Analysis of the Current Status of Health Information-Seeking Behavior and Factors Affecting Lymphoedema In Postoperative Breast Cancer Patients: A Cross-Sectional Study

Analysis of the Current Status of Health Information-Seeking Behavior and Factors Affecting Lymphoedema In Postoperative Breast Cancer Patients: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the Current Status of Health Information-Seeking Behavior and Factors Affecting Lymphoedema In Postoperative Breast Cancer Patients: A Cross-Sectional Study Huan Zheng, Fang Chen, Lu Wang, Kai Cao, Xiaoyan Zhao, Lewen Shao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7234335/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Health information-seeking behavior (HISB) among postoperative breast cancer (BC) patients significantly contributes to lymphoedema prevention and management, enhancing patients' self-care abilities and health outcomes. Identifying influencing factors can provide scientific evidence and practical insights for developing effective lymphoedema-focused health education programs for this population. Objective This study aimed to investigate the current state and determinants of HISB in patients experiencing lymphoedema following BC surgery. Methods A cross-sectional study involving 196 patients was conducted from December 2024 to January 2025 at the Department of Breast Surgery in a tertiary hospital in Hangzhou, Zhejiang Province. Data collection utilized the General Information Questionnaire, the Upper Extremity lymphoedema Knowledge, Belief, and Behavior (KBB) scale, and the HISB Scale. Multiple linear regression was employed to identify factors associated with HISB among participants. Results The mean HISB score related to lymphoedema among the 196 postoperative BC patients was 178.21 ± 25.018. Multiple linear regression analysis revealed that the KBB level regarding upper limb lymphoedema, number of family members, age, education level, and discharge instructions significantly influenced patients' lymphoedema-related HISB. Conclusion Postoperative BC patients generally exhibited insufficient levels of lymphoedema-related HISB. Healthcare providers should prioritize patients who are older, less educated, and from smaller families. Enhancing the effectiveness of lymphoedema-focused health education and communication methods is essential to improve HISB and subsequent self-care behaviors in this patient group. Implication for Practice: This study highlights significant gaps in HISB among postoperative BC patients with lymphoedema, identifying key influencing factors including lymphoedema knowledge, age, educational attainment, family size, and discharge instruction quality. These findings can inform healthcare professionals in refining patient-centered health education and communication strategies, thereby enhancing patient engagement and self-management capabilities. Additionally, the results may guide healthcare policy shifts towards a patient-centered, health-promotion approach. Breast cancer Lymphoedema Information seeking Nursing care Introduction According to global cancer statistics in 2022, breast cancer (BC) is the leading malignancy among women worldwide, accounting for 2.3 million new cases (Bray et al. 2024 ). Breast cancer-related lymphoedema (BCRL), a common postoperative complication, results from structural damage to the lymphatic system, impairing the return of interstitial fluid (Latifi et al. 2020 ). The incidence of BCRL varies depending on the surgical method, extent of radiotherapy, timing of follow-up, and diagnostic measurement methods, with peak occurrence between 12 and 30 months after surgery, affecting approximately 50% of patients (Epstein and Street 2011 ). Lymphoedema is a chronic condition characterized by progressive swelling and functional impairment of the affected limbs (Link et al. 2022 ), leading to physical pain, psychological distress, economic burdens, and significantly impacting patients' quality of life. Current research on managing BCRL emphasizes improved surgical techniques, such as optimized axillary lymph node dissection (Lu et al. 2022 ), and preventive rehabilitation (Rafn et al. 2022 ). However, existing studies frequently overlook the necessity of long-term, lifelong self-management strategies crucial for preventing onset or alleviating symptoms of BCRL. Studies indicate a general lack of awareness about BCRL among postoperative BC patients (Wong et al. 2024 ), possibly attributable to insufficient patient education regarding BCRL management (Acebedo et al. 2021 ) or inadequate information provision by healthcare professionals (Hill et al. 2022 ). Therefore, timely delivery of educational resources and social support is critical for effectively preventing and managing BCRL. Patients' health information-seeking behavior (HISB) serves as a fundamental approach enabling active acquisition of health knowledge and involvement in decision-making, significantly influenced by health beliefs (knowledge, attitudes, and behaviors) and risk perceptions (Hasenoehrl et al. 2020 ). Within the framework of the health belief model, HISB represents proactive patient-driven health behavior motivated by perceived disease threat and self-efficacy (Pervane et al. 2020 ). Furthermore, social support theory suggests that family support and access to information channels can notably alleviate barriers to acquiring health information (Pervane et al. 2020 ). Therefore, this cross-sectional study aims to investigate: 1) how health beliefs (knowledge-attitudes-behaviors) influence the intensity of patients' informational needs through risk perception; and 2) how social support (family demographics, information channels) enhances the effectiveness of information acquisition. The findings aim to transcend traditional biomedical perspectives, providing a theoretical foundation for developing a three-tier “hospital-community-family” information support network, thereby facilitating a shift from disease-oriented management to holistic health promotion. Method Study Design This cross-sectional study aimed to evaluate lymphoedema-related HISB among postoperative BC patients and identify its influencing factors. Participants This study was conducted between December 2024 and January 2025, selected 196 patients from the Department of Breast Surgery at a tertiary hospital in Hangzhou, Zhejiang Province. Inclusion criteria were: (1) age ≥ 18 years; (2) undergoing their first BC surgery; (3) pathologically confirmed BC diagnosis, with awareness of the diagnosis; (4) clear consciousness, no language barriers, basic reading skills, and ability to use a cell phone; (5) no history of other malignant tumors or serious chronic diseases; (6) voluntarily signed informed consent. Exclusion criteria encompassed: (1) severe organ dysfunction (heart, liver, kidney); (2) limb dysfunction or amputation; (3) foreign nationality, psychiatric illness, or involvement in medical disputes. Questionnaires with repetitive consecutive identical answers, incomplete entries, or completion times of less than two minutes were excluded. Measures General Information Questionnaire A researcher-developed questionnaire was used to collect demographic and disease-related information. Upper Extremity lymphoedema Knowledge, Belief, and Behavior (KBB) Scale Developed by Shen et al. ( 2023 ), this scale assesses lymphoedema-related prevention knowledge (10 items), attitudes (7 items), and behaviors (6 items) across three dimensions, using a 5-point Likert scale. Higher scores indicate better knowledge, attitudes, and self-management behaviors. The scale's reliability was demonstrated by a Cronbach's α of 0.931, a split-half reliability of 0.875, a re-test reliability of 0.91, and a correlation coefficient of r = 0.78 (p < 0.001) with the validated lymphoedema Breast Cancer Questionnaire (LBCQ) (Zimmerman and Shaw 2020 ). In this study, Cronbach’s α was 0.816. Health Information-Seeking Behavior (HISB) Scale Developed by Zamani et al. ( 2014 ) and adapted for the Chinese context by Sun et al. (2019), this scale underwent rigorous translation procedures including forward translation, back-translation, and pilot testing to ensure cultural appropriateness. The scale comprises 43 items across four dimensions: attitudes towards information-seeking (6 items), information needs (14 items), information sources (15 items), and barriers to accessing health information (8 items). It employs a 5-point Likert scale, with higher scores reflecting greater HISB. The Cronbach's α for this scale in this study was 0.815. Sample Size Using convenience sampling, the required sample size was calculated based on the formula N = Z²σ²/e², where N is the sample size, σ represents the standard deviation, e indicates the absolute error, and Z is the value corresponding to the confidence level (e.g., Z = 1.96 for a 95% confidence interval (CI)). Literature indicates a typical sampling attrition rate of up to 25% (shao, 2012, p12-14; Li, 2014). This study included 31 variables: 24 from the demographic questionnaire, three from the KBB Scale, and four from the HISB Scale. Considering potential questionnaire