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Richtering SS, Morris R, Soh SE, Barker A, Bampi F, Neubeck L, Coorey G, Mulley J, Chalmers J, Usherwood T, Peiris D, Chow CK, Redfern J. Examination of an eHealth literacy scale and a health literacy scale in a population with moderate to high cardiovascular risk: Rasch analyses. PLoS One 2017; 12:e0175372. [PMID: 28448497 PMCID: PMC5407817 DOI: 10.1371/journal.pone.0175372] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 03/06/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Electronic health (eHealth) strategies are evolving making it important to have valid scales to assess eHealth and health literacy. Item response theory methods, such as the Rasch measurement model, are increasingly used for the psychometric evaluation of scales. This paper aims to examine the internal construct validity of an eHealth and health literacy scale using Rasch analysis in a population with moderate to high cardiovascular disease risk. METHODS The first 397 participants of the CONNECT study completed the electronic health Literacy Scale (eHEALS) and the Health Literacy Questionnaire (HLQ). Overall Rasch model fit as well as five key psychometric properties were analysed: unidimensionality, response thresholds, targeting, differential item functioning and internal consistency. RESULTS The eHEALS had good overall model fit (χ2 = 54.8, p = 0.06), ordered response thresholds, reasonable targeting and good internal consistency (person separation index (PSI) 0.90). It did, however, appear to measure two constructs of eHealth literacy. The HLQ subscales (except subscale 5) did not fit the Rasch model (χ2: 18.18-60.60, p: 0.00-0.58) and had suboptimal targeting for most subscales. Subscales 6 to 9 displayed disordered thresholds indicating participants had difficulty distinguishing between response options. All subscales did, nonetheless, demonstrate moderate to good internal consistency (PSI: 0.62-0.82). CONCLUSION Rasch analyses demonstrated that the eHEALS has good measures of internal construct validity although it appears to capture different aspects of eHealth literacy (e.g. using eHealth and understanding eHealth). Whilst further studies are required to confirm this finding, it may be necessary for these constructs of the eHEALS to be scored separately. The nine HLQ subscales were shown to measure a single construct of health literacy. However, participants' scores may not represent their actual level of ability, as distinction between response categories was unclear for the last four subscales. Reducing the response categories of these subscales may improve the ability of the HLQ to distinguish between different levels of health literacy.
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Affiliation(s)
- Sarah S. Richtering
- The George Institute for Global Health, Sydney, NSW, Australia
- Hôpitaux Universitaires de Genève, Université de Genève, Geneva, Switzerland
| | - Rebecca Morris
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona Bampi
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Lis Neubeck
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Nursing School, Charles Perkin Centre, University of Sydney, Sydney, NSW, Australia
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, United Kingdom
| | - Genevieve Coorey
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
| | - John Mulley
- The George Institute for Global Health, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
| | - Tim Usherwood
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
| | - Clara K. Chow
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
- Westmead Hospital, Sydney, NSW, Sydney, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Sydney, Australia
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Sudbury-Riley L, FitzPatrick M, Schulz PJ. Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance. J Med Internet Res 2017; 19:e53. [PMID: 28242590 PMCID: PMC5348620 DOI: 10.2196/jmir.5998] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/23/2016] [Accepted: 01/30/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The eHealth Literacy Scale (eHEALS) is one of only a few available measurement scales to assess eHealth literacy. Perhaps due to the relative paucity of such measures and the rising importance of eHealth literacy, the eHEALS is increasingly a choice for inclusion in a range of studies across different groups, cultures, and nations. However, despite its growing popularity, questions have been raised over its theoretical