eHealth may be generally described as the use of Internet-based and mobile technologies to assess, monitor, and improve health. eHealth activity among post-treatment cancer survivors is a vital area of study as survivors are a growing group with greater healthcare needs than the general population and more frequent healthcare involvement. eHealth represents a promising approach to addressing the multiple and often overwhelming needs of cancer survivorship, yet data show that survivors do not engage in a wide range of eHealth activity. This raises the questions 1) to what extent are diverse cancer survivors engaged in eHealth activity, and 2) what are the determinants of eHealth activity? Previous work suggests that those with greater healthcare needs may be more likely to use eHealth resources, raising the possibility that African American (AfAm) survivors may be more likely to engage in certain eHealth activities due to the survivorship disparities experienced by this group. Furthermore, lower rates of some eHealth activities versus others make it probable that survivors use non-digital/electronic strategies to manage their healthcare needs, specifically, their personal health information management (PHIM). In the proposed R01 study, we will conduct theory-driven mixed methods interviews in a population-based sample of approximately 1230 AfAm and white breast, prostate, and colorectal cancer survivors to assess general eHealth activity as well as specific activities. We will then select a subsample of 144 participants for an ethnography of PHIM in one's home or primary PHIM setting to examine the role of eHealth in the context of all PHIM practices. Finally, these data will guide the development of survivor-centered design principles that will inform the development of a software application prototype that will facilitate access to digital cancer survivorship resources Specific aims are 1) To examine racial differences in general eHealth activity among AfAm and white cancer survivors;2) To examine racial differences in specific categories of eHealth activity among AfAm and white cancer survivors;and 3) To explore the role of eHealth activity in the broader context of personal health information management among AfAm and white cancer survivors;4) To develop survivor-centered design principles that will be applied to the development of an eHealth tool for cancer survivors;and Exploratory Aim - To compare cancer survivors with and without internet access in terms of social-structural determinants of access and clinical and healthcare-related factors relevant to survivorship. The proposed study is relevant to public health because it will investigate eHealth activity among cancer survivors, of which there are 13.7 million in the U.S. today, many of whom confront a wide range of challenges to their physical, psychological, and social well-being. The technology within eHealth resources has the potential to address the needs of this population on a large scale. The proposed population-based study will identify determinants of eHealth activity, provide deep insight into the role of eHealth in survivors'overall PHIM, and establish survivor-centered design principles for optimized eHealth tool development.
The proposed study is relevant to public health because it will investigate eHealth activity among cancer survivors, of which there are 13.7 million in the U.S. today, many of whom confront a wide range of challenges to their physical, psychological, and social well-being. The technology within eHealth resources has the potential to address the needs of this population on a large scale. The proposed population-based study of racially diverse survivors will identify determinants of eHealth activity in this group, provide deep insigh into the role of eHealth in survivors'overall personal health information management, and establish specific survivor- centered design principles for the development of eHealth tools optimized for survivors.