inefficiencies, the sample size was increased by 10–20%, resulting in an estimated requirement of 165 to 330 participants. Ultimately, the final sample comprised 196 participants. Data Collection and Ethical Approval This study strictly adhered to ethical research standards. Consent was obtained from all participants prior to the study. Participants were comprehensively informed regarding the study’s purpose, procedures, potential risks and benefits, and their right to withdraw at any time. Written informed consent was provided by each participant. Participant anonymity was ensured throughout the study by employing unique identifiers instead of personal data. All collected data were handled confidentially and securely stored. For electronic data collected via Questionnaire Star, secure data transmission and storage protocols were utilized to safeguard participant information. Paper-based questionnaires were stored in locked cabinets with restricted access. The study was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (IIT20240734B) and conducted in accordance with the ethical standards outlined in the Declaration of Helsinki and its subsequent amendments. The reporting method adheres to the STROBE checklist to ensure transparency and completeness of the research presentation. Data Analysis Data entry and statistical analyses were conducted using SPSS 25.0. Categorical data were described using frequencies and percentages (%), whereas normally distributed continuous data were presented as mean ± standard deviation (SD). Independent samples t-tests and one-way analyses of variance (ANOVA) were employed to compare groups. Variables found to be significant in these initial analyses were further included as independent variables in a multiple regression model, with the lymphoedema HISB score for postoperative BC patients serving as the dependent variable. All statistical tests were two-sided, and p-values < 0.05 indicated statistical significance. Results General Characteristics of Survey Respondents This study enrolled 196 postoperative BC patients. Consistent with disease demographics, the majority were female (99.49%, n = 195), and males represented 0.51% (n = 1). Participants ranged in age from 28 to 76 years, with a mean age of 49.44 ± 13.996 years. Additional demographic details are summarized in Table A.1 . Current Status of Lymphoedema HISB in Postoperative BC Patients and Univariate Analysis Results The mean HISB scale score for lymphoedema among postoperative BC patients was 178.21 ± 25.02. The mean scores for each dimension were as follows: health information-seeking attitude, 26.03 ± 4.44; information needs, 63.18 ± 9.48; information sources, 56.87 ± 10.07; and barriers to accessing information, 32.13 ± 6.71. Univariate analysis revealed statistically significant differences in lymphoedema HISB scores among postoperative BC patients based on education level, family size, number of axillary lymph node dissections, radiotherapy site, receipt of lymphoedema prevention instructions upon hospital discharge, occurrence of axillary web syndrome post-surgery, and awareness of lymphoedema-related outpatient clinics (p < 0.05; Table A.2 ). Correlation Analysis Between HISB and Lymphoedema Knowledge in Postoperative BC Patients Correlation analysis revealed a significant positive relationship between lymphoedema HISB scores and the total KBB scale scores for upper limb lymphoedema among postoperative BC patients (r = 0.871, p < 0.001). Additionally, the number of radiotherapy treatments was significantly positively correlated with HISB scores (r = 0.157, p < 0.05). In contrast, a significant negative correlation was observed between age and both HISB scores (r=-0.810, p < 0.001) and total KBB scores (r=-0.594, p < 0.001) (Table A.3 ). Multiple Linear Regression Analysis of Factors Influencing HISB for Lymphoedema in Postoperative BC Patients In this study, the lymphoedema HISB score in postoperative BC patients was used as the dependent variable, while variables showing statistical significance in the univariate and correlation analyses were included as independent variables in a multiple linear regression model. Assignments for categorical independent variables are shown in Table A.4 ; numerical variables were entered as original values. Multivariate analysis indicated that age, education level, total upper limb lymphoedema KBB score, family size, number of axillary lymph nodes removed, and receipt of lymphoedema prevention instructions at hospital discharge significantly influenced HISB (p < 0 .05). Detailed regression results are presented in Table A.5 . Discussion Current Status and Univariate Analysis of Lymphoedema HISB in Postoperative BC Patients The results of this study indicated that the mean total HISB score for lymphoedema in postoperative BC patients was 178.21 ± 25.02, which was higher than the mean score reported by Li et al. ( 2024 ). However, it remains slightly lower than the median score of 182, suggesting an overall low level of HISB among these patients. This finding may relate to patients' insufficient understanding of lymphoedema-associated risks (Qin et al., 2023 ), where inadequate knowledge weakens trust in professional information and consequently diminishes patients’ motivation to actively seek health information (Bandura 2001 ). This situation explains the relatively low mean attitude score (26.026 ± 4.435), which was below the median score (27.00), indicating that knowledge level significantly influences patients' attitudes toward lymphoedema complications (Qin et al. 2023 ). The mean score for patients' information needs was 63.184 ± 9.483, revealing a high demand for information about postoperative lymphoedema. However, individual differences were observed, consistent with Ludwigso et al. (2024), indicating varied urgency in seeking health information among patients. Patients' awareness of lymphoedema’s potential impact on quality of life after surgery heightened their demand for information regarding signs and symptoms, self-care behaviors, treatment options, access to healthcare services, and coping strategies for anxiety (Dorri et al. 2020 ). The mean score for utilization of information sources was 56.872 ± 10.065, closely aligned with the median of 57.000, suggesting moderate and balanced selection of health information sources among patients. Health education provided by healthcare professionals partially influenced patients’ information choices, indicating limitations in available sources. While some patients depended heavily on specific information channels, others explored multiple sources. However, the information provided by healthcare professionals often does not fully satisfy patient needs, prompting patients to seek relevant information through social networks and other channels. Unfortunately, such information is frequently fragmented and insufficient to adequately support patient decision-making (Fu et al. 2023 ). In this study, the mean score for barriers to information access was 32.128 ± 6.706, indicating substantial difficulties faced by patients in obtaining health information. While the overall level of barriers appeared consistent, the variability in scores suggested significant individual differences in the type and severity of obstacles encountered. Common barriers included complex information, technological challenges (e.g., unfamiliarity with the Internet), financial constraints (e.g., inability to afford information access), and limited healthcare resources (Shen et al. 2023 ). In addition, inadequate family support hindered some patients’ ability to manage these obstacles, with several reporting insufficient time and energy to concentrate on lymphoedema care (Zhao et al. 2021 ). Although postoperative BC patients exhibited considerable demand for lymphoedema-related health information, their actual access remained limited. Despite patients' awareness of lymphoedema’s health implications, difficulties in accessing information, restricted information sources, and numerous barriers collectively contributed to the overall low HISB levels. Economic factors (34.69% of patients had a monthly household income below 5000 RMB) and technological barriers (22.96% of patients resided in rural townships) formed a compounded obstacle. This finding aligns with barriers identified by Latifi et al. ( 2020 ). Therefore, healthcare providers should adopt stratified support strategies to effectively address and mitigate these postoperative information barriers. Lymphoedema HISB in Postoperative BC Patients is Influenced by Multiple Factors Age and Education Age was negatively associated with HISB (β=-0.810, p < 0.001), which is consistent with findings reported by Liu ( 2022 ). Younger patients were more likely to seek information, primarily due to older patients' lower capacity for accessing information. Additionally, younger patients exhibit higher self-efficacy and greater comprehension abilities, which typically decline with advancing age, thereby hindering older adults' processing of complex information (Zhao et al. 2021 ). This observation aligns with the dual components of digital divide