title: In whom do cancer survivors trust online and offline?
abstract: BACKGROUND
  In order to design effective educational intervention for cancer survivors, it is necessary to identify most-trusted sources for health-related information and the amount of attention paid to each source.
  
  
  OBJECTIVE
  The objective of our study was to explore the sources of health information used by cancer survivors according to their access to the internet and levels of trust in and attention to those information sources.
  
  
  METHODS
  We analyzed sources of health information among cancer survivors using selected questions adapted from the 2012 Health Information National Trends Survey (HINTS).
  
  
  RESULTS
  Of 357 participants, 239 (67%) had internet access (online survivors) while 118 (33%) did not (offline survivors). Online survivors were younger (p<0.001), more educated (p<0.001), more non-Hispanic whites (p<0.001), had higher income (p<0.001), had more populated households (p<0.001) and better quality of life (p<0.001) compared to offline survivors. Prevalence of some disabilities was higher among offline survivors including serious difficulties with walking or climbing stairs (p<0.001), being blind or having severe visual impairment (p=0.001), problems with making decisions (p<0.001), doing errands alone (p=0.001) and dressing or bathing (p=0.001). After adjusting for socio- demographic status, cancer survivors who were non-Hispanic whites (OR=3.49, p<0.01), younger (OR=4.10, p<0.01), more educated (OR=2.29, p=0.02), with greater income (OR=4.43, p<0.01), and with very good to excellent quality of life (OR=2.60, p=0.01) had higher probability of having access to the internet, while those living in Midwest were less likely to have access (OR=0.177, p<0.01). Doctors (95.5%) were the most and radio (27.8%) was the least trusted health related information source among all cancer survivors. Online survivors trusted internet much more compared to those without access (p<0.001) while offline cancer survivors trusted health-related information from religious groups and radio more than those with internet access (p<0.001 and p=0.008). Cancer survivors paid the most attention to health information on newsletters (63.8%) and internet (60.2%) and the least to radio (19.6%). More online survivors paid attention to internet than those without access (68.5% vs 39.1%, p<0.001) while more offline survivors paid attention to radio compared to those with access (26.8% vs 16.5%, p=0.03).
  
  
  CONCLUSIONS
  Our findings emphasize the importance of improving the access and empowering the different sources of information. Considering that the internet and web technologies are continuing to develop, more attention should be paid to improve access to the internet, provide guidance and maintain the quality of accredited health information websites. Those without internet access should continue to receive health-related information via their most trusted sources.
authors.affiliation: Geriatrics/Gastrointestinal Oncology Services, 3Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, USA E-mail : shahroka@mskcc.org.
authors.forename: Armin
authors.initials: A
authors.lastname: Shahrokni
authors.forename: Sanam
authors.initials: S
authors.lastname: Mahmoudzadeh
authors.forename: Bryan Tran
authors.initials: BT
authors.lastname: Lu
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003625:Data Collection; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007255:Information Services / Q000706:statistics & numerical data* / Q000639:trends; D020407:Internet / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000534:rehabilitation; D010353:Patient Education as Topic; D011379:Prognosis; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D035502:Trust