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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Jun 10, 2019
Open Peer Review Period: Jun 13, 2019 - Aug 8, 2019
(currently open for review and needs more reviewers - can you help?)

Influences of eHealth literacy on obtaining knowledge about colorectal cancer among Internet users accessing a reputable cancer website

  • Seigo Mitsutake; 
  • Ai Shibata; 
  • Kaori Ishii; 
  • Rina Miyawaki; 
  • Koichiro Oka



To develop websites that enhance Internet users’ health knowledge, it is important to identify relevant factors associated with obtaining health knowledge via the Internet. Although an association between eHealth literacy (eHL) and knowledge of colorectal cancer (CRC) has been reported, little is known whether eHL is associated with obtaining knowledge of CRC via the Internet.


This study aimed to compare the results obtained from Internet users with high or low eHL in searching and using a reputable cancer website to gain CRC knowledge.


This study used respondents to Internet based pre-and post-surveys conducted in 2012. Potential respondents (n = 3,307) were identified from registered individuals aged 40–59 years (n = 461,160) in a Japanese Internet survey company. A total of 1,069 participants responded (response rate: 32.3%), and these pre-survey responders were then divided into high or low eHL groups using the Japanese eHealth Literacy Scale median score (23.5 points). From each group, 130 randomly selected individuals were invited to review the contents of a reputable CRC website, the Cancer Information Service managed by the National Cancer Center, and to respond to a post-survey via e-mail; responses were obtained from 107 individuals from each group. Twenty responses to knowledge statements regarding the definition, risk factors, screening prevention and symptoms of CRC were obtained at pre- and post-surveys, and differences in the correct responses between high and low eHL groups compared using the McNemar test.


The mean age of the participants was 49.1 (5.5) years. Four statements showed a significant increase in correct responses in both eHL groups pre- and post-survey: “S4. The risk of CRC is greater as a person gets older” (high eHL: P = 0.039, low eHL: P = 0.012), “S8. Cigarette smoking is a risk factor for CRC” (high eHL: P < 0.001, low eHL: P = 0.020), “S11. Obesity is a risk factor for CRC” (high eHL: P = 0.030, low eHL: P = 0.047), and “S12. Excess alcohol consumption is a risk factor for CRC” (high eHL: P = 0.002, low eHL: P = 0.003). Three statements showed a statistically significant increase in correct responses in the high eHL group only: “S1. CRC is cancer of the colon or rectum” (P = 0.003), “S5. The risk of CRC is the same between men and women” (P = 0.041), and “S9. Red meat intake is a risk factor for CRC” (P = 0.002), whereas only one response did in the low eHL group: “S17. Bloody stools are a symptom of CRC” (P = 0.004).


Low eHL Internet users appeared less capable of obtaining knowledge of CRC through searching and understanding information from a reputable cancer website than high eHL Internet users.


Please cite as:

Mitsutake S, Shibata A, Ishii K, Miyawaki R, Oka K

Influences of eHealth literacy on obtaining knowledge about colorectal cancer among Internet users accessing a reputable cancer website

JMIR Preprints. 10/06/2019:14966

DOI: 10.2196/preprints.14966


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