theory (van Dijk 2006 ): older patients encounter the “Access Divide” due to insufficient digital literacy, impeding effective utilization of online health resources, and also experience the “Usage Divide” as their limited ability to critically evaluate information makes them susceptible to misinformation. This study also found that educational attainment negatively correlated with HISB (β=-0.015, p < 0.001), contrasting with findings reported by Liu ( 2022 ). This discrepancy can be explained by the health belief model: patients with lower educational levels may perceive lymphoedema as more threatening and thus rely more heavily on family support to overcome their limited access to information (Janz and Becker 1984 ). This highlights the need for targeted health education programs tailored to patients' educational backgrounds and social support systems. According to Zhao et al. ( 2021 ), married females with lower educational attainment typically bear greater household responsibilities (Yaohui and Rudai 2025 ). In contrast, 99.49% of participants in this study were female, and 88.776% were married. According to role conflict theory (Goode 1960; Smoktunowicz et al. 2017 ), female patients experience greater anxiety regarding postoperative complications, such as lymphoedema exacerbated by household tasks, due to competing pressures from their caregiving roles. This motivates them to mitigate uncertainty through proactive information-seeking behaviors, consistent with the stress-buffering hypothesis (Cohen & Wills, 1985 ). Thus, patients with lower educational levels may be compelled to seek information on reducing lymphoedema risks following BC surgery due to a heightened perception of threat. In contrast, patients with higher education may rely more extensively on existing knowledge and underestimate their informational needs, indicating that educational interventions should be customized to accommodate distinct patient perceptions and educational backgrounds. Family Support In this study, patients from households with ≥ 5 family members had significantly higher HISB scores (β = 2.432, p < 0.001), while widowed patients exhibited the lowest HISB score (157), aligning with findings reported by Liu ( 2022 ). These results suggest that family support positively influences patients' lymphoedema-related HISB, consistent with Cohen & Wills' (1985) buffer hypothesis, which proposes that emotional and instrumental support from family members can mitigate barriers to accessing health information (Cohen and Wills 1985 ). Marital status also affects patients' informational needs and psychological well-being; notably, spousal support strongly motivates postoperative BC patients to actively seek health information (Latifi et al. 2018 ). Family support enhances patients’ confidence and encourages their proactive engagement with health information. However, it is important to monitor for potential family overprotection. Therefore, health education should incorporate family role-management training to balance support with patient empowerment (Zhao et al. 2021 ), and introduce additional sources of information through family involvement to enhance patient comprehension of lymphoedema-related health information and foster active participation in health decisions. Patients can contribute to overall family functioning by sharing and interacting around health-related information, thereby promoting proactive disease-prevention and health-promotion behaviors (Lee 2020 ). In the Chinese cultural context, family size and support likely exert significant influence on HISB among postoperative BC patients with lymphoedema, as close familial bonds provide security, reliability, and motivation to actively seek information (Lu et al. 2022 ). Therefore, future lymphoedema-related health education initiatives should assess family support levels: for patients with substantial family support, healthcare professionals should empower both patients and families to strengthen self-efficacy and balanced support. Conversely, for patients with limited family support, it is crucial to enhance support from healthcare professionals and actively engage governmental and community-based organizations to foster a supportive environment. This approach aims to establish a systematic and comprehensive social support network, ultimately improving patients' HISB. Disease Factors The present study showed that postoperative BC patients who underwent axillary lymph node dissection involving ≥ 15 nodes had higher HISB scores (β = 1.542, p = 0.004), aligning with disease perception theory. According to the Health Belief Model by Janz and Becker ( 1984 ), highly invasive procedures, such as extensive lymph node dissection, significantly heighten patients’ perceptions of disease threat (Perceived Susceptibility: OR = 2.15, p < 0 .01; Perceived Severity: SMD = 0.89), thus markedly stimulating their motivation to seek health information (Janz and Becker 1984 ). Axillary lymph node clearance is a significant risk factor for postoperative lymphoedema development in BC patients (Cobb and DeSnyder 2023 ); more extensive clearance correlates with greater physical trauma and potential risk. Patients' perceptions of disease severity significantly influence HISB, motivating them to seek more information as the perceived threat increases (Zimmerman and Shaw 2020 ). The current study found a significant positive relationship between disease perception intensity and HISB. In contrast, a longitudinal study by Liu ( 2022 ) identified an inverted U-shaped relationship between disease perception intensity and efficacy in health information use:: moderately elevated perceptions of disease threat (e.g., through educational interventions regarding postoperative complications) promoted information-seeking behaviors (β = 0.32, p < 0.001), while excessively heightened threat perceptions (e.g., misinformation-induced anxiety) negatively impacted adherence behaviors (β=-0.18, p = 0.032). This observation supports Li's (2024) concept of a “perception-behavior conversion threshold,” highlighting the necessity of balancing risk warnings and empowerment in health education (Yuanyuan 2024 ). Therefore, healthcare professionals should prioritize shaping accurate perceptions of lymphoedema among postoperative BC patients, emphasizing risk factors specific to each patient’s disease characteristics and treatment methods. This strategy aims to enhance patients' understanding of the disease, thus motivating proactive information-seeking behaviors related to lymphoedema and ultimately improving their HISB. Patient Education The results of this study indicate that patients who received structured discharge instructions, and those with higher KBB scores regarding lymphoedema demonstrated more proactive HISB. Validation of the health belief model indicates that behavioral changes are stimulated by “cueing factors.” In contrast, the group lacking structured discharge instructions (48.98%) had significantly lower HISB scores (β = -4.274), highlighting the importance of structured patient education. However, current health education models may inadequately address patients' needs due to complex content (Latifi et al. 2020 ). Moreover, healthcare providers frequently fail to consider patients' existing knowledge, acceptance levels, and actual informational requirements, resulting in a standardized, one-size-fits-all educational approach. This oversight neglects patient subjectivity and contributes to a mismatch between information supply and patient demand (Epstein and Street 2011 ), adversely affecting perceptions of doctor-patient communication quality. Studies have shown (Link et al. 2022 ) that improving doctor-patient communication and improving patient education can significantly boost patients' HISB, with perceived communication quality playing a pivotal role in facilitating information-seeking behaviors. Within the family-oriented Chinese healthcare context, healthcare professionals remain the primary source of patient information (82.6% of all sources) (Lu et al. 2022 ). However, the tendency to defer to authority inherent in collectivist cultures may suppress patients' proactive information-seeking. Therefore, leveraging the synergistic framework combining the Health Belief Model and Social Support Theory, a three-tiered intervention strategy was developed: (1) enhancing stepped educational content by leveraging patients’ risk perceptions; (2) creating a supportive information environment through family empowerment; and (3) utilizing the Teach-Back method to enhance doctor-patient dialogues and incorporating co-decision-making communication modules to elevate perceived communication quality. The integration of these strategies aims to strengthen health beliefs, enhance social support, and ultimately promote effective patient engagement. Limitations This study has several limitations due to its single-center and cross-sectional design. The sample, primarily drawn from a tertiary hospital in Hangzhou, may introduce selection bias and might not adequately represent broader patient populations. The cross-sectional approach provides