摘要
Little research has examined the antecedent characteristics of patients most likely to seek online cancer information.
This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services.
Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients’ psychosocial status were correlated with specific online cancer information seeking behaviors.
Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancerrelevant self-regulatory competencies and skills.
Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information.
Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information.
This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.
小研究審查了先行特徵的患者最有可能尋求在線癌症的信息。
這項研究採用了認知社會健康信息處理（C - SHIP）模型作為一個框架，以了解心理特徵之前網上癌症相關的信息尋求農村乳腺癌患者誰往往有較少的健康保健提供者和有限的本地支持服務。
檢查144例誰是免費提供的計算機硬件，互聯網接入，並培訓如何使用交互式癌症通信系統，前測調查分數說明病人的心理社會地位的高低與特定癌症信息網上尋求行為。
每個因素指定的C -戰艦模型有明顯的關係與在線癌症信息尋求行為，與新發現的最強的癌症相關的編碼和自我構，癌症相關的信念和預期，與癌症相關的自律能力和技能。
具體來說，病人更多的負面評價在這些領域更可能尋求在線癌症信息。
此外，前因變量與 C型戰艦模型有更頻繁的關係與經驗與信息，以教學信息。
這項研究支持了該模型的適用性辨別為何人患有癌症可能尋求網上信息，以應付他們的疾病。
Introduction
Breast cancer is the most commonly diagnosed cancer in the United States and the second leading cause of cancer death in women according to 2007 estimates by the American Cancer Society.
Researchers have emphasized the importance of exploring the different contexts in which people use health information (Ziebland, 2004).
Currently, many breast cancer patients are turning to the Internet for health education and support. In a national study, the National Cancer Institute found that 56.5% of breast cancer patients who have been online have visited an Internet site specifically to learn about cancer (Nelson et al., 2004).
Additional analysis of this same dataset found that among women who have had breast cancer, the Internet is second only to their health care providers in terms of where they would go first if they had a strong need to get information about cancer (Shaw, Han, Hawkins et al., 2006).
簡介
乳腺癌是最常見的癌症，在美國和第二大癌症死亡原因的婦女據估計到2007年由美國癌症協會。
研究人員強調了重要性，探索不同的上下文中，人們使用健康信息（Ziebland，2004）。
目前，許多乳腺癌患者正在轉向互聯網進行健康教育和支持。在一個全國性的研究，美國國家癌症研究所發現，56.5％的乳腺癌患者誰已經訪問了一個互聯網在線網站專門了解癌症（納爾遜等人，2004年）。
其他分析發現，同樣的數據集婦女誰曾乳腺癌，互聯網是僅次於他們的衛生保健提供者而言，他們會去的第一個，如果他們有強烈的需要獲得有關癌症（肖，漢，霍金斯等人，2006年）。
Not only are patients seeking information on the Internet, but research also shows that such behavior can contribute to improved learning outcomes (Gustafson et al., 2001, 2005; Shaw, Han, Baker et al., 2006a).
Little research, however, has examined the antecedent characteristics of people who are most likely to seek online cancer information.
Additionally, we are not aware of any extant research exploring the characteristics that precede who searches for what topics of online cancer information.
While numerous cancer-related topics are available online including medical, psychosocial, and practical concerns, not all of these topics are relevant to all information seekers.
Finally, cancer patients can seek out information in different forms, including either didactic, fact-based forms, or experiential, narrative forms (i.e., learning how other patients have coped with their treatments and their side effects).
Again, no published research thus far has examined the characteristics of those who seek out didactic versus experiential online cancer information.
不僅是患者在因特網上尋找信息，但研究也表明，這種行為可以有助於提高學習效果（古斯塔夫森等人，2001年，2005年，邵逸夫，漢，貝克等人，2006年a）。
小研究，但是，審查了先行特徵的人誰是最有可能尋求在線癌症的信息。
此外，我們不知道任何現存的研究探索的特點，先搜索哪些議題誰在線癌症信息。
雖然許多癌症相關的話題在網上提供包括醫療，心理和實際問題，並非所有這些主題相關的所有信息搜索者。
最後，癌症病人可以尋找信息以不同的形式，包括任何說教，以事實為基礎的形式，或體驗，敘事形式（即，學習如何應付與其他病人的治療和其副作用）。
同樣，沒有發表的研究迄今已研究的特點，那些誰尋求教學與體驗網上癌症信息。
Importantly, though cancer is difficult for anyone experiencing it, rural residents face additional challenges endemic to rural life including fewer health care providers and limited local information resources and community support services (Engelman et al., 2005).
