How does the information-seeking literature portray avoidance?
The information-seeking literature—most of it concerned with practical issues regarding the stages, mechanisms, processes, channels, sources, and sometimes barriers that mediate information seeking—cites relatively few behavioral theories [45, 46
]. And given that virtually all of this literature assumes that people choose to seek information, the idea of avoiding information is rarely discussed. The notion of avoidance more commonly appears in discussions of research models [1, 4, 6, 47
]. Among these, only Johnson's and Wilson's information-seeking models explicitly discuss mechanisms whereby people may avoid information. In contrast, the other models tend to limit themselves to the selection
of certain information in preference to other information.
A model of “information behaviour” by Wilson [6
] is the latest in a series of diagrams dating back to 1981. Wilson identifies the factors in his model from literature in other fields, including “decision making, psychology, innovation, and health communication and consumer research” [6
]. Wilson's complex model () invokes explicit theories at points to explain why some needs prompt information seeking more so than others (stress/coping theory, from psychology), why some sources of information are used more than others (risk/reward theory, from consumer research), and why people may, or may not, pursue a goal successfully, based on their perceptions of their own efficacy (social learning theory, from psychology).
Wilson's model of “information behaviour”
Wilson's “activating mechanisms” can be thought of as motivators: What motivates a person to search for information, how, and to what extent? These motivators are affected by intervening variables of five types: psychological predispositions (e.g., tendency to be curious or averse to risk), demographic background (e.g., age or education), factors related to one's social role (e.g., role as a manager or a mother), environmental variables (e.g., available resources), and characteristics of the sources (e.g., accessibility and credibility).
An important aspect of Wilson's model is that it explicitly recognizes avoidance behaviors in its references to psychological literature on coping and stress. These behaviors are invoked immediately after a need arises. The importance of this model is its recognition that the typical “intervening variables” (psychological, demographic, role-related, environmental, or source characteristics) may not come into play,
if the nature of the need or the information needed to address it is too threatening or stressful. Although Wilson does not discuss it in detail, a later “activating mechanism” also contains a component that is relevant to avoidance: self-efficacy as represented in Bandura's [48
] social learning theory (more recently called the “Theory of Planned Behavior”). Similar to Johnson's model, perceptions of self-efficacy are also related to avoidance behaviors.
Johnson's model, “the Comprehensive Model of Information Seeking” (CMIS), has been cited repeatedly in reviews of the information-behavior literature (e.g., Case [49
], Rice et al. [50
], and Wilson [6
]) and is particularly helpful in understanding health-related information seeking—or avoidance. It contains seven factors under three headings. It is pictured as a quasi-causal process that flows from left to right (), beginning with four “antecedent” factors. The significance of the components of Johnson's model's is not obvious in its depiction but rather is explained in depth in his writings.
Johnson's Comprehensive Model of Information Seeking (CMIS)
In Johnson's CMIS, the antecedent factors motivate a person to seek information. The first two are grouped together under the label of “background factors,” for example, “demographics” (i.e., one's age, gender, and ethnicity, along with socioeconomic variables like education, occupation, wealth, etc.). A background factor far more difficult to characterize is one's “direct experience” in relation to the domain of interest. The concept of experience brings up issues of knowledge representation and memory too complex to consider here; suffice it to say that typically one starts out knowing something—perhaps little or a great deal—about the phenomenon of interest, as well as about the ways one can find out information about it. Thus, a key concept under the heading of experience is the “social network” of the individual with an information need: “Who do I know who might know the answer to my questions or know how to find out?” For example, Johnson focuses on information about cancer, and thus a prime determinant of knowledge is: “Who do I know who has had cancer?” Because a majority of families are touched by the disease in some way and because the occurrence of cancer in one member of the family often motivates other family members to seek information about treatment, cancer information has high levels of social significance.
Just as the first and second factors are grouped together, the third and fourth fall under the heading of “personal relevance.” Most of the subtopics of this review fall under the personal relevance category, including fear, denial, avoidance, and ignoring of information. Personal relevance factors include “beliefs” about the topic invoked and the “salience” of information about it. Both depend on a person's degree of knowledge—or, conversely, their state of ignorance— about the topic, and both indirectly invoke the issue of avoiding information.