only a single-time-point assessment, precluding the establishment of causal relationships between influencing factors and HISB among postoperative BC patients. Future research should adopt multicenter, longitudinal designs and include participants from diverse geographic regions and economic backgrounds to enhance the representativeness and generalizability of findings. It is also essential to conduct comparative analyses between urban and rural populations to better understand the influence of geographic disparities on HISB related to lymphoedema in this patient group. Additionally, the gender imbalance, with female participants comprising 99.49% of the study population, significantly restricts the applicability of the findings. Future studies should aim to include more male participants to comprehensively explore HISB among BC patients. In conclusion, despite offering valuable insights, the present study’s limitations should be acknowledged. Future multicenter longitudinal studies with more representative and gender-balanced samples is needed to clarify the dynamics of HISB, examine urban-rural differences more thoroughly, and elucidate the causal mechanisms among related variables. Conclusion In summary, this study demonstrated that lymphoedema HISB among postoperative BC patients is influenced by multiple factors, including upper limb lymphoedema KBB scores, the extent of axillary lymph node dissections, family size, age, and education level. Healthcare professionals should tailor health education initiatives according to these influential factors to improve lymphoedema-related HISB among BC survivors. Additionally, refining the communication model between healthcare providers and patients is crucial to address existing mismatches between information supply and patient demand. Leveraging the interactive mechanisms of health beliefs (e.g. perceived disease threat, self-efficacy) and social support factors (e.g. family size, information sources) will further influence HISB, ultimately promoting proactive lymphoedema HISB among postoperative BC patients. Declarations Conflicts of Interest: The authors declare no conflicts of interest. Acknowledgments: The researchers would like to sincerely appreciate all the participants in this study. Statistics: The authors affirmed that the methods used in the data analyses are suitably applied to our data within our study design and context. Reporting Method : The reporting method follows the STROBE checklist to ensure transparency and completeness in the presentation of the research. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Previous presentations: None. Author Contribution Author Contributions:Huan Zheng: conceptualization, investigation, data curation, formal analysis, writing – original draft.Fang Chen: conceptualization, methodology, writing – review and editing.Lu Wang: methodology, writing – review and editing.Kai Cao: investigation，data curation.Xiaoyan Zhao: investigation.Lewen Shao: conceptualization, validation, supervision, writing – review and editing. Data Availability This statement will replace any statement written within the manuscript and is the one that we will publish.The data of this study contain participants' personal privacy information (e.g., [specific details such as disease diagnosis, family information, etc.]). 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Yaohui, Z., and Rudai, B. 2025. “The Decline in Female Labor Force Participation in China from a Family Perspective.” Journal of Wuhan University (Philosophy and Social Science Edition) 78, no. 1: 133–145. Yuanyuan, L. 2024. “The Relationship and Mediating Effect between Illness Perception and SelfManagement Behaviors of Breast CancerRelated Lymphedema.” PhD diss., Henan University. Zamani, M., Soleymani, M. R., Afshar, M., et al. 2014. “InformationSeeking Behavior of Cardiovascular Disease Patients in Isfahan University of Medical Sciences Hospitals.” Journal of Education and Health Promotion 3: 83. Zhao, H., Wu, Y., Zhou, C., et al. 2021. “Breast CancerRelated Lymphedema Patient and Healthcare Professional Experiences in Lymphedema SelfManagement: A Qualitative Study.” Supportive Care in Cancer 29, no. 12: 8027–8044. Zimmerman, M. S., and Shaw, G. J. 2020. “Health Information Seeking Behaviour: A Concept Analysis.” Health Information and Libraries Journal 37, no. 3: 173–191. Additional Declarations No competing interests reported. Supplementary Files Appendices.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 26 Apr, 2026 Reviews received at journal 22 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers invited by journal 02 Sep, 2025 Editor assigned by journal 02 Sep, 2025 Submission checks completed at journal 31 Jul, 2025 First submitted to journal 28 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7234335","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510472425,"identity":"56387082-1dcb-4329-bd60-152a36bfde61","order_by":0,"name":"Huan Zheng","email":"","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Zheng","suffix":""},{"id":510472426,"identity":"c570a772-01a3-4206-8c34-9190deb5a211","order_by":1,"name":"Fang Chen","email":"","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Chen","suffix":""},{"id":510472427,"identity":"0460b3d7-d0b0-4e81-a2eb-fe76b50b9be6","order_by":2,"name":"Lu Wang","email":"","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Wang","suffix":""},{"id":510472428,"identity":"aa30ea42-e9f6-4719-a366-adcbb2686794","order_by":3,"name":"Kai Cao","email":"","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Cao","suffix":""},{"id":510472429,"identity":"4ae44e76-8b60-41e1-a201-e753136c3a32","order_by":4,"name":"Xiaoyan Zhao","email":"","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Zhao","suffix":""},{"id":510472430,"identity":"3723aa79-784c-456e-9bfe-403f32228cdd","order_by":5,"name":"Lewen Shao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACfvmDDQcSKmwYGBuAPB5itEjOYG488OFMGglaDG6wNx+c2XYYwiNOy+3GhsO8beftmWckMD5428Ygb07QYXcONhzmOXebmXFGArPh3DYGw50NBLTwHUgEaim7zQbUwibN28aQYHCAkDVgLWzneIBa2H8TpUXgRmLDwRltByRAtjATpUWyBxgvH84kGzD2PGyWnHNOwnADIS387O2PPyRU2Nkbticf/PCmzEaesF9gwLABHJkSxKoHAnkS1I6CUTAKRsEIAwAVxEdkF4qQxgAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lewen","middleName":"","lastName":"Shao","suffix":""}],"badges":[],"createdAt":"2025-07-28 13:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7234335/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7234335/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90777989,"identity":"d75f5316-02f1-4c27-a7b6-151cb0b23cbe","added_by":"auto","created_at":"2025-09-08 03:46:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":820854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7234335/v1/6d6f4fcf-eea7-4e75-b93c-fe23b37d74e8.pdf"},{"id":90777498,"identity":"d40cf44c-939b-48a0-be5c-e88551274bf6","added_by":"auto","created_at":"2025-09-08 03:38:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35719,"visible":true,"origin":"","legend":"","description":"","filename":"Appendices.docx","url":"https://assets-eu.researchsquare.com/files/rs-7234335/v1/8d6536780848722e8d2981a4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the Current Status of Health Information-Seeking Behavior and Factors Affecting Lymphoedema In Postoperative Breast Cancer Patients: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to global cancer statistics in 2022, breast cancer (BC) is the leading malignancy among women worldwide, accounting for 2.3\u0026nbsp;million new cases (Bray et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Breast cancer-related lymphoedema (BCRL), a common postoperative complication, results from structural damage to the lymphatic system, impairing the return of interstitial fluid (Latifi et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The incidence of BCRL varies depending on the surgical method, extent of radiotherapy, timing of follow-up, and diagnostic measurement methods, with peak occurrence between 12 and 30 months after surgery, affecting approximately 50% of patients (Epstein and Street \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Lymphoedema is a chronic condition characterized by progressive swelling and functional impairment of the affected limbs (Link et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), leading to physical pain, psychological distress, economic burdens, and significantly impacting patients' quality of life. Current research on managing BCRL emphasizes improved surgical techniques, such as optimized axillary lymph node dissection (Lu et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and preventive rehabilitation (Rafn et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, existing studies frequently overlook the necessity of long-term, lifelong self-management strategies crucial for preventing onset or alleviating symptoms of BCRL. Studies indicate a general lack of awareness about BCRL among postoperative BC patients (Wong et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), possibly attributable to insufficient patient education regarding BCRL management (Acebedo