More granular research in examining antecedent characteristics of cancer information seeking among rural cancer patients could provide useful insights to improve outcomes for this vulnerable population.
重要的是，雖然癌症是它遇到困難的人，農村居民面臨更多的挑戰特有的農村生活，包括減少衛生保健提供者和信息資源有限的地方和社區支援服務（Engelman等，2005）。
更精細的研究，研究先行特徵的癌症信息尋求農村癌症病人可以提供有益的見解，改善預後這個弱勢群體。
Theoretical Framework: The C-SHIP Model
To examine what psychosocial characteristics are important for understanding online cancer-related information seeking, we employ the C-SHIP model as our conceptual framework.
The C-SHIP model integrates constructs relevant to health information seeking used in the many theoretical models within the fields of health, social, personality, cognitive, clinical, and developmental psychology (Miller, Shoda, & Hurley, 1996).
Using the overarching social–cognitive perspective (Bandura, 1986; Cantor & Kihlstrom, 1987; Mischel, 1973, 1990; Mischel & Shoda, 1995), the C-SHIP model draws from established concepts and findings from the broader field of psychology to identify cognitive–affective units in health information processing.
Contributing concepts include strategies for encoding health information (Gritz & Bastani, 1993; Leventhal, 1970; Leventhal, Suls, & Leventhal, 1993); self-efficacy (Bandura, 1986); expectancy and value constructs in the health belief model (Becker, 1974), protection motivation theory (Maddux & Rogers, 1983), the theory of reasoned action (Ajzen & Fishbein, 1980), and the theory of planned behavior (Ajzen, 1985); and affects and emotions (Salovey & Birnbaum, 1989; Smith & Lazarus, 1990).
理論框架：C -船模
要研究哪些是重要的心理特徵了解網上癌症相關資訊尋求，我們採用了C -戰艦模型作為我們的概念框架。
這架C -戰艦模型集成結構相關的健康信息尋求用在許多領域內的理論模型的健康，社會，人格，認知，臨床和發展心理學（米勒，莊田，與赫爾利，1996）。
使用總體社會認知的角度（班杜拉，1986;康托和Kihlstrom，1987;米契爾，1973年，1990年;米契爾和莊田，1995年），C -戰艦模型吸引了來自確定的概念和結論，從更廣泛的領域的心理，以確定認知情感的單位在衛生信息的處理。
特約概念包括戰略衛生信息編碼（Gritz＆Bastani，1993;利文撒爾，1970;多囊卵巢，Suls，和利文撒爾，1993），自我效能（班杜拉，1986）;期望和價值結構的健康信念模式（貝克爾， 1974年），保護動機理論（Maddux和羅傑斯，1983），理性行為理論（Ajzen＆菲斯，1980），並計劃行為理論（Ajzen，1985），以及影響和情感（沙洛維及伯恩鮑姆，1989;史密斯和拉撒路，1990）。
The C-SHIP model identifies the following cognitive–affective units in health information processing:
(1) health relevant encodings;
(2) health beliefs and expectancies;
(3) affects;
(4) health goals and values; and
(5) self-regulatory competencies and skills (Miller et al., 1996; Miller, Fang, Diefenbach, & Bales, 2001).
This model posits that individuals differ with regards to both the particular cognitive–affective units (i.e., their beliefs, values, emotions, goals, competencies) and the dynamic processes through which these units interact with one another to generate health-related behavior, in this case online cancer information seeking.
The C-SHIP model emphasizes the important psychosocial features of the particular situation as perceived and interpreted by the individual.
This model has been used to explain how these constructs interact to bring about health protective behaviors (i.e., breast self-exam).
The current study extends the C-SHIP model beyond health-protective behavior.
For this study, we apply the C-SHIP model to examine how these constructs may be activated during a health crisis.
We use this framework to investigate the relevance of these constructs in influencing cancer-related information seeking of rural women in the aftermath of their breast cancer diagnosis.