Johnson says that “ignoring … happens when an individual consciously knows that a problem exists, but chooses not to confront it” [1
]. Mere ignorance, by itself, is not typically a motivator for information seeking. People are only motivated to seek information when they both know that they are ignorant and
the missing information becomes salient. As we explore below, sometimes people prefer to be ignorant, particularly in matters of health. A confounding problem is that people sometimes believe information that turns out to be flawed. These kinds of false truths
can suppress or distort information seeking.
The concept of salience implies that information is not only perceived to be relevant to a need, but that it is also applicable to a person's concerns. Thus, salience is the key motivator in deciding to look for information [1
]. Beliefs are important in information seeking because they constrain the individual's thinking and level of motivation regarding information seeking: the beliefs that a person has about the world and answers to questions like: “Is there a problem?” “Is there a solution?” and “Can I change my situation?” Beliefs are not only about facts, but also about our relation to the current situation, in other words, people's degree of control over events, their self-efficacy. If people do not believe that knowing more about a topic will allow them to effect a change, then they are not likely to seek information. Conversely, feeling that they can solve a problem will motivate them to find the means to do so—which includes information.
The second column of Johnson's model, “information-carrier factors,” encompasses the factors that have preoccupied many older studies of information seeking: the “characteristics” and “utility” of the information channels seekers select and use. As Johnson highlights [1
], what information seekers are concerned about is the content of the information, not the channel through which it arrives. However, people have a strong preference for information that comes directly from other people. Use of other channels tends to be predicted by the social presence
they offer, that is, how much they are perceived as being like a face-to-face conversation with another person or, as Johnson puts it, “the extent to which they reveal the presence of other human interactants and can capture the human, feeling side of relationships” [1
Regarding the utility of channels, Johnson says that they are selected on the basis of their match with the seeker's needs and expectations regarding likely satisfactions to be obtained. Potential utility is equated with “interest, usefulness and importance for achieving one's goals” [1
]. Johnson cites studies suggesting that ease of accessibility often wins out over authoritativeness (the latter implying better utility).
The final components of Johnson's model are “information-seeking actions.” Searches for information involve conscious choices among channels and sources but also imply processes, feelings, and a whole host of other behavioral and cognitive elements. Johnson notes that among the more general difficulties inherent in studying the actions people take when they look for information is a distinction between active and passive acquisition. It is difficult, if not impossible, to know whether someone has sought and found information in their environment (active acquisition) or, instead, been exposed to it in a public service announcement while watching television for other reasons (passive acquisition).
Models for studying avoidance of threatening health information
These new models of information seeking by Wilson and Johnson have explicitly addressed the issue of information avoidance, each in a different way. Both the Wilson and Johnson models address relevant aspects of empirical findings on health-related information seeking (below). This is particularly true of the Johnson model, because it has been developed with cancer information seeking in mind. Both models allow for a decision (conscious or unconscious) to avoid information, and both incorporate the concepts of anxiety and self-efficacy as motivating or inhibiting factors.
Wilson's model depicts anxiety as the initial “activating mechanism” that determines whether one decides to pursue information, in which case, other “intervening” variables may come into play. In Johnson's model, emotions like fear and actions like denial or “ignoring” information are found among the “personal relevance factors.” In both models, self-efficacy plays a key role in the decision to seek information. In Wilson's model, the self-efficacy concept is explicitly invoked, while in Johnson's model, it is subsumed under individual judgments of the salience of information.
We will now consider how information avoidance occurs in one area of human behavior, learning about cancer, and the implications for research on that topic.
An example: avoiding information about cancer
A focus on the avoidance of information contrasts with the emphasis of most information-campaign research. Much of the (especially early) literature on health information overemphasizes human rationality and efficiency in information seeking (e.g., see the reviews in Rice and Atkin [51, 52
]). Yet as Rimal and Real [53
] indicate, the “self-protective” aspects of information seeking tend to be neglected in the health literature. Public health professionals recognize that encouraging safe practices by emphasizing potentially harmful effects may be “tuned out” by readers, viewers, and listeners who simply “would rather not know.” This issue is increasingly critical, because the health consumerism movement has placed responsibility for decision making in the hands of individuals. That makes examining the role of information seeking in regard to health matters even more important to reduce morbidity and mortality.
Perhaps no health problem results in as much anxiety as facing the threat of cancer. Cancer is especially difficult to cope with because it is represented by a variety of diseases and stages. It is also a threat of almost mythic dimensions: virtually everyone knows someone who has had and perhaps has even died of cancer. The mass media are filled with reports about cancer and its victims.