foundations, and the factorial validity and multigroup measurement properties of the scale are yet to be investigated fully. OBJECTIVE The objective of our study was to examine the factorial validity and measurement invariance of the eHEALS among baby boomers (born between 1946 and 1964) in the United States, United Kingdom, and New Zealand who had used the Internet to search for health information in the last 6 months. METHODS Online questionnaires collected data from a random sample of baby boomers from the 3 countries of interest. The theoretical underpinning to eHEALS comprises social cognitive theory and self-efficacy theory. Close scrutiny of eHEALS with analysis of these theories suggests a 3-factor structure to be worth investigating, which has never before been explored. Structural equation modeling tested a 3-factor structure based on the theoretical underpinning to eHEALS and investigated multinational measurement invariance of the eHEALS. RESULTS We collected responses (N=996) to the questionnaires using random samples from the 3 countries. Results suggest that the eHEALS comprises a 3-factor structure with a measurement model that falls within all relevant fit indices (root mean square error of approximation, RMSEA=.041, comparative fit index, CFI=.986). Additionally, the scale demonstrates metric invariance (RMSEA=.040, CFI=.984, ΔCFI=.002) and even scalar invariance (RMSEA=.042, CFI=.978, ΔCFI=.008). CONCLUSIONS To our knowledge, this is the first study to demonstrate multigroup factorial equivalence of the eHEALS, and did so based on data from 3 diverse nations and random samples drawn from an increasingly important cohort. The results give increased confidence to researchers using the scale in a range of eHealth assessment applications from primary care to health promotions.
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Affiliation(s)
| | - Mary FitzPatrick
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Peter J Schulz
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland
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Paige SR, Krieger JL, Stellefson M, Alber JM. eHealth literacy in chronic disease patients: An item response theory analysis of the eHealth literacy scale (eHEALS). PATIENT EDUCATION AND COUNSELING 2017; 100:320-326. [PMID: 27658660 PMCID: PMC5538024 DOI: 10.1016/j.pec.2016.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/16/2016] [Accepted: 09/15/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND Chronic disease patients are affected by low computer and health literacy, which negatively affects their ability to benefit from access to online health information. OBJECTIVE To estimate reliability and confirm model specifications for eHealth Literacy Scale (eHEALS) scores among chronic disease patients using Classical Test (CTT) and Item Response Theory techniques. METHODS A stratified sample of Black/African American (N=341) and Caucasian (N=343) adults with chronic disease completed an online survey including the eHEALS. Item discrimination was explored using bi-variate correlations and Cronbach's alpha for internal consistency. A categorical confirmatory factor analysis tested a one-factor structure of eHEALS scores. Item characteristic curves, in-fit/outfit statistics, omega coefficient, and item reliability and separation estimates were computed. RESULTS A 1-factor structure of eHEALS was confirmed by statistically significant standardized item loadings, acceptable model fit indices (CFI/TLI>0.90), and 70% variance explained by the model. Item response categories increased with higher theta levels, and there was evidence of acceptable reliability (ω=0.94; item reliability=89; item separation=8.54). CONCLUSION eHEALS scores are a valid and reliable measure of self-reported eHealth literacy among Internet-using chronic disease patients. PRACTICE IMPLICATIONS Providers can use eHEALS to help identify patients' eHealth literacy skills.
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Affiliation(s)
- Samantha R Paige
- University of Florida, Department of Health Education and Behavior, PO Box 118210, Gainesville, FL 32611, USA.
| | - Janice L Krieger
- University of Florida, STEM Translational Communication Center, 2024 Weimer Hall, Gainesville, FL 32611, USA.
| | - Michael Stellefson
- University of Florida, Department of Health Education and Behavior, PO Box 118210, Gainesville, FL 32611, USA.
| | - Julia M Alber
- University of Pennsylvania, Center for Health Behavior Research, 110 Blockley Hall, Philadelphia, PA 19104, USA.