這架C -戰艦模型確定了以下認知情感的單位在衛生信息處理：
（1）健康相關的編碼;
（2）健康的信念和預期;
（3）影響;
（4）健康的目標和價值觀;
（5）自我監管能力和技能（米勒等人，1996;米勒，方，迪芬巴赫，和包，2001年）。
該模型假定，個人不同的問候都特別的認知，情感單位（即，他們的信仰，價值觀，情感，目標，能力）和動態過程，通過這些單位彼此互動，以產生與健康有關的行為，這種情況下，網上癌症信息尋找。
這架C - SHIP模式強調的重要心理特點的特殊形勢感知和解釋個人。
該模型已被用來解釋這些結構相互作用，帶來健康保護行為（即乳房自我檢查）。
目前的研究擴展了C -戰艦模型超越衛生防護行為。
在這項研究中，我們採用了C - SHIP模型來研究如何激活這些結構可能是在一個健康危機。
我們用這個框架來探討相關的這些結構在影響癌症相關的信息尋求農村婦女在後的乳腺癌的診斷。
By emphasizing the unique individual and situational contexts relevant to information processing, the C-SHIP model calls for assessments of expectations, beliefs, and affects that are situation and behavior specific, rather than global characteristics.
For our analysis, we chose the following constructs based on their representation of one of the five C-SHIP cognitive–affective units as well as for their ability to address individual or behavioral-specific contexts.
通過強調個人的獨特背景和情境相關的信息處理，C - SHIP模式要求評估的預期，信心，並影響該行為的情況和具體的，而不是全球性的特點。
對於我們的分析，我們選擇了以下的結構根據其代表性之一的五C - SHIP認知，情意單位以及個人的能力或行為，以解決特定的背景。
Cancer-Relevant Encodings and Self-Construals.
This group of factors includes strategies and constructs involved in the appraisal of one’s own health and illness (Miller et al., 2001).
In our study, one’s level of life functioning represents this category.
Life functioning is a general marker of how an illness impacts one’s daily experience.
Level of functioning may influence one’s sense of activation for
pro-health behaviors in one of two possible directions.
Information may be a vital resource for making changes to improve treatment side effects, or making lifestyle changes to cope with disability brought on by illness.
Alternatively, reduced functioning may impair the patient’s ability to utilize available online health information.
癌症相關的編碼和自我構。
這個小組的因素包括戰略和結構參與評價自己的健康和疾病（Miller等，2001）。
在我們的研究，一個人的水平生活的功能代表這一類。
生命的運作是一個普遍的一種疾病的標記如何影響一個人的日常經驗。
等級功能可能會影響一個人的意識活化親健康行為中有兩種可能的方向。
可能是一個重要的信息資源進行更改，以提高治療的副作用，或使生活方式的改變，以應付殘疾帶來的疾病。
另外，降低運作可能會損害病人的能力，利用網上提供的健康信息。
Cancer-Relevant Beliefs and Expectancies.
This category includes expectations activated while processing health-related information (Miller et al., 2001).
Perceptions of self-efficacy in dealing with one’s cancer situation are a key cognitive mechanism influencing illness adjustment (for a review see Case, Andrews, Johnson, & Allard, 2005).
Accordingly, those with higher self-efficacy may have a greater sense of competence to use cancer-related information and would be more likely to utilize information in adapting to cancer.
Low self-efficacy, in this case belief in the futility of treatment, feeling powerless, or feeling unable to have an influence in one’s health or care outcomes, can lead to less information seeking and higher anxiety (Becker & Rosenstock, 1989; Katz, 1968; Lichter, 1987).
An alternative perspective, however, would suggest that patients could seek out cancer information as a coping mechanism to build up their sense of efficacy to help them in their struggle with breast cancer (Ziebland et al., 2004).
