Fatalism is predetermined and cannot be changed by own actions or efforts [1]. Fatalistic belief about cancer prevention refers to the belief that cancer prevention is beyond one’s control and that developing cancer is inevitable and incurable [2]. Although a significant portion of cancer cases can be avoided, the majority of American adults maintain fatalistic beliefs about cancer prevention [3, 4], with pessimism, helplessness and confusion [2, 5]. Individuals with such cancer fatalism have posed a significant challenge to cancer prevention behaviors, such as cancer screening and cancer treatment [6–8]. Worse yet, studies reported that the individuals had a fatalistic attitude highly associated with a family history [9–12]. Individuals with a cancer family history (CFHs) were more likely to rate their quality of care as fair or poor, to believe that they can prevent cancer or receive treatment negatively [13]. As a result, they have become one of the groups with severe cancer fatalism and are more likely to seek cancer-related information [14–17].
Using social media for health-related purposes has been identified as an effective intervention for addressing cancer fatalism [18–21]. While its effects are widely acknowledged, it has been widely recognized as contributing to the spread of health misinformation [22]. A study found that 77% (n = 150) of the videos or comment sections shared on social media contained content that could be misleading or biased, and these were watched by more than 6 million people. [23]. Exposure to health misinformation (EHM) also typically has a negative impact on people's attitudes towards healthy behaviors and triggers negative emotional responses [24]. However, cancer is one of the most frequently searched topics on the Internet in the United States. social media is becoming a more important source of cancer-related information. The effects of such EHM on people's cancer fatalism following health-related social media use have yet to be investigated. Moreover, CFHs have a preference for social media as their prevalent source of information [25]. Few studies have specifically examined how online cancer information affects cancer fatalistic attitudes among CFHs. Thus, it remains an essential issue that requires further attention and resolution.
To address these issues, this study seeks to survey the mechanism among a specific group, CFHs, to develop an effective strategy for mitigating cancer fatalism, with a focus on the function of misinformation exposure on social media. In other words, how does EHM influence the implementation of this strategy to reduce CFHs’ cancer fatalism? If we identify statistically significant associations, our findings will hold significant implications for future research on the link between online cancer information seeking and cancer fatalism.
The association of social media activities with cancer fatalism.
The advantages of social media’s interactivity, participation and anonymity allow individuals to engage in more social media activities (SMAs) for health-related purposes. Scholars found that the specific groups related to cancer experience, such as cancer patients [26], cancer survivors [27], and CFHs [28], performed more frequently in these activities. Participating in SMAs among cancer-experienced groups can be divided into three types: information browsing, information sharing and information discussion [29–32].
Patients can mitigate their cancer fatalism through SMAs. First, seeking health information on SMAs allows patients to acquire a wide range of knowledge, increasing their understanding of cancer and confidence in the face of uncertainty. For instance, health information browsing on social media frequently and broadly involves cancer diagnostic searches, new cancer knowledge acquisition, and cancer education on platforms [29, 32, 33], which serves as an effective way to complementary information [34]. Adequate knowledge empowers patients to take protective actions rather than depression [35], and fatalism would decrease. Second, SMAs enable patients to explore information from their social networks, which helps to reduce fatalism. For instance, patients shared factual and personal questions or symptoms within the groups and received responses from professionals, other group members, and the group’s administrators, who promptly provided detailed and useful answers [36] and offered peer-to-peer support for problems they faced in real life [32], either helping correct or leverage patients cancer fatalism [37]. CFHs, as a cancer-experienced group, are more likely than no or uncertain CFHs to scan and seek cancer information among the American public [12, 14, 17]. Added to their cancer susceptibility, cancer severity and cancer fears [15], we considered that SMAs would mitigate their cancer fatalism. Thus, we proposed the first hypothesis
H1 SMAs are negatively associated with cancer fatalism.
The link between perceived benefits and barriers of social media
Social media use can allow individuals to seek, find, understand and evaluate health information. Scholars have already looked into cancer patients’ perceived benefits of SMAs from an e-health literacy perspective. Patients who use social media are more informed about their condition and can make better decisions [38], and increased knowledge reduces uncertainties associated with such information [39]. Individuals’ self-confidence in future desired information-seeking activities [40] enables them to navigate SMAs more effectively and critically evaluate information. The necessary skills to apply these resources help them mitigate cancer fatalism [41]. Given that CFHs’ health information seeking on SMAs promotes their knowledge increase [16] and reduces distress [42], we considered that CFHs also perceived benefits (i.e., confidence in online information seeking (COIS)) from social media, which then influenced their cancer prevention beliefs.
