The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use

Trends of global health literacy research (1995-2020): Analysis of mapping knowledge domains based on citation data mining

Background

During uncertainties associated with the COVID-19 pandemic, effectively improving people’s health literacy is more important than ever. Drawing knowledge maps of health literacy research through data mining and visualized measurement technology helps systematically present the research status and development trends in global academic circles.

Methods

This paper uses CiteSpace to carry out a metric analysis of 9,492 health literacy papers included in Web of Science through mapping knowledge domains. First, based on the production theory of scientific knowledge and the data mining of citations, the main bodies (country, institution and author) that produce health literacy knowledge as well as their mutual cooperation (collaboration network) are both clarified. Additionally, based on the quantitative framework of cocitation analysis, this paper introduces the interdisciplinary features, development trends and hot topics of the field. Finally, by using burst detection technology in the literature, it further reveals the research frontiers of health literacy.

Results

The results of the BC measures of the global health literacy research collaboration network show that the United States, Australia and the United Kingdom are the major forces in the current international collaboration network on health literacy. There are still relatively very few transnational collaborations between Eastern and Western research institutions. Collaborations in public environmental occupational health, health care science services, nursing and health policy services have been active in the past five years. Research topics in health literacy research evolve over time, mental health has been the most active research field in recent years.

Conclusions

A systematic approach is needed to address the challenges of health literacy, and the network framework of cooperation on health literacy at regional, national and global levels should be strengthened to further promote the application of health literacy research. In the future, we anticipate that this research field will expand in two directions, namely, mental health literacy and eHealth literacy, both of which are closely linked to social development and issues. The results of this study provide references for future applied research in health literacy.

Inequalities in Health Care Experience of Patients with Chronic Conditions: Results from a Population-Based Study

Patients' experience is an acknowledged key factor for the improvement of healthcare delivery quality. This study aims to explore the differences in healthcare experience among patients with chronic conditions according to individual sociodemographic and health-related variables. A population-based and cross-sectional study was conducted. The sample consisted of 3981 respondents of the Basque Health Survey (out of 8036 total respondents to the individual questionnaire), living in the Basque Country, aged 15 or older, self-reporting at least one chronic condition. Patient experience was assessed with the Instrument for Evaluation of the Experience of Chronic Patients questionnaire, which encompasses three major factors: interactions between patients and professionals oriented to improve outcomes (productive interactions); new ways of patient interaction with the health care system (the new relational model); and the ability of individuals to manage their care and improve their wellbeing based on professional-mediated interventions (self-management). We conducted descriptive and regression analyses. We estimated linear regression models with robust variances that allow testing for differences in experience according to sociodemographic characteristics, the number of comorbidities and the condition (for all chronic or for chronic patients' subgroups). Although no unique inequality patterns by these characteristics can be inferred, females reported worse global results than males and older age was related to poorer experience with the new relational model in health care. Individuals with lower education levels tend to report lower experiences. There is not a clear pattern observed for the type of occupation. Multimorbidity and several specific chronic conditions were associated (positive or negatively) with patients' experience. Health care experience was better in patients with greater quality of life. Understanding the relations among the patients' experience and their sociodemographic and health-related characteristics is an essential issue for health care systems to improve quality of assistance.

Perceived Efficiency Outcomes, Sources and Awareness of Online Health Information among the Elderly during COVID-19

The Internet and social media are crucial platforms for health information. Factors such as the efficiency of online health information, the outcomes of seeking online health information and the awareness of reliable sources have become increasingly important for the elderly during the COVID-19 pandemic. This study aimed to examine differences between elderly individuals' income above and below the average monthly wage in relation to their online health information efficiency and the outcomes of seeking online health information; to evaluate types of online information sources with online health information efficiency and the outcomes of seeking online health information; and to explore online health information efficiency as a mediator between health status and awareness of online sources. A cross-sectional study design was conducted with 336 elderly participants age 65 or older. The participants volunteered to complete a questionnaire. No differences were found between the two groups regarding efficiency in retrieving health information from official online health sites and Google. Perceived efficiency mediated health status and awareness of online sources. In these challenging times, it is important to provide a tailor-made education strategy plan for reliable sources of online health information for the elderly, in order to enhance their technology safety skills. It is also important to explore other mediating variables between health status and awareness of online sources.

Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

Background

COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of health care needs to be informed by vulnerable populations, such as people living with dementia.

Aim

To understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic.

Design and setting

Qualitative interviews with community-based patients living with dementia and their carers were carried out between May–August 2020, while the COVID-19 pandemic was ongoing in England.

Method

Semi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis.

Results

Three main themes were derived relating to: proactive care at the onset of COVID-19 restrictions; avoidance of healthcare settings and services; and difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk or reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging difficulties, rescheduling/missed calls, and inclusion of the voice of the person with dementia.

Conclusion

While remote consultations could be effective, proactive calls could be more structured around needs. Consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure good practice.

The Impact of an Internet Use Promotion Programme on Communication, Internet Use, and the Extent of Social Networks among Low-Income Older Adults

We examined whether an internet use promotion intervention influences low-income older adults’ communication modes, internet use, and social networks using existing data collected for an intervention. Participants living in public senior housing facilities in the United States (n = 77) completed surveys before and after a 12-week computer and internet training. The six-item Lubben Social Network Scale (LSNS-6) was used to measure the extent of older adults’ social networks. The primary mode of communication shifted from more traditional means to internet-based communications (p < .0005 in a Fisher’s exact test). The frequency of internet use significantly increased (p < .00005 in a one-sided Sign test). Overall, the LSNS-6 score increased by 4.1 points (p < .00005 in a Welch’s t-test). The LSNS-6 score increase was significantly larger among African Americans than Whites, controlling for gender (p < .05 in negative binomial regression). Moderate (p < .005) and frequent internet users (p < .05) had higher LSNS-6 scores than rare internet users at posttest when gender and race were controlled for in linear regression. Comparatively more improvement in the extent of social networks among African Americans suggests greater benefits of such interventions for population groups of disadvantaged backgrounds. Larger social networks among moderate and frequent internet users than rare users suggest positive impacts of internet communications on social networks.

Practical Solutions to Address COVID-19-Related Mental and Physical Health Challenges Among Low-Income Older Adults

Low-income older adults are disproportionately impacted by the COVID-19 pandemic. In this perspective article, we review the context in which low-income older people experience the pandemic and the mental and physical health consequences they have faced to date. Then, we offer practical solutions to help improve low-income older adults' sleep, physical activity, nutrition, and stress that require no or low financial commitment. We argue that governments, communities, and organizations should make greater efforts to promote healthy living for low-income older adults in times of health emergencies to ensure their ability to be universally adopted, regardless of income and resources.

Attitudes Toward Health, Healthcare, and eHealth of People With a Low Socioeconomic Status: A Community-Based Participatory Approach