癌症相關的信念和預期。
這一類包括預期激活在處理與健康有關的信息（Miller等，2001）。
知覺的自我效能感在處理與人的癌症的情況是一個重要的認知機制影響疾病的調整（見案例進行檢討，安德魯斯，約翰遜和阿拉德，2005）。
因此，那些具有較高的自我效能感可能有更大的權限使用的癌症相關的信息，將更有可能利用信息在適應癌症。
低自我效能感，在這種情況下，相信在徒勞的治療，感覺力不從心，或感覺不能有一個影響人的健康或保健效果，可能會導致更少的信息要求和更高的焦慮（貝克爾和羅森斯托克，1989;卡茨1968年，Lichter，1987）。
另一種觀點，但是，這表明，癌症病人可以尋求信息作為一種應對機制，以建立自己的意識的療效，以幫助他們在他們的奮鬥與乳腺癌（Ziebland等，2004）。
Cancer-Relevant Affects.
Factors in this group include affective states that are activated when processing cancer-related information (Miller et al., 2001), and influence subsequent information processing related to the cancer experience.
Psychological adjustment affects the degree to which a cancer patient seeks information about her illness (Harris, 1998).
Greater emotional difficulty, assessed here as lower levels of emotional well-being and higher levels of negative emotions, may cue the need for information to make personal changes or receive validation for one’s experience, therefore motivating cancer information seeking.
Clinical levels of negative affect, characterized by despair, low motivation and low initiation of activity, and fatigue, however, may impair one’s capacity to seek helpful resources.
The literature depicts mixed findings for the effect of mood on information seeking.
In a general sample, Cotton and Gupta (2004) found that happier people were more likely to look online for health information.
For breast cancer patients, low levels of mental health predicted
greater use of the Internet for health-related reasons (Bowen et al., 2003).
Cancer-related anxiety has been found both to be associated with less information seeking (Pifalo, Hollander, Henderson, DeSalvo, & Gill, 1997; Wilkinson & Wilson, 1983) and with greater information seeking (Manfredi, Czaja, Buis, & Derk, 1993).
Such mixed findings illustrate the importance of context-relevant assessment emphasized in the C-SHIP model.
癌症相關的影響。
本組的因素包括情感狀態被激活時，處理癌症相關的信息（Miller等，2001），並影響以後的信息處理有關的癌症的經驗。
心理調整影響的程度，一個癌症病人尋求有關她的病（哈里斯，1998）。
難度大的情感，評估這裡下級情緒福祉和更高層次的負面情緒，可能會提示需要對信息做出修改或接收驗證個人為自己的經驗，因此激勵癌症信息尋找。
臨床水平的負面影響，
特點是絕望，低動機，低啟動活動，和疲勞，
不過，可能會損害一個人的能力，以尋求有用的資源。文獻描述
混合結果的影響情緒上的信息尋找。在一般的樣品，
棉花和Gupta（2004）發現，快樂的人更容易上網查閱
衛生信息。對於乳腺癌患者中，低層次的心理健康預測
更多地使用互聯網的健康有關的原因（鮑文等人，2003年）。
癌症相關的焦慮已發現既要與較少的信息
求（Pifalo，霍蘭德，恆基兆業，DeSalvo，與吉爾，1997;威爾金森和威爾遜，
1983年）和尋求更多的信息（曼弗雷迪，Czaja，Buis，與 Derk，1993）。
這種混合的結果說明了重要的上下文相關的評估強調
在C型戰艦模型。
Cancer-Relevant Goals and Values.
This category includes desired and valued health outcomes along with their relative subjective importance (Miller et al., 2001).
Once one is diagnosed with cancer, specific health and treatment related goals likely emerge.
For some, their goal may be to fight the cancer to the very end, ‘‘leaving no stone unturned’’ as they try a variety of clinical trials in the face of standard treatment failure.
Others may find at some point they prioritize quality over quantity
of life, and seek palliative treatment.
Some patients may strive to remain active in treatment decisions, whereas others prefer to defer decision-making to their clinicians.
Medical information seeking has been found to be motivated by a desire to be involved with treatment decision making (Degner et al., 1997).
癌症相關的目標和價值。
這一類包括理想和價值的健康結果以及它們的相對主觀的重要性（Miller等，2001）。
當一個被診斷出患有癌症，健康和治療相關的具體目標有可能出現。
一些人認為，他們的目標可能是癌症的鬥爭進行到底，不留千方百計''''，因為他們嘗試各種臨床試驗中，面對標準治療失敗。
其他人可能會發現在某些時候，他們優先考慮質量而不是數量
生活，並尋求姑息治療。
有些病人可能努力保持積極治療的決定，而其他人則傾向於推遲決策的臨床醫生。
尋求醫療信息已被發現是出於這樣一種願望，參與治療決策（Degner等，1997）。
Cancer-Relevant Self-Regulatory Competencies and Skills.
