Abstract A19: A mixed methods approach to assessing ehealth activity among African American cancer survivors
Authors: Thompson Hayley S. , Katz Anne , Barnes Charity , Smith Mary , Eaton Tara 
Published: May 2016

Abstract
The research literature on eHealth activity across different patient populations is rapidly expanding, yet little is known about eHealth among diverse cancer survivors. Most existing measures of such activity are quantitative (QUAN). Compared to qualitative (QUAL) methods, QUAN methods are limited in capturing in-depth information regarding eHealth experiences that can inform user-centered design of technologies optimized for survivors' use. The goal of the pilot project reported here was to develop a mixed methods approach to assessing the full scope of eHealth activity among African American cancer survivors.
Based on a literature review, study investigators created a measure that included 27 eHealth activities across 5 domains: informational, communal, self-care/management, expert care, and transactional. An embedded mixed methods design was used in which QUAN items represented the “primary strand” of data and QUAL probes represented the “secondary strand.” Within each domain, participants responded to QUAN items regarding each activity that asked if they were aware the activity was possible; if they had ever engaged in the activity personally; whether someone else (surrogate) had engaged in the activity on their behalf; the recency of the eHealth activity; how often the activity was related to their cancer; and their interest in engaging in the activity in the future. Then, QUAL probes were presented asking about the reasons they had participated in domain-specific activities and general problems or challenges within activities, or what had kept them from engaging in the activities and the support/resources needed to do so in the future.
Participants were 23 African American breast, prostate, and colorectal (CRC) cancer survivors (12 breast; 7 prostate; 2 female CRC; 1 male CRC) identified through the Metropolitan Detroit Cancer Surveillance System, a member of NCI's SEER program. The mean age among participants was 60 years and time since end of primary treatment ranged from 13-46 months. In this pilot sample, 78% reported using the internet. Personal engagement in eHealth activities was highest in the informational domain (range: 9-72% across items) and the most reported activity was searching online for information about specific symptoms or problems. Personal engagement was lowest in the transactional domain. Across both personal and surrogate engagement, eHealth activities most often reported as related to cancer most or all of the time were searching online for information about how to reduce healthcare costs (60%), searching online for information about a hospital or healthcare facility (62.5%), and using technology to track medical symptoms (100%). Across all participants, interest in future engagement was greatest in the informational domain, including searching online for information about specific symptoms (86%), medical treatments or procedures (78%), and signing up to receive online, email or mobile updates on medical issues (74%). Interest in the future engagement was lowest for the communal domain. QUAL probes revealed several challenges within eHealth activities including difficulties in identifying credible health-related online resources; verifying the credibility of online health information; determining effective search terms to find relevant information; managing different policies across healthcare providers related to the electronic exchange of information; and technical problems with devices.
Findings led to the revision of this mixed methods approach such that additional QUAN items and QUAL probes were added, with QUAL probes specific to eHealth activities rather than eHealth domains . The revised measure is currently being administered as part of an AHRQ-funded R01 study of eHealth activity among 1200 African American and white cancer survivors in the metropolitan Detroit area.
Citation Format: Hayley S. Thompson, Anne Katz, Charity Barnes, Mary Smith, Tara Eaton. A mixed methods approach to assessing ehealth activity among African American cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A19.