Avoiding information is closely linked to feelings of anxiety and fear, as well as to other cognitive and emotional variables like perceptions of treatment efficacy, self-efficacy, and locus of control (the degree to which one's fate is governed externally versus controlled by one's self). While information is often thought of as reducing
anxiety, such is not always the case. A recent study of the effects of a consumer health information service [54
] found that 52% of the people who received information said that it reduced their anxiety about a health concern; yet for another 10%, having the medical information increased
their anxiety. While 10% is a modest percentage, it at least indicates that receiving more information does not have the same positive results for everyone.
Raised anxiety is tied to perceptions of efficacy
in several ways. Anxiety is related to individual beliefs in the efficacy of medical procedures associated with cancer [55, 56
]. That portion of the population who (rightly or wrongly) believe that a diagnosis of cancer means certain death and uncontrollable pain [57
] tend to feel powerless in regard to cancer [58, 59
]. While many treatments are becoming steadily more efficacious, cancers (e.g., of the lung) remain for which effective treatments are limited. Feelings of powerlessness, in turn, lead to less
information seeking, because many feel it does not make much sense to learn more about things over which they have no control [60
A related variable is locus of control, as distinct from self-efficacy. Self-efficacy depends more on the context of a situation, while locus of control is more a personality trait that crosses situations [55
]. According to Bandura [48, 61
], individuals' sense of locus of control affects their feelings of self-efficacy. If one feels that outcomes in life are determined by factors external to the self, then searching for information is relatively futile. In that situation, avoiding information may become a more attractive response to threat.
Lack of information seeking when faced with disease appears irrational, because this is when information could be most beneficial and result in reduced morbidity and mortality [1, 62
]. Yet studies indicate that people are less likely to look for information as their proximity to cancer increases. Patients with cancer may be less likely to look for information, even though their situation calls for more information [63
]. Tendencies toward fatalism and avoidance can short circuit any information seeking at all.
Cancer genetics as an area for studying information avoidance
Genetic research offers many new avenues to address issues of predisposition for cancer and to identify early onset of the disease, so that treatment can be more effective and less invasive. Genetic screening is thought to have the potential for transforming how cancer may be treated as well as prevented [64
]. However, genetic counseling and testing is necessary to fulfill this promise to increase prevention and recovery from cancer through an early warning system.
But genetic information is inherently complex and individualistic, and ongoing research is constantly adding to the volume and variety of available information. This complexity means that an individual must be knowledgeable about the nature of genetics before they can even use such data—whether general or individualized—to make decisions about their own health situation. Thus, informing the public about cancer-related genetics information offers special challenges because of the complexity of the health issues involved and because of the ever-evolving body of scientific knowledge [65
A significant portion of the US public is interested in genetics and genetic testing and recognizes that these advances can affect their health care decisions. In a recent national survey [66
], more than a third of adults said they had followed the developments leading to the mapping of the human genome. Nearly two-thirds of the respondents said that they were likely to take a genetic test if it could identify whether or not they were at risk of contracting a disease.
Other studies in the scientific literature support these general findings. For instance, a general population survey found high levels of interest in genetic testing (82%) [67
]. Regarding cancer genetics, Andrykowski et al. [68
] again found high interest in predictive genetic testing for cancer in general (87%), and breast cancer in particular (93%). Our survey research among 886 adult residents of a southeastern state [69
] found that 38% worried about inherited types of cancer “often” or “sometimes” and that 59% said they would definitely or probably have a screening test if it were available to them.
While these results suggest significant demand for genetic testing and related information, they may overestimate the demand for such information. The medical literature shows cases of increased anxiety [70, 71
], depression [72, 73
], and other psychosocial responses to genetic testing. Given the possibility for such negative scenarios, it is understandable why people may choose not
to seek genetic testing and may simply be content with their current situations [70
]. Alpert [74
] points out that the “right not to know” is a compelling issue for genetic testing when diseases (such as Huntington's) are involved for which neither cures nor preventative measures exist. In such cases, it is not only a matter of who is tested but with whom they share the results. Some family members may not want to know the results of their relative's test.
Repeated studies of cancer patients find a core, albeit a minority, who do not want information under any circumstances [75, 76
]. Studies have found that anxiety levels are higher among those who decline to be tested than those who get either a positive or negative result [77
]. Given the advances in genetic research about cancer, it is important to understand the mechanism of information avoidance to best reach people who may benefit from genetic counseling or testing.