Perceived Active Control over Online Health Information: Underlying Mechanisms of Mode Tailoring Effects on Website Attitude and Information Recall.

Previous tailoring research has traditionally studied effects of system-initiated message content to match individual characteristics. Recently scholars have explored how tailoring health information to individual modality preferences and processing styles can increase message effectiveness. Using a web-based experiment among a representative sample of Internet users (N = 392; 25-86 years), this study investigated the underlying mechanisms that might explain the effects of mode tailoring on website attitudes and recall of online health information. Results from structural equation modeling showed that mode tailoring - enabling users to self-customize a health website's presentation mode (via textual, visual, audiovisual information) - increased users' perceived active control, which in turn contributed to higher perceived relevance and website engagement, and reduced cognitive load. Positive indirect effects of mode tailoring (vs. no tailoring) through these mechanisms were found for both website attitude and information recall. The findings suggest that perceived active control is the key driver of mode tailoring effects. Mode tailoring can be a promising and novel strategy to maximize the effectiveness of tailored health communications. The authors discuss the implications for theory and design of digital health information.

Fear and forget: how anxiety impacts information recall in newly diagnosed cancer patients visiting a fast-track clinic.

INTRODUCTION: One-day fast track programs for cancer diagnostics and treatment planning are increasingly being implemented in health care. Fast-track programs are highly effective at reducing waiting times, and thus well received by patients and healthcare providers. However, these programs may also burden patients, as patients generally receive a lot of information from multiple healthcare providers within a short time span. This might increase anxiety and negatively impact recall of medical information in newly diagnosed patients. This study examines whether anxiety influences information recall at the moment of diagnosis, and whether this relation differs for younger and older patients. METHODS: Data were collected from 78 colorectal cancer patients visiting a one-day fast-track multidisciplinary outpatient clinic. All consultations that took place were recorded on a video. Anxiety was measured at baseline (T1) and immediately after consultations (T2) with the STAI-6. Information recall was assessed by telephone within 36-48 hours after patients' visit (T3) using open questions. RESULTS: After consultations (T2), 32% of patients experienced clinical anxiety levels. Patients recalled ∼60% of medical information (T3). Information recall was negatively impacted by anxiety (ß = -.28, p = .011), and negatively related to higher age (ß = -.23, p = .031), and lower education level (ß = .27, p = .013). Although older patients (M = 53.99) recalled 11% less information than younger patients (M = 64.84), age was not related to anxiety and did not moderate the anxiety-recall relationship. CONCLUSION: High levels of anxiety after receiving a cancer diagnosis negatively influence how much information patients remember after visiting a one-day fast-track clinic. This calls for interventions that may reduce patients' anxiety as much as reasonably possible and support patients' information recall. Researchers, practitioners, and hospitals are encouraged to continue exploring ways to optimize information provision to cancer patients in current modern healthcare.

Optimising eHealth tools for older patients: Collaborative redesign of a hospital website.

Most hospital websites have not been developed in collaboration with patients and, therefore, rarely take into account the preferences and abilities of older patients. This study describes the systematic redesign of an existing hospital website in a co-design process with patients and professional stakeholders (e.g. researchers, physicians, nurses, department heads, policymakers, website designers), with the aim to make it more user-friendly for older patients with colorectal cancer (CRC). The redesign process consisted of three phases, where (I) both existing content and design were evaluated among CRC patients; (II) a prototype website was developed based on these insights; which (III) was evaluated again before making final adjustments. Mixed research methods were used for the redesign process. Specifically, insights from existing literature, outcomes from qualitative and quantitative empirical studies conducted by our team, and expert knowledge from relevant stakeholders, were collected and discussed in multidisciplinary consensus meetings, and served as input for the redesigned website. While the existing website was evaluated poorly, the qualitative evaluation of the prototype website in phase 3 showed that the newly redesigned website was usable for older CRC patients. A practical roadmap on how to collaboratively redesign and optimise existing eHealth tools to make them suitable for and operational in clinical settings is provided.

Tailored Web-Based Information for Younger and Older Patients with Cancer: Randomized Controlled Trial of a Preparatory Educational Intervention on Patient Outcomes.

