This study examined the psychometric properties of a new scale developed specifically to measure health information orientation, in this case for advanced cancer caregivers. Overall, compared to social and physical factors, the ways in which individuals interact with health information has received relatively little attention in health psychology research (Viswanath & Kreuter, 2007
), though the health information environment (i.e., available health information and the media through which that information is disseminated) plays a central role in cancer prevention and control (Hiatt & Rimer, 1999
). A better understanding of how to promote positive experiences with health information among chronically ill individuals and their caregivers would help to support the development of an “intelligent” health information environment that offers deep support to users (Hesse, 2005
). The scale presented in this study fills a current gap in research by providing a method for measuring cancer caregivers' orientation to engaging with health information.
Confirmatory factor analysis of the Health Information Orientation Scale supported two unique subscales: Information Engagement and Information Apprehension. Each subscale demonstrated adequate reliability. It is noteworthy these subscales are not correlated, suggesting caregivers' engagement with health information is a distinct construct from their apprehension about utilizing health information. While some may be reluctant to use information for coping, they nevertheless may do so.
Construct validity was supported through associations with information competence, coping mechanisms and emotional distress, with all associations in the expected direction. Information engaging caregivers had greater information competence. A sense of competence in one's ability to understand and make use of health information likely promotes greater willingness and possibly greater desire for seeking and working with health information. Caregivers with higher information engagement were also more likely to engage in active coping, planning, and use of instrumental support, complimenting other studies demonstrating information seeking as related to seeking instrumental social support (Carver et al., 1989
) and problem-focused coping (Bar-Tal & Spitzer, 1999
Caregivers endorsing higher information apprehension had poorer information competence. This was anticipated as several items in the Information Apprehension subscale reflect a lack of competence in working with health information (i.e., difficulty making sense, overwhelmed by amount). Apprehensive caregivers were also more likely to engage in coping through denial. This likely reflects the tendency for some to address anxiety through avoidant coping behaviors, including avoiding health information. Finally, information apprehensive caregivers experienced greater emotional distress manifesting as anxiety, depression, and anger. Those with higher anxiety regarding their loved one's cancer may likely have heightened anxiety regarding information about cancer. Similarly, those with apprehension about handling health information when faced with a health crisis may have difficulty coping in this context where information is critical (Dew, 1996
; Powers, Gallagher-Thompson, & Kraemer, 2002
). Accordingly, feelings of anxiety, depression, and anger may likely arise.
As in the initial pilot study (Bernard, 2004
), formal education was the only demographic characteristic associated with information orientation, Apprehension specifically. This compliments other findings that age, gender, and cancer type are not associated with information orientation (monitoring or blunting; Rees & Bath, 2000
). However, in this study, caregivers with less formal education reported greater apprehension related to health information, suggesting this group may need increased support when engaging with health information. As education level can be associated with literacy level, utilization of traditional resources for information, particularly books, brochures and websites, may be difficult for less educated populations, and therefore approached with more apprehension.
Study Limitations and Future Directions
While correlations supporting validity of both Information Engagement and Apprehension were significant, the magnitudes of the coefficients were generally low. As the primary longitudinal study was not designed to develop and validate the HIOS, limited measures were available to examine construct validity. Accordingly, measures that seemingly addressed constructs reflected in other health information seeking literature were chosen, however other measures and constructs may prove better tests for establishing the validity of these subscales. These lower correlations may also reflect limited variance in the Engagement and Apprehension factors where this sample tended to be highly engaged with little apprehension regarding information seeking. Accordingly, some study sample limitations are noteworthy. This sample consists of a well educated, higher income caregiver sample who agreed to participate in a study examining online information and support seeking. These caregivers may be biased towards information seeking, whereas those with lower education and socio-economic levels and/or who are apprehensive or avoid information may be underrepresented. Future research on this measure needs to reflect more diverse socio-economic and ethnic/racial sampling to address generalizability across caregiver populations.
Consideration of these findings within the context of this advanced cancer caregiving population is also important. These caregivers, in comparison to those caring for someone with earlier stage disease, are more likely to be facing palliative rather than curative treatment options and end of life. Accordingly, the need or desire for seeking health information may be different in advanced disease. Future research could compare information orientation across disease stages and also examine whether it is a stable or state-dependent coping mechanism over the disease course. The literature is mixed in its presentation of information seeking as more trait-like (Miller, 1987
) and generalizable across situations, or state-like and situation or context specific (Ramirez et al., 2002
Additionally, the two factors may have alternative interpretations. For example, the factor interpreted as Information Engagement contains those items that specifically refer to decision making, whereas items in the Apprehension are more general in their context. Accordingly, the two factors may be interpreted as utilization of information in decision-making versus a general health information orientation. Though the statistical properties of the scale were all in the acceptable range, some of the CFA fit statistics (RMSEA), factor loadings, and the subscale internal consistencies were sub-optimal; more research using this scale in larger samples will be needed to determine whether its psychometric properties warrant continued use. Future research using the HIOS in a variety of health contexts will further refine the nature of these constructs.
The Health Information Orientation Scale is an experimental scale that requires further testing before its full validity and predictive potential can be assessed. However, it has demonstrated promise to be a useful tool in determining caregivers who prefer utilizing health information and those who have apprehension regarding health information through conceptually unique subscales of Information Engagement and Information Apprehension, which have acceptable reliability and validity. These subscales would serve to identify subtypes of caregivers who may best benefit from particular styles of health education, and may inform the design and delivery of health communication interventions to best meet the needs of this population. Although this study focused on cancer caregivers, this measure is likely applicable to both patient and caregiver populations and across a variety of health issues.