br media used to deliver health information
media) used to deliver health information fully reflect the target audience’s characteristics, including gender, age, and media preferences. This consideration can help attenuate the audience’s perceived overload of online health information processing and, ultimately, may enhance its health literacy.
This study also found that decisional balance (i.e., attitudes and beliefs) regarding CRC screening is positively associated with CRC screening uptake. Previous studies also supported these positive associations between decisional balance and cancer screening outcomes [61–63], highlighting a potential role of decisional balance in facilitating CRC screening outcomes. This finding may suggest that CRC screening interventions among older Korean Americans can target their attitudes and beliefs about the screening. As the literature indicated earlier, Korean Americans have consistently reported culture-related attitudes and beliefs (e.g., no perceived need for screening in the absence of symptoms, diagnosis of cancer meaning death, or embarrassment and modesty concerns related to cancer screening and communicating screening) as major barriers to accessing and adhering to CRC screening [64–67]. Therefore, there is the need for health care
providers to be culturally sensitive to and competent in communicating health information with older Korean Americans who have misbeliefs or negative attitudes pertaining to CRC screening. The development of culturally appropriate and tailored educational materials or online delivery medium may be useful in improving their culture-interwoven beliefs and attitudes concern-ing CRC screening, which can be essential to facilitating CRC screening.
However, the findings of this Herboxidiene study should be carefully interpreted for interventions and practice due to several limi-tations the study contains. In the hypothesized models of this study, a single item was employed to measure information overload. As Jiang and Beaudoin suggested , using multiple items of the CMM-based elaboration processing measure may offer a clearer understanding of development of health literacy from OHIS. Furthermore, this study adopted the measurement of health literacy from Haun et al. , but future studies need more valid measurement. Additionally, although this study used multi-theoretical frameworks and found significant pathways among the variables, the nature of a cross-sectional design does not allow for their simple causal relationships. Next, the convenience sampling used in this study inhibits generalization of these findings into all older Korean Americans due to the limitations of non-probability sampling. Finally, this study hypothesized the path models using several variables of interest building on the theoretical frameworks, but different theories or models and known variables might explain better these relationships in the pathways, which can help better understand how OHIS influences CRC screening outcomes through health literacy.
The present study adopted the conceptual frameworks of the Health Literacy Skills Framework and the Cognitive Mediation Model to test the hypothesized paths for OHIS to develop health literacy, which, in turn, leads to CRC screening outcomes. Based on these frameworks, this study found significant associations among OHIS, health literacy, and information overload and between decisional balance and uptake of all CRC screening tests. This study also found a significant relationship between health literacy and decisional balance for sigmoidoscopy and colonoscopy, respec-tively. These findings provide useful implications for interventions and practice directed toward facilitating CRC screening by targeting health literacy and decisional balance (i.e., attitudes and beliefs) about CRC screening among Korean Americans in the state of Georgia. Moreover, these findings draw attention of practitioners and researchers to bolstering access to online health information and developing culturally competent health informa-tion and online platforms for its effective delivery to older Korean Americans especially with limited health literacy and negative attitudes and beliefs toward CRC screening tests. These collective efforts can enhance health equity through eliminating disparities in CRC and its screening outcomes among Korean Americans.
4.3. Practice implications
The findings also highlight the critical roles of health professionals in promoting CRC screening among Korean Amer-icans. Whereas more than 80% of American adults use the Internet for a wide variety of health-related problems and needs, it is also true for underrepresented older immigrants to experience barriers to accessing and utilizing health information online . Health professionals may close this digital gap by efforts to develop intergenerational ties between older and younger people, includ-ing adolescents or college students and elderly residents at community or long-term care facilities. In these ties, younger