On the other hand, American CFHs, like other cancer patients, face barriers to cancer information-seeking (BCIS), but their experiences are more intense than those of non-CFHs (Arora et al., 2008). BCIS refers to the challenge individuals encounter while looking for cancer information, including putting in a lot of effort, frustration, and confusion, which has a higher negative impact on fatalistic beliefs about cancer prevention [43, 44]. BCIS accelerating cancer fatalism could be attributed to several underlying processes. First and foremost, untrustworthy information on social media leads to an inaccurate assessment of patients' cancer risk and they may perceive a higher barrier to taking preventative action. Second, a lack of understanding of cancer information [41] might make it more difficult for patients to access such information, potentially exacerbating their fears of cancer and pessimism. Third, information overload on social media causes ineffective information management, anxiety and indecision [44, 45]. Confusion over information causes patients to struggle to extract desired information from a large amount of data, preventing them from making informed decisions[46]. Based on these considerations, it is critical to remove barriers when seeking cancer information to reduce cancer fatalism for CFHs.
In HBM, perceived benefits can positively influence health behaviors and attitudes, while perceived barriers can make it difficult to take action [47]. Barriers to seeking correlated negatively with the perceived confidence to seek health information [43]. However, prior studies have found a link between perceived benefits and barriers, highlighting the importance of improving COIS to overcome the BCIS. Individuals with greater confidence in health information-seeking, as an indicator of eHealth literacy, have mastered advanced searching skills that allow them to gain more knowledge about cancer prevention [48], which helps individuals read and comprehend information [49], reduce information overload, finally removing perceived BCIS than those with insufficient health literacy [50].
Cancer fatalism is a type of health attitude and belief; individuals can gain confidence from SMAs; COIS is designed to remove the BCIS, and BCIS is the primary predictor of cancer fatalism; thus, a link between SMAs and cancer fatalism via COIS and BCIS can be developed. Moreover, studies have shown that CFHs are more likely to recognize the benefits of engaging in cancer-related preventive behaviours due to their perceived vulnerability to the condition, which outweighs the perceived barriers [51]. Therefore, we expect that CFHs will prioritize increasing confidence through various SMAs, followed by removing the barriers to CFHs seeking cancer information, eventually lowering cancer fatalism. Accounting for these relationships, we proposed the following hypotheses
H2 The effect of SMAs on cancer fatalism would be mediated by COIS.
H3 BCIS is negatively associated with cancer fatalism.
H4 COIS is negatively related to BCIS, which sequentially mediates the link between SMAs and cancer fatalism.
Moderating effects of health misinformation exposure on social media
Health misinformation is defined as factual claims about health that are unsupported by scientific evidence or expert opinion [52, 53]. Previous studies have examined that The use of social media increases the likelihood of individuals being exposed to health misinformation[22, 54–56], and exposure to health misinformation (EHM) has adverse effects on individuals' attitudes and beliefs regarding health behaviors [57, 58]. In this study, we considered that EHM could act as a moderator between SMAs and attitudes or beliefs. Individuals with higher EHM, may search more frequently, use longer queries, and click on more results [59], raising their barriers to searching experiences and doubting their ability to seek desired information. Given their increased risk of developing the disease, CFHs are more likely to actively seek cancer-related information on social media [25], and they can use the Internet to assess their cancer risk [60]. We expected that CFHs may be particularly vulnerable to the negative effects of misinformation, so we assumed that the association between SMAs and COIS would be weaker for CFHs with higher EHM. In contrast, CFHs with more SMAs but less EHM may maintain their original attitudes. SMAs and COIS may have a stronger relationship in those with lower EHM. In line with this, we proposed the following hypothesis:
H5 SMAs will have a greater impact on COIS for CFHs who are more EHM than those who are not.
Assuming that CFHs have varying levels of EHM impacts on the relationship between different SMAs and COIS, it is also possible that EHM may conditionally affect the strength of the indirect association between SMA and cancer fatalism, indicating a pattern of moderated mediation between the study variables.
H6 SMAs have a stronger impact on cancer fatalism via the mediators of COIS and BCIS for CFHs more EHM than those without.
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