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    2022-05-18

    r> Table 1
    Descriptive statistics.
     β = 0.169, p < .01), respectively, but health literacy was not significantly associated with sigmoidoscopy uptake (H2).
    Fig. 3 shows the path from OHIS to health literacy to colonoscopy uptake, and testing the hypotheses revealed similar results compared to the previous model. Namely, OHIS was positively associated with health literacy (H1; β = 0.144, p < .05) and information overload (H1a; β = 0.179, p < .01), respectively; information overload was inversely associated with health literacy (H1b; β = -0.241, p < .001). This model also demonstrated that decisional balance was positively associated with health literacy ( H2a; β = .177, p < .01) and colonoscopy uptake (H2b; β = .262, p <
    .001), respectively, but health literacy was not significantly associated with colonoscopy uptake (H2). Finally, Fig. 4 shows the path from OHIS to health literacy to FOBT uptake. Like the previous two models, OHIS was positively associated with health literacy (H1; β = 0.149, p < .05) and
    information overload (H1a; β = 0.180, p < .01), respectively; information overload was inversely associated with health literacy (H1b; β = -0.244, p < .001). Unlike the other models, this Trehalose 6-phosphate FOBT model showed health literacy was neither associated with decisional balance nor FOBT uptake, thereby H2 and H2a both were not supported. However, this model found a Trehalose 6-phosphate significant positive association between decisional balance and FOBT uptake (β = 0.161, p < .05).
    4. Discussion and conclusion
    First of all, this study identified the path from OHIS to health literacy to uptake of sigmoidoscopy and colonoscopy, respectively, which is supported by both the Health Literacy Skills Framework and the Cognitive Mediation Model and the existing literature [21– 23,32–38]. The findings shed light on the development of interventions leveraging OHIS and health literacy for facilitating CRC screening among Korean Americans. One interventional approach can be community-based educational programs that target the enhancement of skills for using digital devices (e.g., computers, tablets, and smartphones) and e-health literacy—“the ability of people to use emerging information and communications technologies to improve or enable health and health care” [58]. These programs should comprise health information searching using reliable search engines and online communications with health providers, family, and friends. An increasing number of baby boomers are currently active Internet users and often seek health information through Internet-enabled devices [59]. Health care providers also have increasingly adopted Internet-based commu-nications with their patients through email, text message, or secured websites as an essential tool to set up appointments, remind of follow-up visits, and share test results [29,33]. However, diploid is also notable that there is an age-related digital divide in accessing and utilizing digital technologies and online health information especially among underrepresented older people in the U.S. [37,40,58]. Therefore, it is important for these interven-tional efforts to focus on empowering these underserved people to fully access needed health information online and make better-informed health decisions for CRC screening uptake and mainte-nance.
    As expected in the hypothesized models, this study found that perceived overload of information processing is positively related to OHIS, while it is negatively related to health literacy. This is consistent with the Cognitive Mediation Model and Jiang and Beaudoin’s study on analyzing 2013 Health Information National Trends Survey data [52]. According to the Cognitive Mediation Model [43,60], people who are motivated by health-related needs and purposes tend to increase attention to media and relevant