Examining Online Health Information Seeking, Health Motivations, and Cancer Screening Knowledge Among Korean Americans Using Cognitive Mediation Model

Background and Purpose: Colorectal cancer (CRC) screening outcomes for Korean Americans (KAs) remain suboptimal, falling short of the Healthy People 2020 goal (70.5%). Research has shown that such underutilization of the screening tests is associated with limited knowledge of screening guidelines. Furthermore, a growing evidence of research reveals the positive associations between cancer screening knowledge and online health information seeking (OHIS) behaviors motivated by health concerns and needs. However, little is known about the mechanisms by which OHIS behaviors develop cancer screening knowledge among KAs. Thus, this study adopted the Cognitive Mediation Model (CMM) as a theoretical framework to examine factors of OHIS and health motivations contributing to CRC screening knowledge among KAs. The CMM posits that people’s motivations influence their health knowledge development through attention to health information.

Methods: Convenience sampling was performed to recruit KAs aged 50 and 80 from a metropolitan area in the Southeastern U.S. A total of 421 participants completed a cross-sectional survey as to information regarding socio-demographics, OHIS, health motivations (i.e., self-rated health status and history of cancer and CRC screening), and CRC screening knowledge. Most participants were female (61%), married (84%), and insured (73%). The mean age of the participants was 58.7 (SD=8.02), 60% had completed college, and 42% had an annual household income below $40,000. About 47% self-rated their English proficiency as very poor or poor; 9% self-rated their health status as very poor or poor.

Hierarchical linear regression analyses were implemented to investigate if three blocks of variables significantly reduce unexplained variance in CRC screening knowledge. Based on the CMM, the three blocks of variables were added to the regression model in the following order: [1] sociodemographic characteristics, [2] OHIS, and [3] health motivations.

Results: Block 1 (=[1]) accounted for 25.0% of the variance in CRC screening knowledge (F[7, 262]=12.467, p<.001) with Education (β=.140, SE=.180, p<.05) and English proficiency (β=.363, SE=.193, p<.001), respectively, predicting CRC screening knowledge. Next, Block 2 (=[1]+[2]) significantly increased the portion of explained variance (ΔR²=.038, p<.001) with English proficiency (β=.337, SE=.190, p<.001) and OHIS (β=.212, SE=.050, p<.001), respectively, predicting CRC screening knowledge. In the final step, Block 3 (=[1]+[2]+[3]) accounted for 30.1% of the variance in CRC screening knowledge (F[12, 257]=9.216, p<.001) with OHIS (β=.201, SE=.051, p<.01), English proficiency (β=.322, SE=.195, p<.001), and CRC screening history (β=.112, SE=.110, p<.05), respectively, predicting CRC screening knowledge. However, Block 3 did not significantly reduce the portion of unexplained variance.   

Conclusions and Implications: This study found OHIS and previous CRC screening experiences to be a factor contributing to CRC screening knowledge among KAs, which is consistent with the CMM. The findings suggest that there is the need for social workers to develop interventions that promote KAs’ engagement in online activities, including searching for CRC screening guidelines and navigating healthcare systems online. For practice, the findings highlight the critical role of medical social workers in helping KAs have positive experiences in receiving CRC screening. These efforts will lead eventually to increasing CRC screening through improving screening knowledge among KAs.