BACKGROUND: Many patients with cancer, including older patients (aged ≥65 years), consult the Web to prepare for their doctor's visit. In particular, older patients have varying needs regarding the mode in which information is presented (eg, via textual, visual, or audiovisual modes) owing to age-related sensory (eg, impaired vision and hearing) and cognitive decline (eg, reduced processing speed). Therefore, Web-based information targeted at older patient populations is likely to be used and processed more effectively, and evaluated more positively, when tailored to age-related capabilities and preferences. This, in turn, may benefit patient outcomes. OBJECTIVE: This randomized controlled trial tested the effects of a Web-based tailored educational intervention among newly diagnosed younger (<65 years) and older (≥65 years) patients with cancer. We compared the intervention group who viewed a mode-tailored website (ie, enabling patients to tailor information using textual, visual, and audiovisual modes) with 3 control groups view a nontailored website (ie, text only, text with images, and text with videos). We examined website experience outcomes (ie, website satisfaction, website involvement, knowledge, anxiety, and communication self-efficacy) and consultation experience outcomes (ie, question asking during consultation, anxiety, and information recall). METHODS: Patients from a multidisciplinary outpatient clinic (N=232) viewed a mode-tailored or nontailored website as preparation before their hospital consultations to discuss diagnosis and treatment. Data were collected before (T1), during (T2), and after (T3) visitation. Website experience outcomes were assessed with questionnaires (T1). Patients' question asking was coded from videotaped consultations, and anxiety was assessed through a questionnaire (T2). Telephone interviews were conducted to assess knowledge acquired from the website before (T1) and after consultation (T3), and information recall from the consultation (T3). RESULTS: The preparatory website was well used across all conditions (mean 34 min). Younger patients viewing the mode-tailored website were more satisfied before consultation (P=.02) and reported lower anxiety after consultation (P=.046; vs text only). This pattern was not found in older patients. Mode tailoring yielded no other significant differences in patient outcomes. Regression analyses showed that website involvement (beta=.15; P=.03) and, to a lesser extent, website satisfaction (beta=.15; P=.05) positively associated with knowledge before consultation (T1). In turn, higher knowledge before consultation (beta=.39; P<.001), together with time on the website (beta=.21; P=.002; T1), predicted information recall from consultations (T3). Patients with higher knowledge before consultation (T1) also reported higher knowledge from the website afterward (T3; beta=.22; P=.003). CONCLUSIONS: Offering preparatory online information before consultations benefits information processing and patient outcomes of both younger and older newly diagnosed patients with cancer. Younger patients benefit even more when information is offered in a mode-tailored manner. We discuss the theoretical, methodological, and practical implications for patient-provider communication research in an electronic health era. CLINICAL TRIAL: Netherlands Trial Register NTR5904; https://www.trialregister.nl/trial/5750.

Anxiety during cancer diagnosis: Examining the influence of monitoring coping style and treatment plan.

OBJECTIVE: Studies on anxiety within oncology show a high prevalence of anxiety both during and after the course of the disease. However, little is known about factors that influence the level of anxiety in the diagnostic phase. This study examines the presence of anxiety during diagnosis and treatment planning and explores how a monitoring (ie, information seeking) coping style and the suggested treatment plan (ie, with or without chemotherapy) interact with anxiety. METHODS: Anxiety scores (6-item State-Trait Anxiety Inventory) were collected from 81 colorectal cancer patients before and after their visit to the outpatient Gastrointestinal Oncological Center Amsterdam. A cut-off score (>44) was used to indicate highly anxious patients. RESULTS: More than half (59%) of the patients were classified as highly anxious before consultation. Although anxiety scores significantly decreased after consultation (t = 3.149, P = .002), 37% of the patients remained highly anxious. Reductions in anxiety were specifically observed for patients with a higher monitoring coping style and patients for whom a treatment plan without chemotherapy was proposed. Interestingly, high monitors for whom treatment without chemotherapy was proposed showed a major decrease in anxiety, whereas low monitors for whom treatment starting with chemotherapy was proposed showed a great increase in anxiety. CONCLUSIONS: The diagnostic phase is associated with high levels of anxiety. Distinct patterns of anxiety were identified, depending on patients' coping style and the suggested treatment plan. Remarkably, patients with a lower monitoring coping style became particularly anxious when they were advised to start treatment with chemotherapy.

How Tailoring the Mode of Information Presentation Influences Younger and Older Adults' Satisfaction with Health Websites.

Although older adults are increasingly using online health information, many websites are not senior-friendly, which might lead to user-problems and dissatisfaction among older people. It has been suggested that websites targeted at older adults should take into account age-related abilities and limitations, for example by providing the opportunity to adjust the modality (i.e., "mode") of information presentation based on visual and auditory capabilities. This study investigates the effects of a mode-tailored website, allowing users to self-tailor the mode of information presentation, on younger and older adults' satisfaction with health websites. The results from a 5 (condition: tailored vs. text, text with visuals, text with audiovisual, combination) × 2 (age: younger [25-45] vs. older [≥ 65] adults) experimental study (N = 563) show that mode tailoring positively influenced satisfaction with the attractiveness and comprehensibility of the website, as compared to non-tailored conditions. These effects on website satisfaction were not different for younger and older adults. The current study provides relevant insights for researchers and practitioners in the field of digital health communication.

Effects of preparatory and action planning instructions on situation-specific and general fruit and snack intake.