This group of factors includes knowledge and strategies used for dealing with barriers to disease-managing behaviors (Miller et al., 2001).
A patient’s competency in seeking cancer-related information can be determined largely by her competence in participating in her health care and utilizing information, as well as by actual and perceived barriers to information.
Previous research demonstrated that both perceived health competence and participation in health care are associated with a greater desire for and use of health information (Ziebland, 2004).
Studies primarily have been cross-sectional and correlational in nature, however, therefore, the direction of this relationship remains unclear.
A sense of competence in participating in health care may serve as the foundation for information-seeking behavior that complements existing health care participation (Kivits, 2006).
Alternatively, it has been postulated that patients’ optimal participation in their health care necessitates having appropriate information (Fallowfield, 2001; Wallberg, 2000).
Accordingly, patients may actively seek out cancer information to increase their sense of competence in participating in their health care (Ziebland et al., 2004).
Furthermore, those who have experienced barriers to receiving information within the health care system, due to cost or a lack of knowledge or time, may welcome a cancer information resource that is easy to use, convenient, and available for free (Pandey, Hart, & Tiwary, 2003).
癌症相關的自律能力和技能。
這個小組的因素包括知識和策略用於處理障礙疾病管理的行為（Miller等，2001）。
病人的能力，尋求與癌症相關的信息可以在很大程度上取決於她的能力在參加她的健康保健和利用信息，以及通過實際的和知覺障礙的信息。
此前的研究表明，無論自覺健康的能力和參與衛生保健是與一個更大的願望和使用衛生信息（Ziebland，2004）。
主要研究了橫截面和相關性的性質，但是，因此，這種關係的方向仍不清楚。
感能力在參與衛生保健可以作為基礎的信息尋求行為，補充現有的醫療參與（Kivits，2006）。
另外，它被假設病人的最佳參與他們的衛生保健就必須有相應的信息（法洛菲爾德，2001; Wallberg，2000）。
因此，患者可能會積極尋求癌症信息意識，提高他們的能力在參與他們的衛生保健（Ziebland等，2004）。
此外，那些有經驗的障礙，誰接收的信息在衛生保健系統，由於成本或缺乏知識或時間，可能歡迎癌症信息資源，易於使用，方便，可免費（潘迪，哈特， ＆Tiwary，2003）。
The literature has shown that social support has a strong impact on how people cope with cancer, as it can serve as both a source of information and validation.
Provision of information is one of the defining attributes of social support (Langford, Hinson, Bowsher, Maloney, & Lillis, 1997). Social support networks of friends and family serve as resources for providing information and directing information seeking (Basch, Thaler, Shi, Yakren, & Schrag, 2004; Coulton, 1990; Echlin & Rees, 2002; Elf & Wikblad, 2001; Johnson & Meischke, 1993).
Accordingly, individuals who lack such social support may need to seek information in other venues such as the Internet.
文獻表明，社會支持具有較強影響人們如何應對癌症，因為它可以作為兩個來源的信息和驗證。
提供信息是其中一個定義屬性，社會支持（蘭福德，辛森，Bowsher，馬宏升，與利利斯，1997）。社會支持網絡的朋友和家人作為資源提供信息和指導信息尋求（豹馳，泰勒，石，Yakren，與施拉格，2004; Coulton，1990年; Echlin和里斯，2002;精靈＆Wikblad，2001;強 Meischke ，1993）。
因此，個人誰沒有這樣的社會支持可能需要尋求信息在其他場地，如互聯網。
Cancer Information: Source and Content Structure
Previous studies using cross-sectional self-report methodologies have played an important role in helping to understand cancer patients’ information seeking preferences and intended behaviors.
The most valid indicator of cancer information seeking behavior, however, is to measure what people actually do as compared with what they say they did or will do.