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104
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Richtering SS, Hyun K, Neubeck L, Coorey G, Chalmers J, Usherwood T, Peiris D, Chow CK, Redfern J. eHealth Literacy: Predictors in a Population With Moderate-to-High Cardiovascular Risk. JMIR Hum Factors 2017; 4:e4. [PMID: 28130203 PMCID: PMC5303199 DOI: 10.2196/humanfactors.6217] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/30/2016] [Accepted: 12/18/2016] [Indexed: 11/20/2022] Open
Abstract
Background Electronic health (eHealth) literacy is a growing area of research parallel to the ongoing development of eHealth interventions. There is, however, little and conflicting information regarding the factors that influence eHealth literacy, notably in chronic disease. We are similarly ill-informed about the relationship between eHealth and health literacy, 2 related yet distinct health-related literacies. Objective The aim of our study was to investigate the demographic, socioeconomic, technology use, and health literacy predictors of eHealth literacy in a population with moderate-to-high cardiovascular risk. Methods Demographic and socioeconomic data were collected from 453 participants of the CONNECT (Consumer Navigation of Electronic Cardiovascular Tools) study, which included age, gender, education, income, cardiovascular-related polypharmacy, private health care, main electronic device use, and time spent on the Internet. Participants also completed an eHealth Literacy Scale (eHEALS) and a Health Literacy Questionnaire (HLQ). Univariate analyses were performed to compare patient demographic and socioeconomic characteristics between the low (eHEALS<26) and high (eHEALS≥26) eHealth literacy groups. To then determine the predictors of low eHealth literacy, multiple-adjusted generalized estimating equation logistic regression model was used. This technique was also used to examine the correlation between eHealth literacy and health literacy for 4 predefined literacy themes: navigating resources, skills to use resources, usefulness for oneself, and critical evaluation. Results The univariate analysis showed that patients with lower eHealth literacy were older (68 years vs 66 years, P=.01), had lower level of education (P=.007), and spent less time on the Internet (P<.001). However, multiple-adjusted generalized estimating equation logistic regression model demonstrated that only the time spent on the Internet (P=.01) was associated with the level of eHealth literacy. Regarding the comparison between the eHEALS items and HLQ scales, a positive linear relationship was found for the themes “usefulness for oneself” (P=.049) and “critical evaluation” (P=.01). Conclusions This study shows the importance of evaluating patients’ familiarity with the Internet as reflected, in part, by the time spent on the Internet. It also shows the importance of specifically assessing eHealth literacy in conjunction with a health literacy assessment in order to assess patients’ navigational knowledge and skills using the Internet, specific to the use of eHealth applications.
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Affiliation(s)
- Sarah S Richtering
- The George Institute for Global Health, Sydney, Australia.,Hôpitaux Universitaires de Genève, Université de Genève, Geneva, Switzerland
| | - Karice Hyun
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lis Neubeck
- The George Institute for Global Health, Sydney, Australia.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom.,Sydney Nursing School, Charles Perkin Centre, University of Sydney, Sydney, Australia
| | - Genevieve Coorey
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Tim Usherwood
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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105
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Affiliation(s)
- Tania Estapé
- Psychosocial Oncology Department, FEFOC Foundation, Barcelona, Spain
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106
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Griebel L, Kolominsky-Rabas P, Schaller S, Siudyka J, Sierpinski R, Papapavlou D, Simeonidou A, Prokosch HU, Sedlmayr M. Acceptance by laypersons and medical professionals of the personalized eHealth platform, eHealthMonitor. Inform Health Soc Care 2016; 42:232-249. [DOI: 10.1080/17538157.2016.1237953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lena Griebel
- Chair of Medical Informatics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sandra Schaller
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jakub Siudyka
- Kardiosystem Sp. z.o.o., Medicalgorithmics S.A., Warsaw, Poland
| | | | | | | | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- University Hospital Erlangen, Erlangen, Germany
| | - Martin Sedlmayr
- Chair of Medical Informatics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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107
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Triberti S, Barello S. The quest for engaging AmI: Patient engagement and experience design tools to promote effective assisted living. J Biomed Inform 2016; 63:150-156. [PMID: 27515924 DOI: 10.1016/j.jbi.2016.08.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/21/2016] [Accepted: 08/06/2016] [Indexed: 12/25/2022]
Abstract
Recent research highlights that patient engagement, conceived as a patient's behavioral, cognitive and emotional commitment to his own care management, is a key issue while implementing new technologies in the healthcare process. Indeed, eHealth interventions may systematically fail when the patient's subjective experience has not been taken into consideration since the first steps of the technology design. In the present contribution, we argue that such an issue is more and more crucial as regarded to the field of Ambient Intelligence (AmI). Specifically, the exact concept of technologies embedded in the patients' surrounding environment implies a strong impact on their everyday life, which can be perceived as a limitation to autonomy and privacy, and therefore refused or even openly opposed by the final users. The present contribution tackles this issue directly, highlighting: (1) a theoretical framework to include patient engagement in the design of AmI technologies; (2) assessment measures for patient engagement while developing and testing the effectiveness of AmI prototypes for healthcare. Finally (3) this contribution provides an overview of the main issues emerging while implementing AmI technologies and suggests specific design solutions to address them.
