Electronic Theses and Dissertations




Hyunmin Kim



Document Type


Degree Name

Doctor of Philosophy


Health Systems & Policy

Committee Chair

M. Paige Powell

Committee Member

Cyril Chang

Committee Member

Xinhua Yu

Committee Member

George Relyea


Screening for breast cancer, the most common cancer in women and the second leading cause of cancer death, facilitates early detection and timely treatment that can reduce cancer-related morbidity and mortality. Increasingly, health information technology, including personal health records (PHRs) which contain detailed health information, has been suggested as having the potential to improve outcomes and reduce disparities in health care. Updated and relevant health information can help at-risk women participate in breast cancer screening and make appropriate clinical decisions.This dissertation consists of three essays that explore health information seeking behaviors of women at potential risk of breast cancer through PHRs and examines the effects of PHRs on the use of recommended breast cancer screening services, with a focus on racial/ethnic and geographic disparities.The first essay explores the decision-making process of health information seeking among women through the PHR use by developing the two-part Hurdle model. This essay finds that two distinct processes influence health information seeking through PHRs: the use of PHRs and the frequency of use. Furthermore, determinants of these two processes are different: demographic factors are the primary factors for the use of PHRs, and socioeconomic factors, salience, self-efficacy, and health status are the main factors associated with the frequency of use.The second essay examines health information seeking behavior of women at potential risk of breast cancer by exploring factors associated with the use of PHRs for health information seeking. The essay finds that women who use PHRs are younger, more educated, and more interested in exchanging medical information with a provider electronically, as well as value more the importance of getting their own medical information electronically compared with those who do not use PHRs. The third essay examines the effects of PHRs on breast cancer screening among women and its racial and geographic differences using an instrumental variables approach. This essay finds that use of PHRs is positively associated with the use of recommended breast cancer screening services among women, particularly among underserved and racial/ethnic minorities. In conclusion, PHR use can empower at-risk women, particularly underserved and minority women, to participate in recommended breast cancer screening.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.