Low socioeconomic status (SES) is associated with a higher prevalence of unhealthy lifestyles compared to a high SES. Health interventions that promote a healthy lifestyle, like eHealth solutions, face limited adoption in low SES groups. To improve the adoption of eHealth interventions, their alignment with the target group's attitudes is crucial. This study investigated the attitudes of people with a low SES toward health, healthcare, and eHealth. We adopted a mixed-method community-based participatory research approach with 23 members of a community center in a low SES neighborhood in the city of Rotterdam, the Netherlands. We conducted a first set of interviews and analyzed these using a grounded theory approach resulting in a group of themes. These basic themes' representative value was validated and refined by an online questionnaire involving a different sample of 43 participants from multiple community centers in the same neighborhood. We executed three focus groups to validate and contextualize the results. We identified two general attitudes based on nine profiles toward health, healthcare, and eHealth. The first general attitude, optimistically engaged, embodied approximately half our sample and involved light-heartedness toward health, loyalty toward healthcare, and eagerness to adopt eHealth. The second general attitude, doubtfully disadvantaged, represented roughly a quarter of our sample and was related to feeling encumbered toward health, feeling disadvantaged within healthcare, and hesitance toward eHealth adoption. The resulting attitudes strengthen the knowledge of the motivation and behavior of people with low SES regarding their health. Our results indicate that negative health attitudes are not as evident as often claimed. Nevertheless, intervention developers should still be mindful of differentiating life situations, motivations, healthcare needs, and eHealth expectations. Based on our findings, we recommend eHealth should fit into the person's daily life, ensure personal communication, be perceived usable and useful, adapt its communication to literacy level and life situation, allow for meaningful self-monitoring and embody self-efficacy enhancing strategies.

Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis

Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging with providers, to request refills, to make clinical decisions, or to share medical records with another provider. The results indicate that respondents with multimorbidity are more likely to share their medical records with other providers. However, respondents who are 75 and older are less likely to share their medical records with another provider. Additionally, respondents who are 65 and older are less likely to use the EHR for secure direct messaging with their provider. Additional health care strategies and provider communication should be developed to encourage older patients with chronic conditions to leverage the use of patient portals for effective disease management.

Impact of COVID-19 related social support service closures on people with dementia and unpaid carers: a qualitative study

OBJECTIVES

Accessing social care and social support services is key to support the well-being of people living with dementia (PLWD) and unpaid carers. COVID-19 has caused sudden closures or radical modifications of these services, and is resulting in prolonged self-isolation. The aim of this study was to explore the effects of COVID-19 related social care and support service changes and closures on the lives of PLWD and unpaid carers.

METHOD

PLWD and unpaid carers were interviewed via telephone in April 2020. Transcripts were analysed using thematic analysis. Demographic characteristics including household Index of Multiple Deprivation score and weekly hours of social support service usage before and since the COVID-19 outbreak were also collected. Paired samples t-tests was used to compare the mean of weekly hours of social support service usage before and since the outbreak.

RESULTS

50 semi-structured interviews were conducted with unpaid carers (n = 42) and PLWD (n = 8). There was a significant reduction in social support service usage since the outbreak. Thematic analysis identified three overarching themes: (1) Loss of control; (2) Uncertainty; (3) Adapting and having to adapt to the new normal. Carers and PLWD were greatly affected by the sudden removal of social support services, and concerned about when services would re-open. Carers were worried about whether the person they cared for would still be able to re-join social support services.

CONCLUSIONS

PLWD and carers need to receive specific practical and psychological support during the pandemic to support their well-being, which is severely affected by public health restrictions.

Beyond contact-tracing: The public value of eHealth application in a pandemic

This study adopts a public value perspective to examine the eHealth services deployed by national and regional governments to contain the coronavirus (Covid-19) pandemic, including symptoms checkers, information portals and contact-tracing applications. We analyse 50 cases of eHealth applications adopted in 25 European Economic Area (EEA) and outline how these systems and technologies map against four dimensions of public value: user orientation, participation, legality and equity. Our findings reveal that the public value of the eHealth applications adopted in the context of the current pandemic is affected by both endogenous and exogenous factors that undermine their ability to improve the quality of healthcare services and social wellbeing. We conclude by suggesting areas for further research to address such factors and the trade-offs emerging between different dimensions of public value.