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Affiliation(s)
- Stefano Triberti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy.
| | - Serena Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20123 Milan, Italy
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108
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Mitsutake S, Shibata A, Ishii K, Oka K. Associations of eHealth Literacy With Health Behavior Among Adult Internet Users. J Med Internet Res 2016; 18:e192. [PMID: 27432783 PMCID: PMC4969548 DOI: 10.2196/jmir.5413] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/16/2016] [Accepted: 06/04/2016] [Indexed: 11/17/2022] Open
Abstract
Background In the rapidly developing use of the Internet in society, eHealth literacy—having the skills to utilize health information on the Internet—has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users. Objective The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan. Methods The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N=10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses. Results We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy. Conclusions We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users.
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Affiliation(s)
- Seigo Mitsutake
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
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109
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Deinzer R, Harnacke D, Mengel R, Telzer M, Lotzmann U, Wöstmann B. Effectiveness of Computer-Based Training on Toothbrush Skills of Patients Treated With Crowns: A Randomized Controlled Trial. J Periodontol 2016; 87:1333-1342. [PMID: 27367422 DOI: 10.1902/jop.2016.160099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study was conducted to assess plaque removal skills in patients with fixed dental prostheses (FDP), and effectiveness of computer-based training (CBT) of different brushing techniques (Fones versus Bass technique in their common modifications). METHODS Ninety-three patients with FDP were randomly allocated to one of three training groups: 1) C (control group); 2) F (Fones technique group); and 3) B (Bass technique group). All patients received CBT of the basics of toothbrushing. Group C received no further instructions while groups F and B received additional CBT of the modified Fones or the modified Bass technique, respectively. Plaque levels were assessed immediately after patients had been asked to perform oral hygiene to the best of their abilities. RESULTS Prior to training, persistent plaque deposits were found at 80% of marginal sites of natural teeth immediately after patients had performed oral hygiene. Considerably fewer plaque deposits were found on FDP (43%). No significant group differences were observed 6 and 12 weeks after training, either for natural teeth or for FDP (all P >0.05). CONCLUSIONS Plaque removal skills are low in patients with FDP. Apparently, they do not profit from CBT of the techniques studied here. Studies observing their actual brushing behavior should be conducted to elucidate reasons for their deficits and to explore why CBT does not work in this group of patients.
