Study design and period
An institution-based cross-sectional study design was conducted from March 01-30/2019. The quantitative method was used to describe socio-demographic characteristics of respondents, the extent of cancer information seeking and factors associated with cancer information seeking among students.
Study area and setting
Debre Tabor University is one of the newly established public higher education institutions in Ethiopia. The university has a clinic located centrally on the campus and it gives primary healthcare services. The clinic has laboratory, consultation, pharmacy, nursing services, medical records, wound dressing units and in-patient bed facilities for short term admissions. The University has a total of 9572 students.
Sample size determinations
The sample size was calculated using single population proportion formula with the following assumptions: 95% confidence level (CI), Z (1-α/2) =1.96), an expected proportion of cancer information seeking behavior of 50%, and 5% margin of error. As to investigator knowledge, in the country, there were no previously conducted studies which determined the proportion of cancer information seeking behavior in higher institution. Hence, 50% was taken to estimate the required sample size. Furthermore, two sampling stage was applied to reach to the final study units in the process. Considering design effect of two and 10% non-response the final sample size was 844.
Sampling methods and procedure
A stratified multi-stage sampling method was employed to select study subjects. In the first stage, departments were stratified based on health-related and not-health related. And then, proportional allocation was employed to select 13(30%) departments, 2 from health and 11 from non-health related departments by using simple random sampling, we assumed that there was a difference between departments for cancer information seeking. Next departments were stratified by their years of study; we assumed that their years of study and duration of stay in the campus would affect cancer information seeking behavior among students. The total number of students in selected departments was distributed proportionally based on the total number of students in each year of study. In the second stage, individual students from each stratum were selected by using simple random sampling technique.
Dependent variable: Cancer information seeking Yes/ No and was coded as 1 and 0 respectively.
Socio-Demographic Factors: age, gender, year of study, filed of study, club participation, religion, ethnicity, prior residence, internet access.
Behavioral Factors: Smoking, Alcohol drinking, Risky sexual behavior, physical activity.
Health status: General health status, Self-cancer disease history, family cancer disease history.
Health literacy level: Perceived susceptibility to cancer, Perceived severity of cancer, Perceived health self-efficacy.
Cancer information seeking: “Yes” was defined as those who had looked for cancer information within the last year from any source (13).
Cancer information seeking: Respondents were asked two questions about their information seeking ‘‘Have you looked for information intentionally about cancer from any source?’’ and “about how long ago was that?”(14).
Smokers: defined as a respondent who smoke currently either every day or sometimes.
Alcohol drinking: drinker or alcohol miss use defined as if the AUDIT-C mean score is ≥ 4 for male and ≥ 3 for females (15).
Measurements: The AUDIT-C (Alcohol Use Disorder Identification Test) is quantifies alcohol misuse based on three Likert scale questions is a modified, shortened version of the 10-question AUDIT instrument developed by WHO (15).
Health self-efficacy: Respondents were asked questions about their level of confidence ranges from completely confident (5) to not at all confident (1), overall, how confident are you about your ability to take good care of your health?
Perceived susceptibility: Respondents were asked questions about their perception on level of susceptibility for cancer ranging from very likely (5) to very unlikely (1). How concerned are you about getting cancer disease?
Perceived severity: Respondents were asked questions about their own perception on cancer severity. Decide When I think about cancer, I automatically think about death” ranging from not at all (1) to extremely (5).
Health literacy: European health literacy survey questionnaire was used to measure health literacy and HLS-EU-Q with 47 items. The 47 items is assessed using a 4-point scale (very easy=4, easy=3, difficult=2 and very difficult=1) and the score is divided into 4 categories: ‘inadequate’, ‘problematic’, ‘sufficient’ and ‘excellent’ health literacy. Index is computed by the formula, Index=mean-1*(50/3). From the formula, if the index is In between 1 and 13.75 the health literacy is “Inadequate”, In between 13.76 and 25.5 the health literacy is “Problematic”, In between 25.6 and 37.5 the health literacy is “Sufficient” and >37.5 the health literacy is “Excellent” (16).
Data collection tools
Self-administered Amharic version questionnaire comprised of demographic, behavioral, health literacy, health status, psychological factors and looks for cancer information was used. The Health literacy questioner is adopted from European Health literacy survey (16). Cancer information seeking questioners are mainly adapted from the Health Information National Trend survey 2014 (17).
Data collection procedures
For quantitative study, five data collectors and two supervisors were recruited. The questionnaire was first developed in English and then translated to Amharic language and again back to English for appropriateness and easiness in approaching the study participants. The questionnaire was pre-tested for suitability prior to the actual data collection in the University of Gondar.
Data quality control
Data was collected by well-trained data collectors using pretested questionnaires. Training was given for two days to supervisors and data collectors on the objective of study. Close follow up and supervision during data collection time was carried out. Data were reviewed and checked for its completeness before entered and analyses.
Data processing & analysis
Data were entered into Epi- info version 7.2 and exported into SPSS version 20.0 for further statistical analysis. The data were cleaned, coded, and analysed. Descriptive analysis was done to describe socio-demographic characteristics of the study participants and the outcome variable. Binary logistic regression analysis was done to identify association between independent and cancer information seeking behavior at p-value less than 0.2. To identify factors significantly associated with the outcome variables (cancer information seeking yes/no), adjusted odds ratio (AOR) with 95% confidence interval (CI) was used. Variable having p-value less than 0.05 were considered as significant predictors. Hosmer and Lemeshow goodness of fit test was checked that was 0.17 p-values.
Ethical approval was obtained from University of Gondar, Institute of public health ethical review committee. Written permission letter was secured from Debre Tabor University. From each participant written informed consent was obtained. Their name was omitted for assurance of confidentiality and privacy. Interview was performed at suitable and secure place to respondents. Finally, questionnaire was cleaned, stored and analysed at secured place.