Our study was intended to contribute to the field by examining outcomes that represent actual online cancer information seeking behaviors of women using the Comprehensive Health Enhancement Support System (CHESS) ‘‘Living with Breast Cancer’’ program, which is a comprehensive Interactive Cancer Communication System (ICCS) that has been found to be efficacious in numerous previous studies (Gustafson, 2003; Gustafson et al., 1993, 1998, 1999, 2001, 2002, 2005; Hawkins et al., 1997; McTavish et al., 1995; McTavish, Pingree, Hawkins, & Shaw, Gustafson et al., 2006; Shaw, Han, Baker et al., 2006; Shaw, Han, Hawkins et al., 2006; Shaw, Hawkins, McTavish, Pingree, & Gustafson, 2006; Shaw, McTavish, Hawkins, Gustafson, & Pingree, 2000; Taylor et al., 1994).
癌症信息：源和內容結構
以往的研究採用橫斷面自我報告的方法發揮了重要作用，有助於理解癌症病人的信息尋求行為偏好和意圖。
最有效的指標癌症信息尋求行為，然而，是衡量人們實際做的比他們說他們還是會做。
我們的研究是為了促進該領域通過檢查的結果，代表實際的在線癌症信息尋求行為的婦女使用的綜合保健增強支持系統（CHESS）''''生活乳腺癌計劃，這是一個綜合性交互式通信系統癌症（ICCS），它被認為是有效的在許多以往的研究（古斯塔夫森，2003;古斯塔夫森等，1993，1998，1999，2001，2002，2005;霍金斯等人，1997年;麥克塔維什等，1995;麥克塔維什，平格里，霍金斯，與肖，古斯塔夫森等人，2006年肖，漢，貝克等人，2006年肖，漢，霍金斯等人，2006年肖，霍金斯，麥克塔維什，平格里，與古斯塔夫森，2006年;肖，麥克塔維什，霍金斯，古斯塔夫森，與平格里，2000;泰勒等人，1994年）。
CHESS Content
CHESS is a web-based system that provides a range of conceptually distinct services to patients and their families.
Among other services, CHESS offers a large volume of breast cancer related information that is approximately equivalent in volume to a 1000-page book. The information is offered in different formats including didactic services such as short, easy-to-understand excerpts related to living with breast cancer as well as longer articles and resource guides.
Other services offer more experiential, narrative forms of information such as written accounts of how other women have coped with breast cancer and its treatments and video-based vignettes of patients sharing stories about coping with their illness. In this study, we examined three high-level information topics that subsume all of the information found within CHESS:
(1) medical information focusing on treatments and side effects;
(2) psychosocial information focusing on the emotional and social impact of cancer;
and (3) practical concerns focusing on the financial and legal ramifications of living with cancer.
CHESS內容
國際象棋是一個基於 Web的系統，它提供了一系列不同的服務概念為病人及其家屬。
在其他服務，CHESS提供了大量的乳腺癌有關的信息，大約相當於卷1000頁的書。提供的信息是在不同的格式，包括教學服務，如短，易於理解的摘錄有關生活與乳腺癌以及較長的文章和資源指南。
其他服務提供更多的經驗，敘事形式的書面信息，如帳戶如何應付其他婦女乳腺癌及其治療和基於視頻的插曲患者分享故事關於應對他們的病情。在這項研究中，我們審查了三個高層次的信息主題，所有的信息歸入內找到象棋：
（1）醫療信息集中在治療和副作用;
（2）心理信息側重於情感和社會影響的癌症;
（三）切實關注重點放在金融和法律後果的患有癌症。
CHESS Data
Data from a previous CHESS study provide a unique opportunity to examine how antecedent characteristics relate to the form and type of information rural breast cancer patients seek when provided with access to an ICCS.
In this study, cancer patients completed a survey before receiving the intervention.
They then were provided with a free computer, Internet access, and training on how to use the system.
CHESS use data were collected as participants used the website.
CHESS數據
數據從以前的CHESS研究提供了一個獨特的機會，探討如何與先前特點的形式和類型的信息，農村乳腺癌患者尋求時提供了訪問一個 ICCS。
在這項研究中，癌症患者完成的一項調查前接受干預。
然後，他們都提供了免費的電腦，互聯網接入和培訓如何使用該系統。
CHESS使用數據收集的參與者所使用的網站。
Research Aims
The C-SHIP model identifies five psychosocial factors relevant to health information seeking; however, the directions of these relationships are unclear based on the existing literature.