et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) or inadequate information provision by healthcare professionals (Hill et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, timely delivery of educational resources and social support is critical for effectively preventing and managing BCRL. Patients' health information-seeking behavior (HISB) serves as a fundamental approach enabling active acquisition of health knowledge and involvement in decision-making, significantly influenced by health beliefs (knowledge, attitudes, and behaviors) and risk perceptions (Hasenoehrl et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Within the framework of the health belief model, HISB represents proactive patient-driven health behavior motivated by perceived disease threat and self-efficacy (Pervane et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Furthermore, social support theory suggests that family support and access to information channels can notably alleviate barriers to acquiring health information (Pervane et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, this cross-sectional study aims to investigate: 1) how health beliefs (knowledge-attitudes-behaviors) influence the intensity of patients' informational needs through risk perception; and 2) how social support (family demographics, information channels) enhances the effectiveness of information acquisition. The findings aim to transcend traditional biomedical perspectives, providing a theoretical foundation for developing a three-tier “hospital-community-family” information support network, thereby facilitating a shift from disease-oriented management to holistic health promotion.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study aimed to evaluate lymphoedema-related HISB among postoperative BC patients and identify its influencing factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted between December 2024 and January 2025, selected 196 patients from the Department of Breast Surgery at a tertiary hospital in Hangzhou, Zhejiang Province. Inclusion criteria were: (1) age ≥ 18 years; (2) undergoing their first BC surgery; (3) pathologically confirmed BC diagnosis, with awareness of the diagnosis; (4) clear consciousness, no language barriers, basic reading skills, and ability to use a cell phone; (5) no history of other malignant tumors or serious chronic diseases; (6) voluntarily signed informed consent. Exclusion criteria encompassed: (1) severe organ dysfunction (heart, liver, kidney); (2) limb dysfunction or amputation; (3) foreign nationality, psychiatric illness, or involvement in medical disputes. Questionnaires with repetitive consecutive identical answers, incomplete entries, or completion times of less than two minutes were excluded.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneral Information Questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA researcher-developed questionnaire was used to collect demographic and disease-related information.\u003c/p\u003e\u003cp\u003e\u003cb\u003eUpper Extremity lymphoedema Knowledge, Belief, and Behavior (KBB) Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDeveloped by Shen et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), this scale assesses lymphoedema-related prevention knowledge (10 items), attitudes (7 items), and behaviors (6 items) across three dimensions, using a 5-point Likert scale. Higher scores indicate better knowledge, attitudes, and self-management behaviors. The scale's reliability was demonstrated by a Cronbach's α of 0.931, a split-half reliability of 0.875, a re-test reliability of 0.91, and a correlation coefficient of r = 0.78 (p \u0026lt; 0.001) with the validated lymphoedema Breast Cancer Questionnaire (LBCQ) (Zimmerman and Shaw \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In this study, Cronbach’s α was 0.816.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealth Information-Seeking Behavior (HISB) Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDeveloped by Zamani et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and adapted for the Chinese context by Sun et al. (2019), this scale underwent rigorous translation procedures including forward translation, back-translation, and pilot testing to ensure cultural appropriateness. The scale comprises 43 items across four dimensions: attitudes towards information-seeking (6 items), information needs (14 items), information sources (15 items), and barriers to accessing health information (8 items). It employs a 5-point Likert scale, with higher scores reflecting greater HISB. The Cronbach's α for this scale in this study was 0.815.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUsing convenience sampling, the required sample size was calculated based on the formula N = Z²σ²/e², where N is the sample size, σ represents the standard deviation, e indicates the absolute error, and Z is the value corresponding to the confidence level (e.g., Z = 1.96 for a 95% confidence interval (CI)). Literature indicates a typical sampling attrition rate of up to 25% (shao, 2012, p12-14; Li, 2014). This study included 31 variables: 24 from the demographic questionnaire, three from the KBB Scale, and four from the HISB Scale. Considering potential questionnaire inefficiencies, the sample size was increased by 10–20%, resulting in an estimated requirement of 165 to 330 participants. Ultimately, the final sample comprised 196 participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection and Ethical Approval\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study strictly adhered to ethical research standards. Consent was obtained from all participants prior to the study. Participants were comprehensively informed regarding the study’s purpose, procedures, potential risks and benefits, and their right to withdraw at any time. Written informed consent was provided by each participant. Participant anonymity was ensured throughout the study by employing unique identifiers instead of personal data. All collected data were handled confidentially and securely stored. For electronic data collected via Questionnaire Star, secure data transmission and storage protocols were utilized to safeguard participant information. Paper-based questionnaires were stored in locked cabinets with restricted access. The study was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (IIT20240734B) and conducted in accordance with the ethical standards outlined in the Declaration of Helsinki and its subsequent amendments. The reporting method adheres to the STROBE checklist to ensure transparency and completeness of the research presentation.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData entry and statistical analyses were conducted using SPSS 25.0. Categorical data were described using frequencies and percentages (%), whereas normally distributed continuous data were presented as mean ± standard deviation (SD). Independent samples t-tests and one-way analyses of variance (ANOVA) were employed to compare groups. Variables found to be significant in these initial analyses were further included as independent variables in a multiple regression model, with the lymphoedema HISB score for postoperative BC patients serving as the dependent variable. All statistical tests were two-sided, and p-values \u0026lt; 0.05 indicated statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eGeneral Characteristics of Survey Respondents\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study enrolled 196 postoperative BC patients. Consistent with disease demographics, the majority were female (99.49%, n\u0026thinsp;=\u0026thinsp;195), and males represented 0.51% (n\u0026thinsp;=\u0026thinsp;1). Participants ranged in age from 28 to 76 years, with a mean age of 49.44\u0026thinsp;\u0026plusmn;\u0026thinsp;13.996 years. Additional demographic details are summarized in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003eA.1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCurrent Status of Lymphoedema HISB in Postoperative\u003c/b\u003e BC \u003cb\u003ePatients and Univariate Analysis Results\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean HISB scale score for lymphoedema among postoperative BC patients was 178.21\u0026thinsp;\u0026plusmn;\u0026thinsp;25.02. The mean scores for each dimension were as follows: health information-seeking attitude, 26.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44; information needs, 63.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.48; information sources, 56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;10.07; and barriers to accessing information, 32.