Evidence to date suggests heterogeneity in the effects of implementation intentions on health behaviour, including diet. Additional variables and study designs may impact on their effectiveness. Preparatory action, such as making sure fruits are available for consumption, may be an important additional variable. Likewise, most implementation intention research has focused on changes in general intake, yet implementation intention instructions typically require participants to consider behaviour in specific situations. Little is known on how implementation intentions impact situation-specific intake. The present study sought to add to the evidence base by comparing (1) the effects of action planning instructions versus preparatory planning instructions on (2) both situation-specific (as formulated in the implementation intention instruction) and general intake of fruits and in-between meal snack intake frequency. Fruit intake was assessed in average pieces per day, whereas snacking intake was assessed as average frequency in days per week. Using non-probability sampling, 243 undergraduate students who intended to have a healthy diet were randomized to either a standard information control condition, an action planning condition, or a preparatory planning condition. Planning manipulations were based on previous work. Two weeks later, general and situation-specific intake was assessed again in 181 participants. Data were analysed using 2 (time) x 3 (conditions) analyses of variance. Results showed that both planning manipulations were successful in decreasing snack intake frequency in the specified situation, with larger effect sizes for the action planning condition than for the preparatory planning condition. No effects were found on general snack intake frequency or fruit intake. Future planning interventions should more explicitly compare changes in situational and general intake, as well as simultaneously assessed decreases in unhealthy intake and increases in healthy intake.

Digital inequality in communication during a time of physical distancing: The case of COVID-19.

In times of physical distancing, such as during the COVID-19 pandemic, people are likely to turn to digital communication to replace in-person interactions. Yet, persisting digital inequality suggests that not everyone will be equally able or disposed to increasing digital communication during a public health crisis. Using survey data from a national sample of U.S. participants (N = 2,925) that we collected during the early months of the pandemic, we analyzed how sociodemographics, living arrangements, and Internet experiences and skills relate to increases and decreases in various digital communication methods. We find that people privileged in their socioeconomic status, their Internet skills and online experiences are more likely to increase and less likely to decrease digital communication during the pandemic. The findings illustrate how digital inequalities can put already disadvantaged groups at greater risk of diminished social contact during a public health crisis. We discuss the theoretical implications of our findings for digital inequality research, the practical implications for inclusive crisis responses, and directions for future research.

Changes in Digital Communication During the COVID-19 Global Pandemic: Implications for Digital Inequality and Future Research.

Governments and public health institutions across the globe have set social distancing and stay-at-home guidelines to battle the COVID-19 pandemic. With reduced opportunities to spend time together in person come new challenges to remain socially connected. This essay addresses how the pandemic has changed people's use of digital communication methods, and how inequalities in the use of these methods may arise. We draw on data collected from 1,374 American adults between 4 and 8 April 2020, about two weeks after lockdown measures were introduced in various parts of the United States. We first address whether people changed their digital media use to reach out to friends and family, looking into voice calls, video calls, text messaging, social media, and online games. Then, we show how age, gender, living alone, concerns about Internet access, and Internet skills relate to changes in social contact during the pandemic. We discuss how the use of digital media for social connection during a global public health crisis may be unequally distributed among citizens and may continue to shape inequalities even after the pandemic is over. Such insights are important considering the possible impact of the COVID-19 pandemic on people's social wellbeing. We also discuss how changes in digital media use might outlast the pandemic, and what this means for future communication and media research.

From Zero to a National Data Set in 2 Weeks: Reflections on a COVID-19 Collaborative Survey Project.

In March 2020, like much of the rest of the world, we went into lockdown. A week into our new reality, we decided to do a survey study about how people were experiencing the COVID-19 pandemic. In this piece, we describe what motivated us to do the study, how we went about it, and what others can learn from our experiences.

Customization in mobile health apps: explaining effects on physical activity intentions by the need for autonomy.

Given the widespread adoption and technical possibilities of mobile technology, mobile health apps could be potentially effective tools to intervene in people's daily routines and stimulate physical activity. Self-determination theory and the motivational technology model both suggest that mobile technology can promote health behaviour change by allowing users to customize their online experience when using mobile health apps. However, we know very little about why and for whom customization is most effective. Using a between-subjects experimental design, we tested the effects of customization in mobile health apps among a convenience sample (N = 203). We assessed the effects of customization on perceived active control over mobile health apps, autonomous motivation to use mobile health apps, and intention to engage in physical activity, and tested the moderating role of need for autonomy. Structural equation modelling showed that customization in mobile health apps does not increase perceived active control, autonomous motivation, or the intention to engage in physical activity. However, an interaction effect between customization and need for autonomy showed that customization in mobile health apps leads to higher intentions to engage in physical activity for those with a greater need for autonomy, but not for those with a lesser need for autonomy. The implications for theory and practice are discussed.

The effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents.

OBJECTIVE: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents. DESIGN: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2. MAIN OUTCOME MEASURES: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured. RESULTS: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version. CONCLUSION: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.