Using this model as a conceptual framework, we believe that the current study contributes to the field by investigating how these antecedent psychosocial factors relate to specific forms and topics of online cancer information seeking among rural breast cancer patients.
This research is exploratory in nature, offering an initial examination of antecedent pathways.
Accordingly, specific directional hypotheses are not proposed, and research questions are addressed instead.
研究的目的
這架C -戰艦模型確定了五個心理因素有關的健康資訊尋求，但是，方向不明確這些關係的基礎上，現有的文獻。
使用這個模型作為一個概念框架，我們認為，目前的研究有助於研究如何通過這些領域的社會心理因素與先前的具體形式和主題的網上信息，尋求在農村癌症乳腺癌患者。
這項研究是探索性的，提供初步審查前因途徑。
因此，具體的定向假說沒有提出和研究的問題得到解決，而不是。
Methods
Participants
The data analyzed in this study were collected as a part of a larger Digital Divide Pilot Project (DDPP) in which underserved breast cancer patients in rural Wisconsin were given access to CHESS for 4 months (Gustafson, McTavish, Stengle et al., 2005a; Gustafson, McTavish, Stengle et al., 2005b).
Both pretest and 4-month posttest surveys were conducted (92%retention rate from subjects initially enrolled).
The current study analyzed data exclusively from the pretest survey and use of the CHESS information services.
Recruitment was conducted between May 2001 and April 2003, and subjects were paid $15 for each completed survey.
方法
參加者
數據分析在這項研究中收集的一部分作為一個更大的數字鴻溝試點項目（DDPP），其中乳腺癌患者在缺醫少藥的農村威斯康星州獲准使用CHESS為4個月（古斯塔夫森，麥克塔維什，Stengle等人，2005年;古斯塔夫森，麥克塔維什，Stengle等人，2005年b）。
這兩種預試和4個月後測進行了調查（92％的保留率從最初參加科目）。
目前的研究分析數據完全由預試調查和利用國際象棋的信息服務。
招聘是2001年5月間進行2003年4月，和受試者支付15元每完成調查。
Study participants were identified through a variety of sources, including the National Cancer Institute’s Cancer Information Service, the Medicaid program, hospitals and clinics, and public health departments.
Participants were eligible if they were at or below 250% of the federal poverty level, resided within one of 56 rural Wisconsin counties (as defined by the Office of Management and Budget criteria), were within one year of diagnosis of breast cancer or had metastatic breast cancer, were not homeless, and were able to read and understand an informed consent letter.
All study participants were lent a computer, given Internet access for 4 months, and received personal training in how to use the computer, the Internet, and, primarily, CHESS.
參與研究的人發現，通過各種渠道，包括美國國家癌症研究所的癌症信息服務，醫療補助計劃，醫院和診所，衛生部門。
參加者資格，如果他們在或低於250％的聯邦貧困水平，居住在威斯康星州的一個農村的56個縣（定義由辦公室管理和預算標準），一年內乳腺癌的診斷或已轉移乳腺癌，沒有無家可歸者，並能閱讀和理解知情同意書。
所有受試者都借給一台電腦，給上網4個月，並獲得了個人訓練中如何使用計算機，互聯網，以及為主，國際象棋。
Table 1 shows demographic and disease-related characteristics of this sample.
Study participants had a mean age of 51 years old, 67.4% of women were classified as having early stage breast cancer, and 57.7% had received at least some college education.
表1顯示了人口和疾病相關的特徵本樣本。
參與研究的有一個平均年齡51歲，67.4％的女性被歸類為早期乳腺癌，57.7％曾接受過至少一些大專以上學歷。
Measures
Besides basic demographic information, participants answered nine primary measures at the pretest level that were further categorized according to the constructs of the C-SHIP model, as listed in Table 2.
These measures have been widely tested and demonstrated in terms of reliability, validity, and responsiveness to clinical change (Brady et al., 1997; Gustafson et al., 2001, 2002, 2005).
The exact wording of all the items belonging to these scales is included in the Appendix.
For all measures, scores are calculated as averages across scale items.
