[Thesis]. Manchester, UK: The University of Manchester; 2018.
Background. Lung cancer is the leading cause of cancer deaths worldwide. Low survival
rates have been attributed to delays to diagnosis, and some patients report having
symptoms for several months before presenting to health services. Strategies are needed
to encourage timely help-seeking. The Web is increasingly used as a health information
Aim. The aim of this thesis is to explore whether the Web plays a role in help-seeking
behaviour of people with lung cancer prior to diagnosis, and how the Web can be utilised
to encourage earlier presentation to health services for symptomatic people.
Systematic review. To begin, I carried out a systematic review of the literature (N=34),
which highlighted a scarcity of research on Web use for symptom appraisal among cancer
Mixed-methods study. I conducted a survey with recently diagnosed (6 months or less)
lung cancer patients (N=113). Based on survey responses, I purposively selected a
sub-sample of patients and their family/friends ("proxies") for semi-structured interviews
(N=33). In the survey, 20.4% of participants reported they or proxies had researched
their condition online before the diagnosis. Interview results suggest perceived impacts
of online information on symptom appraisal, forming the decision to seek help, and
on interactions with healthcare professionals.
Intervention development and evaluation. Based on my findings, I developed a Web-based
intervention. The intervention provides tailored information about lung cancer, and
uses components based on the Theory of Planned Behaviour ("TPB-components") to encourage
earlier help-seeking. This intervention was tested in an online feasibility study
(N=130), and subsequently in an online randomised controlled trial (N=212) with a
factorial design to test main and interaction effects of tailoring and TPB-components.
The feasibility study and first trial helped identify methodological issues which
were addressed in a second trial with a mixed factorial design. This trial (N=253)
indicated that the self-reported likelihood of visiting a doctor increased significantly
by 11.8% from before to after viewing study information (p<0.001), but no effects
of tailoring or TPB-components were found. When examining only those aged 50+ years,
who are at highest risk of lung cancer, those receiving tailored information reported
an increase of 13.2% in likelihood of seeking help, compared to 3.2% in the untailored
group (p=0.01). Participants aged 50+ receiving the TPB-component reported a larger
increase (13.8%) than those who did not receive the TPB-component (5.2%), but this
did not meet the significance criterion (p=0.054).
Conclusions. According to patients' perceptions, the Web can impact on processes in
the appraisal, help-seeking and diagnostic interval leading up to diagnosis. Presentation
of information about symptoms and risk factors online can produce significant effects
on self-reported likelihood of seeking help. These findings indicate that there is
potential for the Web to be utlised in the endeavour to educate the public about symptoms
and to promote earlier presentation to health services, but due to small effects and
differential dropout in this study, further research is required.