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71. Univariate analysis revealed statistically significant differences in lymphoedema HISB scores among postoperative BC patients based on education level, family size, number of axillary lymph node dissections, radiotherapy site, receipt of lymphoedema prevention instructions upon hospital discharge, occurrence of axillary web syndrome post-surgery, and awareness of lymphoedema-related outpatient clinics (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003eA.2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelation Analysis Between HISB and Lymphoedema Knowledge in Postoperative\u003c/b\u003e BC \u003cb\u003ePatients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCorrelation analysis revealed a significant positive relationship between lymphoedema HISB scores and the total KBB scale scores for upper limb lymphoedema among postoperative BC patients (r\u0026thinsp;=\u0026thinsp;0.871, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the number of radiotherapy treatments was significantly positively correlated with HISB scores (r\u0026thinsp;=\u0026thinsp;0.157, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, a significant negative correlation was observed between age and both HISB scores (r=-0.810, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and total KBB scores (r=-0.594, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003eA.3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultiple Linear Regression Analysis of Factors Influencing HISB for Lymphoedema in Postoperative BC Patients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the lymphoedema HISB score in postoperative BC patients was used as the dependent variable, while variables showing statistical significance in the univariate and correlation analyses were included as independent variables in a multiple linear regression model. Assignments for categorical independent variables are shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003eA.4\u003c/span\u003e; numerical variables were entered as original values. Multivariate analysis indicated that age, education level, total upper limb lymphoedema KBB score, family size, number of axillary lymph nodes removed, and receipt of lymphoedema prevention instructions at hospital discharge significantly influenced HISB (p\u0026thinsp;\u0026lt;\u0026thinsp;0 .05). Detailed regression results are presented in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003eA.5\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eCurrent Status and Univariate Analysis of Lymphoedema HISB in Postoperative BC Patients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study indicated that the mean total HISB score for lymphoedema in postoperative BC patients was 178.21\u0026thinsp;\u0026plusmn;\u0026thinsp;25.02, which was higher than the mean score reported by Li et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, it remains slightly lower than the median score of 182, suggesting an overall low level of HISB among these patients. This finding may relate to patients' insufficient understanding of lymphoedema-associated risks (Qin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), where inadequate knowledge weakens trust in professional information and consequently diminishes patients\u0026rsquo; motivation to actively seek health information (Bandura \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). This situation explains the relatively low mean attitude score (26.026\u0026thinsp;\u0026plusmn;\u0026thinsp;4.435), which was below the median score (27.00), indicating that knowledge level significantly influences patients' attitudes toward lymphoedema complications (Qin et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The mean score for patients' information needs was 63.184\u0026thinsp;\u0026plusmn;\u0026thinsp;9.483, revealing a high demand for information about postoperative lymphoedema. However, individual differences were observed, consistent with Ludwigso et al. (2024), indicating varied urgency in seeking health information among patients. Patients' awareness of lymphoedema\u0026rsquo;s potential impact on quality of life after surgery heightened their demand for information regarding signs and symptoms, self-care behaviors, treatment options, access to healthcare services, and coping strategies for anxiety (Dorri et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The mean score for utilization of information sources was 56.872\u0026thinsp;\u0026plusmn;\u0026thinsp;10.065, closely aligned with the median of 57.000, suggesting moderate and balanced selection of health information sources among patients. Health education provided by healthcare professionals partially influenced patients\u0026rsquo; information choices, indicating limitations in available sources. While some patients depended heavily on specific information channels, others explored multiple sources. However, the information provided by healthcare professionals often does not fully satisfy patient needs, prompting patients to seek relevant information through social networks and other channels. Unfortunately, such information is frequently fragmented and insufficient to adequately support patient decision-making (Fu et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In this study, the mean score for barriers to information access was 32.128\u0026thinsp;\u0026plusmn;\u0026thinsp;6.706, indicating substantial difficulties faced by patients in obtaining health information. While the overall level of barriers appeared consistent, the variability in scores suggested significant individual differences in the type and severity of obstacles encountered. Common barriers included complex information, technological challenges (e.g., unfamiliarity with the Internet), financial constraints (e.g., inability to afford information access), and limited healthcare resources (Shen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In addition, inadequate family support hindered some patients\u0026rsquo; ability to manage these obstacles, with several reporting insufficient time and energy to concentrate on lymphoedema care (Zhao et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Although postoperative BC patients exhibited considerable demand for lymphoedema-related health information, their actual access remained limited. Despite patients' awareness of lymphoedema\u0026rsquo;s health implications, difficulties in accessing information, restricted information sources, and numerous barriers collectively contributed to the overall low HISB levels. Economic factors (34.69% of patients had a monthly household income below 5000 RMB) and technological barriers (22.96% of patients resided in rural townships) formed a compounded obstacle. This finding aligns with barriers identified by Latifi et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, healthcare providers should adopt stratified support strategies to effectively address and mitigate these postoperative information barriers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLymphoedema HISB in Postoperative BC Patients is Influenced by Multiple Factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge and Education\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAge was negatively associated with HISB (β=-0.810, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which is consistent with findings reported by Liu (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Younger patients were more likely to seek information, primarily due to older patients' lower capacity for accessing information. Additionally, younger patients exhibit higher self-efficacy and greater comprehension abilities, which typically decline with advancing age, thereby hindering older adults' processing of complex information (Zhao et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This observation aligns with the dual components of digital divide theory (van Dijk \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2006\u003c/span\u003e): older patients encounter the \u0026ldquo;Access Divide\u0026rdquo; due to insufficient digital literacy, impeding effective utilization of online health resources, and also experience the \u0026ldquo;Usage Divide\u0026rdquo; as their limited ability to critically evaluate information makes them susceptible to misinformation.\u003c/p\u003e\u003cp\u003eThis study also found that educational attainment negatively correlated with HISB (β=-0.015, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), contrasting with findings reported by Liu (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This discrepancy can be explained by the health belief model: patients with lower educational levels may perceive lymphoedema as more threatening and thus rely more heavily on family support to overcome their limited access to information (Janz and Becker \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1984\u003c/span\u003e). This highlights the need for targeted health education programs tailored to patients' educational backgrounds and social support systems. According to Zhao et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), married females with lower educational attainment typically bear greater household responsibilities (Yaohui and Rudai \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In contrast, 99.49% of participants in this study were female, and 88.776% were married. According to role conflict theory (Goode 1960; Smoktunowicz et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), female patients experience greater anxiety regarding postoperative complications, such as lymphoedema exacerbated by household tasks, due to competing pressures from their caregiving roles. This motivates them to mitigate uncertainty through proactive information-seeking behaviors, consistent with the stress-buffering hypothesis (Cohen \u0026amp; Wills, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). Thus, patients with lower educational levels may be compelled to seek information on reducing lymphoedema risks following BC surgery due to a heightened perception of threat. In contrast, patients with higher education may rely more extensively on existing knowledge and underestimate their informational needs, indicating that educational interventions should be customized to accommodate distinct patient perceptions and educational backgrounds.