect of patient-provider discussions of online health information. A national survey of 916 older Chinese adults aged 60-78 was conducted. The findings indicate that OHIS across the three channels can indirectly enhance PCC through patient activation. Moreover, OHIS via mHealth apps is positively associated with PCC, while the relationship between OHIS via social media/search engines and PCC is not significant. The interaction between patients and healthcare providers regarding online health information positively moderated all indirect paths. Notably, a great proportion of older adults (77.7%) engaged in discussions about online health information with healthcare providers. These findings emphasize the importance of considering various media channels and highlight the pivotal role of patient activation in bridging the gap between OHIS and satisfactory healthcare interactions, especially in the Chinese context.

Serum metabolome alterations in hyperhomocysteinemia based on targeted and non-targeted MS-platforms.

BACKGROUND AND AIMS: Hyperhomocysteinemia (Hhcy) is a pathological condition marked by increased level of homocysteine and serves as an independent risk factor for a range of diseases including cardiovascular diseases and Alzheimer's disease. This study aims to examine alterations in Hhcy-related metabolites using serum metabolomics and unravel the distinct metabolic pathways involved, thereby offering a theoretical foundation for the early prevention and treatment of Hhcy. METHODS: Serum samples were collected from 56 individuals with Hhcy and 44 healthy controls. Metabolic alterations in Hhcy were assessed through multi-platform serum metabolomics analyses. Through multivariate statistical analysis and regression modeling, distinct metabolites in the serum were identified, and various metabolic pathways associated with Hhcy were investigated. RESULTS: Our findings revealed 21 significant different metabolites that distinguished Hhcy from healthy controls. These varied metabolites primarily comprised 10 organic acids, 4 amino acids, 2 fatty acids, and 5 other metabolites. The key differential metabolic pathways identified were the TCA cycle, pyruvate metabolism, arginine biosynthesis, as well as alanine, aspartate, and glutamate metabolism. CONCLUSIONS: This study elucidated the variances in metabolic profiles between Hhcy and healthy control groups, highlighting distinct metabolic pathways that may help explain the etiology of Hhcy. These findings offer valuable insights to address the knowledge gaps related to the metabolic alterations associated with Hhcy.

How Do Health Information Scanning and Seeking Influence Excessive Alcohol Drinking Among Chinese Hypertensive Drinkers? A Moderated Mediation Analysis.

China has a longstanding tradition of alcohol consumption, yet excessive drinking poses significant health risks, particularly for individuals with cardiovascular conditions such as hypertension. While existing literature indicates that both health information scanning and seeking behaviors can impact health beliefs and actions, their effects on alcohol prevention remain understudied. Utilizing data from a national survey in China, this study investigates the influence of health information scanning and seeking on alcohol risk knowledge and the frequency of excessive drinking among hypertensive drinkers. Results demonstrate that both health information scanning (b = -.018, p < .05) and seeking (b = -.030, p < .001) are negatively associated with excessive alcohol consumption indirectly through heightened awareness of alcohol as a risk factor for cancer. However, health information scanning is positively linked to excessive drinking directly (b = .203, p < .01). Additionally, cancer information overload positively moderates the relationship between awareness of alcohol as a cancer risk factor and excessive drinking (b = .148, p < .001). Hypertensive drinkers who experience lower levels of cancer information overload are more inclined to reduce excessive alcohol consumption. These findings underscore the different roles of health information scanning and seeking on alcohol control. It is important to implement interventions aimed at encouraging active information seeking and mitigating information overload. Educational programs should be promoted to help high-risk groups accurately understand the risk of excessive drinking.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults' emotional well-being via online patient-provider communication and perceived quality of care (2017-2020).

Purpose: To examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient-provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S. Methods: Data from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed. Results: The results indicated an increment in OPPC and a decline in patient's perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020). Conclusion: Our results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Association between health-related social media use and E-cigarette use among current cigarette users: the roles of anti-tobacco messages and harm perception.