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Affiliation(s)
- Renate Deinzer
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Daniela Harnacke
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Reiner Mengel
- Department of Prosthetic and Orofacial Function, School of Dental Medicine, Philipps University, Marburg/Lahn, Germany
| | - Maria Telzer
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich Lotzmann
- Department of Prosthetic and Orofacial Function, School of Dental Medicine, Philipps University, Marburg/Lahn, Germany
| | - Bernd Wöstmann
- Department of Dentistry, Polyclinic for Dental Prosthetics, Justus Liebig University Giessen
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Xesfingi S, Vozikis A. eHealth Literacy: In the Quest of the Contributing Factors. Interact J Med Res 2016; 5:e16. [PMID: 27226146 PMCID: PMC4899620 DOI: 10.2196/ijmr.4749] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the factors that influence eHealth in a country is particularly important for health policy decision makers and the health care market, as it provides critical information to develop targeted and tailored interventions for relevant patient-consumer segments, and further suggests appropriate strategies for training the health illiterate part of the population. OBJECTIVE The objective of the study is to assess the eHealth literacy level of Greek citizens, using the eHealth Literacy Scale (eHEALS), and further explore the factors that shape it and are associated with it. METHODS This empirical study relies on a unique sample of 1064 citizens in Greece in the year 2013. The participants were requested to answer various questions about their ability to solve health-related issues using the Internet, and to provide information about their demographic characteristics and life-style habits. Ordered logit models were used to describe a certain citizen's likelihood of being eHealth literate. RESULTS The demographic factors show that the probability of an individual being eHealth literate decreases by 23% (P=.001) when the individual ages and increases by 53% (P<.001) when he or she acquires higher level of education. Among the life-style variables, physical exercise appears to be strongly and positively associated with the level of eHealth literacy (P=.001). Additionally, other types of technology literacies, such as computer literacy and information literacy, further enhance the eHealth performance of citizens and have the greatest impact among all factors. CONCLUSIONS The factors influencing eHealth literacy are complex and interdependent. However, the Internet is a disruptive factor in the relationship between health provider and health consumer. Further research is needed to examine how several factors associate with eHealth literacy, since, the latter is not only related to health care outcomes but also can be a tool for disseminating social inequalities.
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Affiliation(s)
- Sofia Xesfingi
- University of Piraeus, Department of Economics, University of Piraeus, Piraeus, Greece.
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111
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Gordon NP, Hornbrook MC. Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan. J Med Internet Res 2016; 18:e50. [PMID: 26944212 PMCID: PMC4799429 DOI: 10.2196/jmir.5105] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/02/2016] [Accepted: 01/23/2016] [Indexed: 11/30/2022] Open
Abstract
Background Patients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60% of American adults aged 65 and older use the Internet, with much lower usage among black and Latino seniors compared with non-Hispanic white seniors, and among older versus younger seniors. Objective Our aims were to (1) identify race/ethnic and age cohort disparities among seniors in use of the health plan’s patient portal, (2) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system, (3) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet, and (4) learn whether older adults not currently using the health plan’s patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them. Methods We conducted two studies of seniors aged 65-79 years. First, we used administrative data about patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white (n=183,565), black (n=16,898), Latino (n=12,409), Filipino (n=11,896), and Chinese (n=6314) members of the Kaiser Permanente Northern California health plan. Second, we used data from a mailed survey conducted in 2013-2014 with a stratified random sample of this population (final sample: 849 non-Hispanic white, 567 black, 653 Latino, 219 Filipino, and 314 Chinese). These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes. Results Adults aged 70-74 and 75-79 were significantly less likely than 65-69 year olds to be registered to use the patient portal, and among those registered, to have used the portal to send messages, view lab test results, or order prescription refills. Across all age groups, non-Hispanic whites and Chinese seniors were significantly more likely than black, Latino, and Filipino seniors to be registered and to have performed these actions. The survey found that black, Latino, and Filipino seniors and those 75 years old and older were significantly less likely to own digital devices (eg, computers, smartphones), use the Internet and email, and be able and willing to use digital technology to perform health care-related tasks, including obtaining health information, than non-Hispanic whites, Chinese, and younger seniors (aged 65-69), respectively. The preference for using non-digital modalities persisted even among Internet users. Conclusions Health plans, government agencies, and other organizations that serve diverse groups of seniors should include social determinants such as race/ethnicity and age when monitoring trends in eHealth to ensure that eHealth disparities do not induce greater health status and health care disparities between more privileged and less privileged groups.