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFamily Support\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, patients from households with \u0026ge;\u0026thinsp;5 family members had significantly higher HISB scores (β\u0026thinsp;=\u0026thinsp;2.432, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while widowed patients exhibited the lowest HISB score (157), aligning with findings reported by Liu (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These results suggest that family support positively influences patients' lymphoedema-related HISB, consistent with Cohen \u0026amp; Wills' (1985) buffer hypothesis, which proposes that emotional and instrumental support from family members can mitigate barriers to accessing health information (Cohen and Wills \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). Marital status also affects patients' informational needs and psychological well-being; notably, spousal support strongly motivates postoperative BC patients to actively seek health information (Latifi et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Family support enhances patients\u0026rsquo; confidence and encourages their proactive engagement with health information. However, it is important to monitor for potential family overprotection. Therefore, health education should incorporate family role-management training to balance support with patient empowerment (Zhao et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and introduce additional sources of information through family involvement to enhance patient comprehension of lymphoedema-related health information and foster active participation in health decisions. Patients can contribute to overall family functioning by sharing and interacting around health-related information, thereby promoting proactive disease-prevention and health-promotion behaviors (Lee \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In the Chinese cultural context, family size and support likely exert significant influence on HISB among postoperative BC patients with lymphoedema, as close familial bonds provide security, reliability, and motivation to actively seek information (Lu et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, future lymphoedema-related health education initiatives should assess family support levels: for patients with substantial family support, healthcare professionals should empower both patients and families to strengthen self-efficacy and balanced support. Conversely, for patients with limited family support, it is crucial to enhance support from healthcare professionals and actively engage governmental and community-based organizations to foster a supportive environment. This approach aims to establish a systematic and comprehensive social support network, ultimately improving patients' HISB.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDisease Factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe present study showed that postoperative BC patients who underwent axillary lymph node dissection involving\u0026thinsp;\u0026ge;\u0026thinsp;15 nodes had higher HISB scores (β\u0026thinsp;=\u0026thinsp;1.542, p\u0026thinsp;=\u0026thinsp;0.004), aligning with disease perception theory. According to the Health Belief Model by Janz and Becker (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1984\u003c/span\u003e), highly invasive procedures, such as extensive lymph node dissection, significantly heighten patients\u0026rsquo; perceptions of disease threat (Perceived Susceptibility: OR\u0026thinsp;=\u0026thinsp;2.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0 .01; Perceived Severity: SMD\u0026thinsp;=\u0026thinsp;0.89), thus markedly stimulating their motivation to seek health information (Janz and Becker \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1984\u003c/span\u003e). Axillary lymph node clearance is a significant risk factor for postoperative lymphoedema development in BC patients (Cobb and DeSnyder \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); more extensive clearance correlates with greater physical trauma and potential risk. Patients' perceptions of disease severity significantly influence HISB, motivating them to seek more information as the perceived threat increases (Zimmerman and Shaw \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The current study found a significant positive relationship between disease perception intensity and HISB. In contrast, a longitudinal study by Liu (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) identified an inverted U-shaped relationship between disease perception intensity and efficacy in health information use:: moderately elevated perceptions of disease threat (e.g., through educational interventions regarding postoperative complications) promoted information-seeking behaviors (β\u0026thinsp;=\u0026thinsp;0.32, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while excessively heightened threat perceptions (e.g., misinformation-induced anxiety) negatively impacted adherence behaviors (β=-0.18, p\u0026thinsp;=\u0026thinsp;0.032). This observation supports Li's (2024) concept of a \u0026ldquo;perception-behavior conversion threshold,\u0026rdquo; highlighting the necessity of balancing risk warnings and empowerment in health education (Yuanyuan \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Therefore, healthcare professionals should prioritize shaping accurate perceptions of lymphoedema among postoperative BC patients, emphasizing risk factors specific to each patient\u0026rsquo;s disease characteristics and treatment methods. This strategy aims to enhance patients' understanding of the disease, thus motivating proactive information-seeking behaviors related to lymphoedema and ultimately improving their HISB.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient Education\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study indicate that patients who received structured discharge instructions, and those with higher KBB scores regarding lymphoedema demonstrated more proactive HISB. Validation of the health belief model indicates that behavioral changes are stimulated by \u0026ldquo;cueing factors.\u0026rdquo; In contrast, the group lacking structured discharge instructions (48.98%) had significantly lower HISB scores (β = -4.274), highlighting the importance of structured patient education. However, current health education models may inadequately address patients' needs due to complex content (Latifi et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Moreover, healthcare providers frequently fail to consider patients' existing knowledge, acceptance levels, and actual informational requirements, resulting in a standardized, one-size-fits-all educational approach. This oversight neglects patient subjectivity and contributes to a mismatch between information supply and patient demand (Epstein and Street \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), adversely affecting perceptions of doctor-patient communication quality. Studies have shown (Link et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) that improving doctor-patient communication and improving patient education can significantly boost patients' HISB, with perceived communication quality playing a pivotal role in facilitating information-seeking behaviors. Within the family-oriented Chinese healthcare context, healthcare professionals remain the primary source of patient information (82.6% of all sources) (Lu et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, the tendency to defer to authority inherent in collectivist cultures may suppress patients' proactive information-seeking. Therefore, leveraging the synergistic framework combining the Health Belief Model and Social Support Theory, a three-tiered intervention strategy was developed: (1) enhancing stepped educational content by leveraging patients\u0026rsquo; risk perceptions; (2) creating a supportive information environment through family empowerment; and (3) utilizing the Teach-Back method to enhance doctor-patient dialogues and incorporating co-decision-making communication modules to elevate perceived communication quality. The integration of these strategies aims to strengthen health beliefs, enhance social support, and ultimately promote effective patient engagement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations due to its single-center and cross-sectional design. The