BACKGROUND: The popularity of e-cigarettes is on the rise among current cigarette users. Therefore, there are concerns about their health implications. This study examined the impact of health-related social media use on e-cigarette use among current cigarette users. It assesses the mediating influence of online anti-tobacco messages and the moderating role of the harm perception of e-cigarettes. METHODS: This study was focused on 563 current cigarette users from the 2022 Health Information National Trends Survey (HINTS). Three tasks were performed: (1) assessing the direct and indirect impacts of health-related social media use on e-cigarette use among current cigarette users, (2) exploring the mediating role of exposure to online anti-tobacco messages, and (3) examining the moderating influence of e-cigarette harm perception on the path from anti-tobacco messages to e-cigarette use. RESULTS: Health-related social media use was positively associated with current cigarette users' e-cigarette use directly (bp = 0.183, p < .01) and indirectly through exposure to online anti-tobacco messages (bp = 0.023, 95% CI: [0.001, 0.051]). Harm perception of e-cigarettes moderated the relationship between online exposure to anti-tobacco messages and e-cigarette use (bp=-0.467, p < .01). The relationship appeared weaker for individuals who perceived greater harm from e-cigarettes. CONCLUSIONS: Health-related social media use positively correlates with e-cigarette use among current cigarette users through exposure to online anti-tobacco messages. The perceived harm of e-cigarettes moderates this indirect path. These findings have implications for public health interventions aimed at smoking cessation.

"I Saw it Incidentally but Frequently": Exploring the Effects of Online Health Information Scanning on Lung Cancer Screening Behaviors Among Chinese Smokers.

In China, lung cancer is the most common cancer with high mortality. While prior research suggests that health information scanning influences cancer screening within the general population, a deeper exploration of the underlying mechanisms is imperative. This study specifically targets smokers, aiming to investigate whether online health information scanning can effectively encourage lung cancer screening and elucidate the mechanisms driving this association. Data were extracted from a Chinese national survey conducted between January and September 2023, exclusively involving current smokers (N = 992). A moderated mediation model was employed to examine a cognitive-affective sequential chain of mediation through risk perceptions and cancer worry. Results showed that 99.1% of Chinese smokers reported online health information scanning, which possessed significant influence. Online health information scanning was positively associated with effective lung cancer screening among smokers directly (OR = 1.927, p < .01) and indirectly (OR = .065, p < .001). The perceived threat of smoking and cancer worry served as the cognitive and affective mediating mechanisms. Furthermore, a moderating effect of eHealth literacy was observed (OR = 6.292, p < .05). Smokers with higher eHealth literacy are more inclined to undergo effective lung cancer screening. Based on these findings, public health sectors should leverage online platforms to disseminate tailored cancer screening education and implement initiatives to enhance public eHealth literacy.

A four-year longitudinal analysis examining the effects of e-cigarette advertisements and disparities among youth with internalizing problems.

BACKGROUND: Prior research indicates a direct, short-term effect of e-cigarette advertising on e-cigarette use among youth. This study seeks to investigate the long-term effects of e-cigarette advertisements and disparities in exposure among adolescents with different levels of internalizing problems. METHODS: Panel data of the Population Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were analyzed. Youth aged 12-17 who were non-e-cigarette users at the time of Wave 3 were included (n = 4,678). A moderated mediation model was employed to examine the mediating role of perceived harm of e-cigarettes and the moderating effect of internalizing problems. RESULTS: Exposure to e-cigarette advertisements in Wave 3 predicted lower harm perception of e-cigarette in Wave 4 (bp = -0.055, p <.01), leading to more e-cigarette use in Wave 5 (bp = -0.042, p <.001). While e-cigarette advertisements exhibited a lasting indirect effect (bp = 0.002, p <.05), there was no long-term direct effect (bp = 0.017, p >.05) on youth e-cigarette use. Furthermore, a moderating effect of internalizing problems was observed (bp = 0.107, p <.05). CONCLUSIONS: E-cigarette advertisements can exert a lasting influence indirectly by diminishing harm perception, particularly among those with lower internalizing problems. Adolescents with higher internalizing problems exhibit lower susceptibility to advertisement influence, yet their perceived harm of e-cigarettes is notably lower than their peers with fewer internalizing problems. These disparities underscore the need for tailored prevention strategies: implementing anti-e-cigarette education programs for adolescents with low internalizing problems and providing mental health care for those facing internalizing challenges. Regulatory measures targeting e-cigarette advertising are also crucial.

How does patient-centered communication work? Trend analysis of mediation through cancer worry and health self-efficacy, 2011-2020.

