Online Health Information Seeking, Electronic Health Literacy, and Quality of Life Among Breast Cancer Survivors: A Mixed-Methods Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Breast cancer remains a major global and regional health concern. Although early detection and advanced therapies have extended survival, many breast cancer survivors (BCS) continue to experience persistent symptom burden and functional limitations. Online health information seeking (OHIS) and electronic health literacy (eHL) may support symptom self-management, yet their independent contributions to health-related quality of life (QoL) remain unclear. This study examined how eHL, OHIS, and exercise task self-efficacy (ESE) relate to QoL among BCS. Methods A concurrent mixed-methods design integrated a cross-sectional survey (N = 478) with semi-structured focus groups (N = 27). QoL was assessed using the EORTC QLQ-C30 and dichotomized into high and low groups based on an empirical cutoff of 57.14 derived from two-cluster K-means analysis. Predictors of high QoL were identified through multivariable logistic regression, and focus group data were analyzed using thematic analysis. Results The mean global QoL score was 58.59 (SD = 18.14). Financial status was the strongest independent predictor of high QoL (adequate: AOR = 4.777, 95% CI 1.765–12.925; fair: AOR = 3.728, 95% CI 1.532–9.073). Higher QoL was also associated with intensive OHIS (≥ 7 hours/week; AOR = 2.253, 95% CI 1.146–4.429) and greater ESE (AOR = 1.031, 95% CI 1.018–1.054), while eHL showed a statistically significant but modest association (AOR = 1.010, 95% CI 1.001–1.018). Symptom interference (AOR = 0.942, 95% CI 0.918–0.967) and recent chemotherapy (AOR = 0.407, 95% CI 0.231–0.715) were associated with lower odds of high QoL. Thematic analysis identified four themes and ten subthemes, encompassing seeking explanations for illness, information appraisal and decision support, using digital resources for self-management, and barriers and supports in digital engagement. Survivors used online resources to inform clinical decisions and manage menopausal and treatment-related symptoms, while some described protective disconnection from information overload and reliance on family members as digital proxies. Conclusions Intensive OHIS and exercise self-efficacy function as modifiable behavioral assets for QoL, whereas eHL showed a modest direct association, suggesting its benefit may depend on active mobilization into self-care. Findings support stage-sensitive digital resources, more accessible health information platforms, and family-centered support to promote digital equity in survivorship care.
Source: Research Square
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213440517