措施
除了基本的人口統計信息，參與者回答9所小學措施，預試水平，進一步分類根據結構的C- SHIP模型，列於表2。
這些措施得到了廣泛的測試，並顯示出計算的可靠性，有效性和響應臨床變化（布雷迪等人，1997年;古斯塔夫森等人，2001年，2002年，2005年）。
確切的措辭都屬於這些項目規模包括在附錄。
對於所有措施，分數計算平均在規模的項目。
CHESS Information Services and Topic Use
To keep a record of patients’ CHESS use, a browser was developed by our research team automatically to collect use data at an individual keystroke level as participants used the system.
This capability enabled us to log each user’s code name, date, time spent, and URL of every web page requested from our web server database.
Seven CHESS use outcomes were included in the study and are described below: overall use of the information service component of CHESS as well as use of each of the two individual information service types, and overall use of the topics available as well as use of each of the three individual topics.
CHESS信息服務和使用主題
要保留記錄病人的CHESS使用，瀏覽器是由我們的研究小組使用的數據自動收集在單個擊鍵水平參與者使用該系統。
這種能力使我們能夠記錄每個用戶的代號，日期，所花費的時間和網址的每個網頁要求從我們的Web服務器數據庫。
七CHESS使用成果是包括在研究和介紹如下：整體採用的信息服務組件的國際象棋以及使用的每個兩個獨立的信息服務類型，整體採用現有的主題，以及使用每個三個人的主題。
Overall use of the Information Service component of CHESS was operationalized as total time spent (in minutes) browsing the following two types of information during the 4-month study period.
整體採用的信息服務組件是可操作性的國際象棋花費的總時間（分鐘）瀏覽以下兩種類型的信息在4個月的研究期間。
1. Didactic Services provide science-based information to convey facts, statistics, and a review of the state of knowledge related to breast cancer and related health care.
Examples include Questions and Answers (short answers to hundreds of frequently asked questions), Instant Library (full articles on breast cancer topics), Web Links (links to selected health-related Internet sites), Resource Directory (descriptions and contact instructions for breast cancer and social service organizations), and Dictionary (descriptions of medical and professional terms).
2. Experiential Services provide real-life text and video accounts of patients’ experiences with diagnosis, treatment decisions, and dealing with the physical, emotional, practical, and existential issues related to living with cancer.
Experiential services within CHESS include Consumer Guide (descriptions of available services, identifying a good provider, being an effective consumer of key health services), Video Gallery (video clips providing real-life accounts of people living with cancer), and Personal Stories (narrative text-based interview accounts of how others coped with breast cancer).
1。教學服務提供科學依據的信息傳達事實，統計數據，並審查國家的有關乳腺癌的知識和相關的健康護理。
例子包括問題和答案（簡短回答到數百常見問題），即時資料庫（完整的文章對乳腺癌主題），網站鏈接（鏈接到選定的健康相關的互聯網網站），資源目錄（描述和說明，對乳腺癌的聯繫和社會服務組織）和字典（說明醫療專業術語）。
2。體驗式服務提供了現實生活中的文字和視頻賬戶病人的經驗與診斷，治療決策，以及處理與物理，情感性，實踐性和存在的問題與患有癌症。
體驗式服務在國際象棋包括消費指南（說明可用的服務，確定了良好的供應商，作為一個有效的消費者的主要健康服務），視頻畫廊（視頻剪輯提供真實賬目的人患有癌症），以及個人的故事（敘事基於文本的採訪賬戶他人如何應付與乳腺癌）。
Overall use of the Topic component of CHESS was operationalized as total time spent (in minutes) in each of the following types of topics during the 4-month study period:
(1) psychosocial topics (information about psychological and social issues);
(2) practical topics (financial, work, and legal concerns);
(3) medical topics (18 breast cancer related topics including breast cancer basics, surgery [e.g., lumpectomy, mastectomy, etc.], and other treatment options [e.g., chemotherapy, radiation]).
整體採用的主題組件作為國際象棋是可操作性花費的總時間（分鐘）在每個以下類型的題目在4個月的研究期間：
（1）心理主題（有關心理和社會問題）;
（2）實踐課題（財務，工作和法律問題）;
（3）醫療議題（18乳腺癌有關的議題，包括乳腺癌基礎知識，手術[例如，乳房腫瘤切除術，切除等]，以及其他治療方案[例如，化療，放療]）。