This study proposed and tested the cross-sectional effects of patient-centered communication (PCC) on cancer screening behaviors via an affective-cognitive sequential chain of mediation through cancer worry and health self-efficacy. Cross-sectional data were analyzed from four iterations of the Health Information National Trends Survey (2011, 2014, 2017, and 2020). The results found that lowered cancer worry following PCC does not show a cross-sectional positive effect in promoting cancer screening behaviors, while enhanced health self-efficacy as a subsequent state is a facilitator of screening behaviors. The findings further demonstrated increased PCC, a rise in cancer worry, and a sustained level of health self-efficacy. Also, our research has identified an upward trend in cancer screening behaviors from 2011 to 2017, followed by a notable decrease in 2020. These insights underscore the nuanced ways PCC can foster cancer screening behaviors, emphasizing the importance of emotional and cognitive aspects in clinical settings.

Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication.

Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.

Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes.

Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.

How does health communication on social media influence e-cigarette perception and use? A trend analysis from 2017 to 2020.

OBJECTIVE: E-cigarettes have achieved a high prevalence rapidly. While social media is among the most influential platforms for health communication, its impact on attitudes and behaviors of e-cigarettes and its changes over time remain underexplored. This study aims to address the gap. METHODS: Four years of data (2017-2020) were derived from the U.S. Health Information National Trends Survey (HINTS) (aged 18-64 years, n = 9,914). Initially, key variables were compared across years. Furthermore, guided by the health belief model, we employed a moderated mediation model to examine the influence of social media health communication on the public's perceptions and behaviors related to e-cigarettes, distinguishing between smokers and non-smokers throughout the four-year period. RESULTS: The evidence shows a process of dynamic interaction between communication, perception, and behavior. (1) We observed an increasing trend of social media health communication (SMH) and perceived relative harm of e-cigarettes (PHE). (2) Higher SMH was associated with more e-cigarette use directly in 2019. (3) Higher SMH was associated with less e-cigarette use indirectly through PHE in 2020. (4) Smokers consistently displayed heightened sensitivity in responding to harm perception compared to non-smokers. CONCLUSIONS: The findings support two mechanisms underlying the association between SMH and e-cigarette use: direct and indirect. The changes in the pathways during the timespan may have been influenced by increased e-cigarette information on social media and public health events like COVID-19. Stricter regulations for unverified e-cigarette advertisements and anti-e-cigarette education on social media are called for to curtail e-cigarette use.

Longitudinal relationship between social media and e-cigarette use among adolescents: the roles of internalizing problems and academic performance.

BACKGROUND: Prior research has investigated the influence of social media on e-cigarette use among adolescents, predominantly through the display of e-cigarette content and advertisements. However, the psychological mechanism underlying this relationship remains underexplored. This study aims to address the mediating effect of youths internalizing problems and elucidate the moderating effect of academic performance from a longitudinal perspective. METHODS: Panel data from the Public Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were utilized in this study. The sample consisted of 3,975 youths between the ages of 12 and 17 years old. A moderated mediation model was utilized for analyses. RESULTS: Adolescents using social media more frequently in Wave 3 reported higher odds of internalizing problems in Wave 4 (bp = 0.061, p < .01), which led to more e-cigarette use in Wave 5 (bp = 0.029, p < .01). A negative moderating effect of academic performance was found in the association between internalizing problems and e-cigarette use (bp=-0.088, p < .05). CONCLUSIONS: Frequent social media use among young individuals leads to an increase in e-cigarette use through enhanced internalizing problems. However, adolescents who perform well academically exhibit higher resistance to e-cigarette use. Based on our findings, we recommend that tailored anti-e-cigarette campaigns and mental health interventions be used to target frequent social media users and academically struggling adolescents to prevent adverse health outcomes.

Social media and partnership jointly alleviate caregivers' psychological distress: exploring the effects of online and offline connectedness.

BACKGROUND: The prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation. OBJECTIVE: This study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being. METHODS: The predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving. RESULTS: A competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp = .0017, p < .05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p < .05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner. CONCLUSIONS: The findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving.

Ehealth and lifestyle change: The mediating roles of social support and patient empowerment.