sample, primarily drawn from a tertiary hospital in Hangzhou, may introduce selection bias and might not adequately represent broader patient populations. The cross-sectional approach provides only a single-time-point assessment, precluding the establishment of causal relationships between influencing factors and HISB among postoperative BC patients. Future research should adopt multicenter, longitudinal designs and include participants from diverse geographic regions and economic backgrounds to enhance the representativeness and generalizability of findings. It is also essential to conduct comparative analyses between urban and rural populations to better understand the influence of geographic disparities on HISB related to lymphoedema in this patient group. Additionally, the gender imbalance, with female participants comprising 99.49% of the study population, significantly restricts the applicability of the findings. Future studies should aim to include more male participants to comprehensively explore HISB among BC patients. In conclusion, despite offering valuable insights, the present study\u0026rsquo;s limitations should be acknowledged. Future multicenter longitudinal studies with more representative and gender-balanced samples is needed to clarify the dynamics of HISB, examine urban-rural differences more thoroughly, and elucidate the causal mechanisms among related variables.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study demonstrated that lymphoedema HISB among postoperative BC patients is influenced by multiple factors, including upper limb lymphoedema KBB scores, the extent of axillary lymph node dissections, family size, age, and education level. Healthcare professionals should tailor health education initiatives according to these influential factors to improve lymphoedema-related HISB among BC survivors. Additionally, refining the communication model between healthcare providers and patients is crucial to address existing mismatches between information supply and patient demand. Leveraging the interactive mechanisms of health beliefs (e.g. perceived disease threat, self-efficacy) and social support factors (e.g. family size, information sources) will further influence HISB, ultimately promoting proactive lymphoedema HISB among postoperative BC patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers would like to sincerely appreciate all the participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirmed that the methods used in the data analyses are suitably applied to our data within our study design and context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting Method\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reporting method follows the STROBE checklist to ensure transparency and completeness in the presentation of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevious presentations:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions:Huan Zheng: conceptualization, investigation, data curation, formal analysis, writing \u0026ndash; original draft.Fang Chen: conceptualization, methodology, writing \u0026ndash; review and editing.Lu Wang: methodology, writing \u0026ndash; review and editing.Kai Cao: investigation，data curation.Xiaoyan Zhao: investigation.Lewen Shao: conceptualization, validation, supervision, writing \u0026ndash; review and editing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis statement will replace any statement written within the manuscript and is the one that we will publish.The data of this study contain participants' personal privacy information (e.g., [specific details such as disease diagnosis, family information, etc.]). In accordance with the requirements of the Ethics Committee, access to the data is restricted based on the principle of privacy protection, and can only be provided under the premise of meeting ethical review conditions. Please contact the corresponding author when necessary.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAcebedo, J. C., Haas, B. 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R., Afshar, M., et al. 2014. \u0026ldquo;InformationSeeking Behavior of Cardiovascular Disease Patients in Isfahan University of Medical Sciences Hospitals.\u0026rdquo; \u003cem\u003eJournal of Education and Health Promotion\u003c/em\u003e 3: 83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao, H., Wu, Y., Zhou, C., et al. 2021. \u0026ldquo;Breast CancerRelated Lymphedema Patient and Healthcare Professional Experiences in Lymphedema SelfManagement: A Qualitative Study.\u0026rdquo; \u003cem\u003eSupportive Care in Cancer\u003c/em\u003e 29, no. 12: 8027\u0026ndash;8044.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZimmerman, M. S., and Shaw, G. J. 2020. \u0026ldquo;Health Information Seeking Behaviour: A Concept Analysis.\u0026rdquo; \u003cem\u003eHealth Information and Libraries Journal\u003c/em\u003e 37, no. 3: 173\u0026ndash;191.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Breast cancer, Lymphoedema, Information seeking, Nursing care","lastPublishedDoi":"10.21203/rs.3.rs-7234335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7234335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHealth information-seeking behavior (HISB) among postoperative breast cancer (BC) patients significantly contributes to lymphoedema prevention and management, enhancing patients' self-care abilities and health outcomes. Identifying influencing factors can provide scientific evidence and practical insights for developing effective lymphoedema-focused health education programs for this population.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to investigate the current state and determinants of HISB in patients experiencing lymphoedema following BC surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study involving 196 patients was conducted from December 2024 to January 2025 at the Department of Breast Surgery in a tertiary hospital in Hangzhou, Zhejiang Province. Data collection utilized the General Information Questionnaire, the Upper Extremity lymphoedema Knowledge, Belief, and Behavior (KBB) scale, and the HISB Scale. Multiple linear regression was employed to identify factors associated with HISB among participants.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean HISB score related to lymphoedema among the 196 postoperative BC patients was 178.21\u0026thinsp;\u0026plusmn;\u0026thinsp;25.018. Multiple linear regression analysis revealed that the KBB level regarding upper limb lymphoedema, number of family members, age, education level, and discharge instructions significantly influenced patients' lymphoedema-related HISB.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePostoperative BC patients generally exhibited insufficient levels of lymphoedema-related HISB. Healthcare providers should prioritize patients who are older, less educated, and from smaller families. Enhancing the effectiveness of lymphoedema-focused health education and communication methods is essential to improve HISB and subsequent self-care behaviors in this patient group.\u003c/p\u003e\u003ch2\u003eImplication for Practice:\u003c/h2\u003e\u003cp\u003eThis study highlights significant gaps in HISB among postoperative BC patients with lymphoedema, identifying key influencing factors including lymphoedema knowledge, age, educational attainment, family size, and discharge instruction quality. These findings can inform healthcare professionals in refining patient-centered health education and communication strategies, thereby enhancing patient engagement and self-management capabilities. Additionally, the results may guide healthcare policy shifts towards a patient-centered, health-promotion approach.\u003c/p\u003e","manuscriptTitle":"Analysis of the Current Status of Health Information-Seeking Behavior and Factors Affecting Lymphoedema In Postoperative Breast Cancer Patients: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-08 03:37:57","doi":"10.21203/rs.3.rs-7234335/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"269179832094439373274453819442649253181","date":"2026-04-27T01:23:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T10:33:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T18:58:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295602468634645521363642990799614457861","date":"2025-11-03T07:32:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156456472982203922272359882245388129607","date":"2025-10-31T08:55:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-02T21:58:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T21:54:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T01:07:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-07-28T13:12:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5fbd0e1f-a40b-40cf-8d38-098c09280bc7","owner":[],"postedDate":"September 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T03:37:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-08 03:37:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7234335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7234335","identity":"rs-7234335","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}