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Abstract
This study tests an expanded Structural Influence Model (SIM) to gain a greater understanding of the social and cognitive factors that contribute to disparities in cancer risk knowledge and information seeking. At the core of this expansion is the planned risk information seeking model (PRISM). This study employed an online sample (N = 1,007) of African American, Hispanic, and non-Hispanic White adults. The addition of four cognitive predictors to the SIM substantially increased variance explained in cancer risk knowledge (R2 = .29) and information seeking (R2 = .56). Health literacy mediated the effects of social determinants (socioeconomic status [SES] and race/ethnicity) on cancer risk knowledge, while subjective norms mediated their effects on cancer risk information seeking. Social capital and perceived seeking control were also shown to be important mediators of the relationships between SES and cancer communication outcomes. Our results illustrate the social and cognitive mechanisms by which social determinants impact cancer communication outcomes, as well as several points of intervention to reduce communication disparities.
ACKNOWLEDGMENTS
The work was supported by the Kellogg Health Scholars Program, under grant P0117943 from the W. K. Kellogg Foundation to the Center for Advancing Health (Hovick) and the University of Texas at Austin, College of Communication, Junior Faculty Fellowship (Kahlor). Dr. Hovick is also supported in part by a cancer prevention fellowship (National Cancer Institute grant R25T CA57730, Shine Chang, PhD, principal investigator) and by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672.
Notes
1 We assess partial mediation because complete mediation is likely rare in practice (Baron & Kenny, Citation1986; Preacher & Hayes, Citation2008). It is also unlikely that proposed mediators account totally for the relationship between social determinants and communication.