Objectives: The purpose of this study was to investigate the impact of eHealth, the use of information and communications technologies to improve or enable health and health care, on lifestyle behaviors through social support and patient empowerment as serial mediators. Methods: We conducted an anonymous online survey of 29 items in October 2019 to assess Chinese people's eHealth activities (i.e. engaging in online health-related activities), social support (including emotional and instrumental support) and patient empowerment, for a lifestyle change. A total of 681 respondents aged 18 or above (49.9% males) with an average age of 30.8 completed the survey. Results: Social support (including emotional and instrumental support) and patient empowerment were found to be salient mediators between eHealth and lifestyle behaviors. Specifically, engaging in eHealth activities can improve both perceived emotional support and instrumental support from care networks, of which both would increase patient empowerment, which subsequently prompted healthy lifestyle behaviors (ß = .01, confidence interval (CI): [.003, .013] for emotional support as the first mediator; ß < .01, CI: [.003, .010] for instrumental support as the first mediator). However, the results showed that engaging in eHealth activities was not directly associated with a healthy lifestyle (ß = .01, p = .65). Conclusions: Our findings suggest that eHealth is effective and useful to drive people into action to develop healthy lifestyle behaviors. Particularly, by providing multiple potential sources of social support, eHealth will promote both emotional support and instrumental support, which is vital to increase patient empowerment, and eventually leads to healthy lifestyle behaviors.

Effects of electronic personal health information technology on American women's cancer screening behaviors mediated through cancer worry: Differences and similarities between 2017 and 2020.

Backgrounds: Thanks to their accessibility and low cost, electronic personal health information (ePHI) technologies have been widely used to facilitate patient-physician communication and promote health prevention behaviors (e.g. cancer screening). Despite that empirical evidence has supported the association between ePHI technology use and cancer screening behaviors, the underlying mechanism through which ePHI technology use influences cancer screening behaviors remains a topic of discussion. Objective: This study investigates the relationship between ePHI technology uses and cancer screening behaviors of American women and examines the mediating role of cancer worry. Methods: Data for this study were from the Health Information National Trends Survey (HINTS) collected in 2017 (HINTS 5 Cycle 1) and 2020 (HINTS 5 Cycle 4). The final sample included 1914 female respondents in HINTS 5 Cycle 1 and 2204 in HINTS 5 Cycle 4. Mann-Whitney U test, two-sample t-test, and mediation analysis were performed. We also referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp) for the comparison. Results: This study reports increased usage of ePHI technologies (from 1.41 in 2017 to 2.19 to 2020), increased cancer worry (from 2.60 in 2017 to 2.84 in 2020), and a stable level of cancer screening behaviors (from 1.44 in 2017 to 1.34 in 2020) among American women. Cancer worry was found to mediate the ePHI effect on cancer screening behaviors (bp = 0.005, 95% confidence interval [0.001, 0.010]) in a positive complementary mediation in 2020. Conclusions: The research findings support a positive association between ePHI technology use and cancer screening behaviors, and cancer worry has been identified as a salient mediator. An understanding of the mechanism that prompts US women's cancer screening practices provides practical implications for health campaign practitioners.

Effect of information encounter on concerns over healthy eating- mediated through body comparison and moderated by body mass index or body satisfaction.

BACKGROUND: Understanding factors that influence healthy or unhealthy eating can inform intervention strategies. This study ascertained whether and how unintentional exposure to food and nutrition information influenced healthy eating concerns. The study tested body comparison, body satisfaction, and body mass index as three mechanisms that potentially link food information encounter, commonly known as information scanning, to healthy eating concerns. METHODS: A sample of 440 online participants (mean age = 29.15 years) was used to investigate: (1) how unintentional exposure to food and nutrition information, i.e., information encounter (IE), affects healthy eating concerns (HEC); (2) how the effect of IE on HEC is mediated by body comparison (BC); (3) how the paths of the mediation model are moderated by body satisfaction (BS) or body mass index (BMI). RESULTS: The findings show a positive and sizable total effect of IE on HEC - a whole-scale increase in information encounter is associated with a substantial increase in healthy eating concerns by 15 percentage points (bp = 0.150). BC is found to mediate the effect of IE on HEC in an all-positive complementary mediation. Both the indirect and the direct-and-remainder paths show sizable effects. The mediated path contributes about 20% of the total effect between IE and HEC (cp = 20%), while the direct-and-remainder path contributes the rest (cp = 80%). BS was found to moderate the relationship between IE and BC, the first leg of the mediation. The moderation effect is large - the effect of IE on BC is much smaller on the highly and the moderately satisfied than on the lowly satisfied (slope differential bp = -.60). BMI was found to moderate the direct-and-remainder effect of IE on HEC, controlling BC. That is, the effect of IE on HEC, after filtering out the mediated effect through BC, is much larger for those with high or low BMI than those with healthy BMI (slope differential bp = .32). CONCLUSIONS: Exposure, even if unintentional, to food and nutrition information is an important predictor of HEC. BC, BS, and BMI are important factors that help to explain the process through which information affects behaviors.

