In this study, we investigated rural-urban differences in cancer information seeking in the United States. Our findings suggest that residents of isolated rural areas are less likely to seek cancer information compared to urban residents, even after controlling for sociodemographic factors, socioeconomic status, and social resources, supporting our hypothesis. Additionally, women, those with higher education, and those with better access to the internet are more likely to seek cancer information. It is also important to note that significant disparities in cancer information seeking between non-White and White residents or rural areas.
One possible explanation for our findings is that exposure to information campaigns in isolated rural areas is lower compared to urban areas. A study evaluating the reach of a health campaign in rural Arkansas found that the information did not adequately reach its target audience, with only 11% of participants recalling the messages (Balamurugan, 2007). Additionally, how messages are framed in the context of rurality has implications for uptake. Studies on smoke-free advertisements in rural areas have found mixed results. There is evidence that loss-frame ads, ads that focus on the disadvantages and costs of noncompliance with established policies, were less likely to be recalled compared to gain-frame ads in rural areas (Rayens, et al., 2016). However, in rural Kentucky, a study found the opposite: that loss-framing was one of the most effective strategies with rural audiences (Kostygina et al., 2014). We suggest that having interventions that are tailored and account for the social context of each rural environment might help increase health information seeking across rural areas. However, more data on the appropriate tailoring of cancer messages for rural areas is needed.
Another possible explanation is that isolated rural communities structure their social networks differently than urban communities. Studies have shown that rural residents are more likely to exchange resources with those closest in their network, have fewer friends on online social media, and have friends who live closer (Gilbert, 2010; Hofferth & Iceland, 2005). It is possible that residents of remote rural areas have social networks that are smaller and more tightly bounded compared to residents of larger rural and urban areas. This can influence the flow of information into and within the network, thus affecting the behaviors of its participants. Specifically, information could be spread faster among these communities, reducing the inclination to seek information from other sources.
In addition to the main predictors, other findings deserve attention. Consistent with the literature, we found that gender, education, and internet access were positively associated with the odds of seeking cancer information. Our findings that women were more likely to seek cancer information is in line with the literature on gender and health, which shows a gendered difference in which women interact more with health systems than men (Galdas, 2005; Thompson, 2016). Having higher education was associated with higher odds of seeking cancer information, findings that are also in line with prior literature showing education is a strong predictor of positive health behaviors and outcomes (Cutler & Lleras-Muney, 2010; Hahn & Truman, 2015). Lastly, we found that having more access points to the internet is associated with greater cancer information seeking. This is predictable and in line with established literature that posits advances in communication technologies have opened the possibilities to intervene and influence cancer prevention and control (Viswanath, 2005).
Our exploratory analysis found an interaction effect where the association between RUCAs and cancer information-seeking varied by race/ethnicity. Non-Whites in isolated and small rural towns were significantly less likely to seek cancer information compared to Whites in the same rural categories. However, these findings should be considered under the limitations of sample size when interacting RUCAs and race/ethnicity. Thus, generalizations of these findings should not be made without further research.
Although data from this study was collected before the COVID-19 pandemic, our findings have relevance for today. The pandemic has highlighted the importance of accurate and timely health information for everyone, including those in rural areas. Our study highlights the need for tailored interventions that account for the social context of rural communities to increase cancer information seeking. Additionally, our findings suggest that advances in communication technologies have opened possibilities up for health information dissemination and outreach, which could be leveraged during public health emergencies such as the COVID-19 pandemic.
In conclusion, our study highlights rural-urban disparities in cancer information seeking and identifies potential explanations for these disparities. Our findings can inform interventions to improve cancer information seeking and dissemination in rural areas and provide insights into the role of social context and communication technologies in shaping health behaviors. Further research is needed to explore these issues in more depth and to identify effective strategies for improving health information access and utilization in rural communities.
Limitations
Despite the contributions of our study, some limitations are worth noting. First, the cross-sectional nature of our study does not allow us to establish causality. Second, the data used in this study are self-reported, and therefore subject to recall and social desirability biases. Future research should consider using longitudinal data to assess the causality of the observed associations between rural-urban status and cancer information seeking. Additionally, more objective measures of cancer information-seeking behaviors should be used, such as tracking online search behavior. It is also important to expand our understanding of the social and cultural factors that may influence cancer information-seeking behaviors among rural populations, including the role of social norms, cultural values, and social support. Finally, interventions should be developed and tested to increase cancer information seeking in rural areas, such as tailored health campaigns and community-based health programs that account for the social context of each rural environment.