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In the past, patients relied on their health care providers for information and guidance on new medications and therapies. Today, patients come to their physician’s office armed with a handful of newspaper articles and computer printouts of the latest medical advances and treatments. Americans are increasingly using the Internet and all types of media to seek health information. The need to provide effective cancer-related information in this dynamic environment is challenging the mission of health care communicators.

Historically, communication about new advances in cancer research and treatment was directed to health care providers, who would disseminate the information to their patients. However, patients today have unprecedented access to medical and health information due to the diffusion of the Internet and improved coverage of medical health news. Over 93 million Americans are surfing the Internet for medical information. Of those, 68 percent have suggested that the information obtained had some impact on a health related decision made either for themselves or a loved one. This presents a challenge to health communicators to maximize the impact of messages about cancer-related information, whether it occurs in the doctor’s office, through the Internet, newspaper articles or television.

Health communications researchers and practitioners are studying how access to an increasing number of disparate sources of medical information is changing the way people obtain medical information and how they are using the information they obtain. Unfortunately, the progress of this research is being impeded due to the lack of data revealing how Americans are using different channels of health communications. To address this need for resources that would enable health communicators to evaluate the effectiveness of messages about cancer, the National Cancer Institute (NCI) initiated the H ealth Information National Trends Survey (HINTS) in 2002. This national survey, conducted every two years, provides information to track trends about how messages on cancer prevention, detection, diagnosis, treatment, and survivorship are being received by the public. The acronym suggests its purpose: to provide important insights, or hints, into the health information needs and practices of the American public.

“This biennial report can be used to determine trends of how people are using a variety of resources to obtain health information,” said Bradford Hesse, Ph.D., acting director of Health Communication and Informatics at NCI and leader of the HINTS initiative. “ In addition, the data can be used to study changes in behavior that have resulted from access to various channels of health communication. Therefore the survey is not only a surveil lance tool, but can be used to study relationships of how knowledge about health care is dependent on these channels of communication.”

The first HINTS survey was conduced from 2002 to 2003 and will serve as baseline data for subsequent surveys. The survey design included telephone interviews with more than 6,300 people, age 18 years or older, and was conducted in both English and Spanish. Those interviewed represented a cross section of the United States. The survey assessed general information about cancer, and knowledge about cancer risk. Questions regarding demographics, diet, exercise and lifestyle also were included to help researchers determine the health status, ethnicity, and economic status of each respondent. Questions such as “How often did your doctor or health professional explain things in a way you could understand?” or “How much attention do you pay to information about health or medical topics on television, radio, newspapers, magazines or the Internet?” provide insights into the resources people consider first for cancer-related information. The data collected provides an invaluable resource to study the cancer communication practices, information preferences, risk behaviors, attitudes, and cancer knowledge across the country.

Data from the 2003 HINTS survey revealed some interesting and perplexing insights into how Americans understand messages about cancer. When asked “If you have a strong need to get information about cancer, where do you go first?” the majority of those surveyed ( 49 percent) preferred to go to their health care provider and indicated a high level of trust for the information they received. When asked, “Have you ever looked for information about cancer?” about 47 percent indicated the Internet was their first source which far exceeded by the number of those going first to their health care providers (11 percent). The tendency to seek information initially from the Internet may reflect the ease that information can be obtained and diversity of information available. The survey data support the trend that the Internet is becoming the primary resource when seeking information about cancer.

Other questions in the survey address the views of respondents regarding information about cancer prevention. When asked if they agreed or disagreed with the negative statement “There is not much people can do to lower their risk of cancer, 72 percent either strongly or somewhat disagreed. On the other hand, when asked if they agreed or disagreed with the statement “There are so many recommendations about preventing cancer, it’s hard to know which ones to follow” about 77 percent either strongly or somewhat agreed. “Most people feel that there are things they can do to prevent cancer, but they are confused by conflicts in the recommendations. We need solutions to how we can better communicate these issues to the public,” said Hesse.

The survey also identified a “knowledge gap” that exists in the United States regarding cancer and awareness of cancer risk. This represents not only differing levels of access to health information, but knowledge about this disease as well. If respondents lived in the northeastern or southwestern states, they were more conscious about health and were better informed about the increased risk of cancer from smoking, for example. This was in contrast to people living in southeastern areas where respondents were less likely to recognize the link between smoking and lung cancer. Researchers are using HINTS data to create geographic plots, or maps, of the United States showing where gaps in knowledge exist and areas that will require increased efforts to provide accurate cancer information. Health care communicators then can develop campaigns to match the needs of each geographical region.

“This will be a great resource for health communication researchers, who can use the baseline data and compare it to future surveys to determine the effectiveness of interventions to increase knowledge about cancer or change behaviors,” Hesse stated. “We don’t have the silver bullet. I can’t tell you that these are the five things you can do to improve perceptions and knowledge about cancer; it will take groups studying this data; to make significant changes.”

The 2003 dataset is publicly available from the HINTS Web site http://hints.cancer.gov and HINTS briefs are being created that will provide easily understood summaries of each biennial survey. Data from the HINTS 2005 survey will be available later this year on the HINTS Web site.

References

• 2005 Pew Trends report (http://pewresearch.org/trends/).  
• Nelson DE, Kreps GL, Hesse BW, Croyle RT, Willis G, Arora NK, Rimer BK, Vish Viswanath K, Weinstein N, Alden S. “ The Health Information National Trends Survey (HINTS): development, design, and dissemination,” Journal of Health Communication , 200 4; 9: 4 43– 460.
• Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, Viswanath K. “Trust and sources of health information: the impact of the internet and its implications for health care providers, findings from the first Health Information National Trends Survey (HINTS),” 2005 in preparation.

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