"Nice You Share in Return": Informational Sharing, Reciprocal Sharing, and Life Satisfaction Amid COVID-19 Pandemic.

Social media become an important space where people receive and share up-to-date health-related information during the rapid global spread of the novel coronavirus (COVID-19). While information sharing in social media has been shown to improve relations, reduce stress, and enhance life satisfaction, little is known about reciprocal sharing. Situated in COVID-19 pandemic, this study conceptualizes information sharing as a communication process during which sharers expect the receivers to reciprocate, while receivers feel obligated to return the favor. Building upon social exchange theory and studies on social media sharing, the study tested a model of moderated mediation in which sharing of COVID-19 information was predicted to enhance life satisfaction by encouraging reciprocal sharing, i.e., information reciprocity. Subjective norms, attitudes, and perceived usefulness of the information was predicted to moderate the mediation. The hypothesized mediation was supported by data from a survey of 511 online participants in China. Furthermore, the indirect effect appeared stronger among the respondents who found the information more useful, reported more positive attitude, or perceived more subjective norms. The findings suggest that expected reciprocation may be an important incentive for social sharing, and received reciprocation may be a central part of the mechanism through which sharing benefits the sharer. Policymakers and communicators may need to take information reciprocity into consideration when designing health information campaign to confront communal threats.

COVID-19 information exposure and vaccine hesitancy: The influence of trust in government and vaccine confidence.

As the novel coronavirus (COVID-19) continues to spread, vaccine hesitancy increasingly threats public health worldwide. Health information from traditional, online and social media may influence vaccine hesitancy. The purpose of this study was to explore the influence of exposure to COVID-19 information from various media on vaccine hesitancy, as well as the mediating roles of public trust in government and vaccine confidence. With a sample of 438 online participants (mean age = 30.69 years) responding to an anonymous questionnaire, the study tested a mediation model using bias-corrected bootstrap. The results indicated that exposure to COVID-19 information from online news media and traditional media can reduce vaccine hesitancy indirectly. Whereas a positive and indirect relationship between COVID-19 information exposure on social media and vaccine hesitancy was revealed. Trust in government and vaccine confidence were found to be salient mediators between exposure to COVID-19 information from various media and vaccine hesitancy. Findings from this study offer implications for strategies to address vaccine hesitancy.

Associations Between COVID-19 Information Acquisition and Vaccination Intention: The Roles of Anticipated Regret and Collective Responsibility.

While public health communication has been suggested to be a key for improving acceptance of COVID-19 vaccination, this study tested mediation pathways through which three types of vaccine information acquisition, i.e. seeking, scanning, and discussing, affect COVID-19 vaccination intention. The pathways comprise two mediators, i.e. anticipated regret due to inaction and collective responsibility. Results suggest that information seeking and discussing may have encouraged the intention to get vaccinated, but mainly indirectly through the two mediators. Information seeking and discussing may have elicited anticipated regret and collective responsibility, which in turn increased vaccination intention. The paths from information scanning were smaller in effect sizes and statistically unacknowledged. Implications and limitations are discussed.

The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors' Health Outcomes: Cross-sectional Survey Study.

BACKGROUND: In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer). OBJECTIVE: This study aims to investigate the effects of the use of PAEHR portals on cancer survivors' health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy. METHODS: Data for this study were derived from the Health Information National Trends Survey (HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95% bootstrapped CIs were used with 10,000 resamplings. RESULTS: No positive direct associations between PAEHR portal use and cancer survivors' health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors' psychological health via (1) PCC (bp=0.029; ß=.023, 95% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; ß=.005, 95% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors' physical health (bp=0.006; ß=.004, 95% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged. CONCLUSIONS: This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors' physical and psychological health.