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Affiliation(s)
- Nancy P Gordon
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
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112
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Aponte J, Nokes KM. Electronic health literacy of older Hispanics with diabetes. Health Promot Int 2015; 32:482-489. [DOI: 10.1093/heapro/dav112] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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113
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Koops van 't Jagt R, Hoeks JCJ, Jansen CJM, de Winter AF, Reijneveld SA. Comprehensibility of Health-Related Documents for Older Adults with Different Levels of Health Literacy: A Systematic Review. JOURNAL OF HEALTH COMMUNICATION 2015; 21:159-177. [PMID: 26594852 DOI: 10.1080/10810730.2015.1049306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A systematic review was conducted to assess the available evidence for the effectiveness of interventions aiming to improve the comprehensibility of health-related documents in older adults (≥50) with different levels of health literacy. Seven databases were searched (2005 forward), and references in relevant reviews were checked. The selection procedure was conducted by 2 independent reviewers. Data extraction and assessment of the quality of the resulting studies were conducted by 1 reviewer and checked for accuracy by a 2nd reviewer. A total of 38 intervention studies had a study population of older adults (n = 35) or made an explicit comparison between age groups, including older adults (n = 3). Inconsistent evidence was found for the importance of design features to enhance the comprehensibility of health-related documents. Only for narratives and multiple-feature revisions (e.g., combining revisions in textual and visual characteristics) did the included studies provide evidence that they may be effective for older adults. Using narrative formats and/or multiple-feature revisions of health-related documents seem to be promising strategies for enhancing the comprehensibility of health-related documents for older adults. The lack of consistent evidence for effective interventions stresses the importance of (a) replication and (b) the use of standardized research methodologies.
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Affiliation(s)
- Ruth Koops van 't Jagt
- a Department of Communication and Information Sciences, Faculty of Arts , University of Groningen , Groningen , The Netherlands
| | - John C J Hoeks
- a Department of Communication and Information Sciences, Faculty of Arts , University of Groningen , Groningen , The Netherlands
| | - Carel J M Jansen
- a Department of Communication and Information Sciences, Faculty of Arts , University of Groningen , Groningen , The Netherlands
| | - Andrea F de Winter
- b Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Sijmen A Reijneveld
- b Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Giesbrecht EM, Miller WC, Jin BT, Mitchell IM, Eng JJ. Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults. JMIR Rehabil Assist Technol 2015; 2:e3. [PMID: 28582240 PMCID: PMC5454553 DOI: 10.2196/rehab.4274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 11/27/2022] Open
Abstract
Background Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. Objective Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. Methods The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. Results Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. Conclusions The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. Trial Registration ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf).
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Affiliation(s)
- Edward Mark Giesbrecht
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Occupational Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - William C Miller
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Occupational Therapy and Occupational Science, University of British Columbia, Vancouver, BC, Canada
| | - Boyang Tom Jin
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian M Mitchell
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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115
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Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LMS. The eHealth Enhanced Chronic Care Model: a theory derivation approach. J Med Internet Res 2015; 17:e86. [PMID: 25842005 PMCID: PMC4398883 DOI: 10.2196/jmir.4067] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/21/2015] [Accepted: 02/07/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. OBJECTIVE The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. METHODS Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. RESULTS We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. CONCLUSIONS The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.
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Affiliation(s)
- Perry M Gee
- School of Nursing, Division of Health Sciences, Idaho State University, Pocatello, ID, United States.
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116
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Tennant B, Stellefson M, Dodd V, Chaney B, Chaney D, Paige S, Alber J. eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. J Med Internet Res 2015; 17:e70. [PMID: 25783036 PMCID: PMC4381816 DOI: 10.2196/jmir.3992] [Citation(s) in RCA: 371] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/06/2015] [Accepted: 02/23/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. OBJECTIVE The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. METHODS A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. RESULTS Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t217.60=-2.98, P=.003. Younger age (b=-0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R(2) =.17, R(2)adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information. CONCLUSIONS Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.
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Affiliation(s)
- Bethany Tennant
- ICF International, 9300 Lee Highway, Fairfax, VA, United States
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