Looking Beyond the Internet: Examining Socioeconomic Inequalities in Cancer Information Seeking Among Cancer Patients

Abstract

The gap in cancer information seeking between high-socioeconomic-status (high-SES) cancer patients and low-SES cancer patients deserves serious attention, considering the importance of information and knowledge in cancer control. We thus explored the association of SES, as measured by education, with cancer patients' overall cancer information seeking, and with seeking from each source (i.e., the Internet, mass media, medical sources, and nonmedical interpersonal sources) and across two topic categories (i.e., treatment, quality of life). We then asked whether the effect of education on treatment information seeking is reduced among those who are particularly motivated to control treatment choices. We conducted a survey with breast, prostate, and colon cancer patients diagnosed in 2005 (n = 2,013), who were randomly drawn from the Pennsylvania Cancer Registry in the fall of 2006. We found that education was more strongly associated with Internet use than with the use of other sources regardless of topics. Also, when information was sought from mass media, education had a greater association with treatment information seeking than with quality-of-life information seeking. Preference for active participation in treatment decision making, however, did not moderate the effect of education on treatment information seeking. The implications of these findings for public health research and cancer patient education were discussed.

ACKNOWLEDGMENTS

This article was supported by grant 5P50CA095856-05 from the National Cancer Institute (NCI). We acknowledge that the NCI does not bear any responsibility for the content reported in this article. We are grateful to Katrina Armstrong, Angel Bourgoin, Xiaoxia Cao, Taressa Fraze, Derek Freres, Bridget Kelly, Lourdes Martinez, Rebekah Nagler, J. Sanford Schwartz, Aaron Smith-McLallen, and Norman Wong for their insightful comments on earlier drafts of the article and/or contributions to instrument development and data collection, and to Robin Otto, Craig Edelman, and personnel at the Pennsylvania Cancer Registry for collaboration on sample development. We also thank Brian Southwell and two anonymous reviewers for their invaluable comments on earlier versions of this article.

Notes

¹AAPOR response rate number 4 refers to the method by which the response rate was calculated for the survey. The American Association for Public Opinion Research has created standardized definitions of response rates, which distinguish between response rates and cooperation rates, cover household, telephone, mail, and Internet modes of administration, discuss the criteria for ineligibility, and specify methods for calculating refusal and noncontact rates. As a result, response and nonresponse rates can now be successfully compared across surveys of different topics and organizations. In addition, these definitions and their widespread acceptance have resulted in a greater willingness of researchers to report low response rates. AAPOR recommends that researchers include in their survey reports the response rate, computed according to the appropriate AAPOR formula—in this case the appropriate response rate number 4.

²We used only one's own education levels in testing the association of education with information seeking done by friends and family as well as by oneself, assuming that our respondents' family and friends have similar levels of education. This assumption is based on the “homophily,” which refers to “the principle that a contact between similar people occurs at a higher rate than among dissimilar people” (McPherson, Smith-Lovin, & Cook, 2001, p. 416). Since social scientists started systematically observing people's social networks and group formations in the 1920s and 1930s, scholars have remarkably consistently detected substantial homophily by sociodemographic, behavioral, and psychological characteristics (McPherson et al., 2001).