Comparing Factors Associated With eHealth Literacy Between Young and Older Adults

The purpose of the current study was to compare the factors associated with adults' eHealth literacy, which is vital for health consumers. A secondary data analysis was conducted with data collected from November 2017 to February 2018 for a project on the development of a Korean version of the eHealth Literacy Scale. Participants were recruited through an online survey for young adults (n = 210, mean age = 25.5 [SD = 4.7] years) and a face-to-face survey for older adults (n = 187, mean age = 73.2 [SD = 4.8] years). Hierarchical multiple regression analyses were used to analyze data and determine eHealth literacy predictors. Older adults held more positive attitudes toward internet health information than young adults (mean = 16.49 [SD = 2.54] and 17.04 [SD = 2.41], respectively; p = 0.029); however, eHealth literacy levels were comparable (mean = 30.50 [SD = 4.62] and 30.95 [SD = 4.17], respectively; p = 0.305). Attitude toward internet health information was a significant predictor of eHealth literacy in both groups, and age was only a predictor among young adults. These results elucidate predictors of eHealth literacy and inform strategies to improve eHealth literacy among young and older adults. [Journal of Gerontological Nursing, 46(8), 46-56.].

In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults

Aim

This study aimed to explore the current status of e-health literacy among Chinese older adults, and to summarize and analyze the related influencing factors.

Subject and methods

Following the PRISMA Checklist, we searched MEDLINE, CINAHL Complete (EBSCO), PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Science and Technology Journal Database to identify the relevant literature published between January 2000 and December 2020. The Mixed Methods Assessment Tool (MMAT) was used to appraise the quality of the studies.

Results

Five articles were included for the systematic review. The results showed that the e-health literacy of Chinese older adults was low. Based on the social-ecological model, the influencing factors at the individual level included age, gender, educational attainment, socioeconomic status, physical and psychological conditions, frequency of internet use, and credibility perception of online health resources; at the interpersonal level, the influencing factors included marital status, being the family carer and being taught how to use internet to find health resources; at the social/community level, influencing factors included language barriers and cultural barriers.

Conclusion

Current e-health literacy among Chinese older adults is low, which is affected by a number of factors. Medical staff should provide detailed health information with guaranteed accuracy and reliability for elderly people. It is necessary to develop intervention programs tailored to varied educational needs of the elderly with different backgrounds (i.e., age, gender, educational attainment, and socioeconomic status) need to be developed in the near future. Family members are encouraged to teach older adults how to use e-health resource in appropriate ways.

Mobile Health (mHealth) Technology: Assessment of Availability, Acceptability, and Use in CKD

RATIONALE & OBJECTIVE

Digital and mobile health (mHealth) technologies improve patient-provider communication and increase information accessibility. We assessed the use of technology, attitudes toward using mHealth technologies, and proficiency in using mHealth technologies among individuals with chronic kidney disease (CKD).

STUDY DESIGN

Cross-sectional survey with open text responses.

SETTING & PARTICIPANTS

Chronic Renal Insufficiency Cohort (CRIC) Study participants who completed current use and interest in using mHealth technologies questionnaires and the eHealth literacy Survey (eHEALS).

EXPOSURE

Participant characteristics.

OUTCOMES

Use of technology (ie, internet, email, smartphone, and mHealth applications [apps]), interest in future mHealth use, and proficiency in using digital and mHealth technologies, or eHealth literacy, determined by eHEALS score.

ANALYTICAL APPROACH

Poisson regression and a qualitative content analysis of open-ended responses.

RESULTS

Study participants (n = 932) had a mean age of 68 years old and an estimated glomerular filtration rate (eGFR) of 54 mL/min/1.73 m2, and 59% were male. Approximately 70% reported current use of internet, email, and smartphones, and 35% used mHealth apps; only 27% had adequate eHealth literacy (eHEALS score ≥ 32). Participants <65 years of age (vs. ≥65), with more education, higher income, better cognition, and adequate health literacy reported more use of technology, and greater interest in using technologies. Participants of White (vs. non-White) race reported more use of internet and email but less interest in future use of mHealth. Younger age, higher annual income, and greater disease self-efficacy were associated with adequate eHealth literacy. Three themes regarding interest in using digital and mHealth technologies emerged: willingness, concerns, and barriers.

LIMITATIONS

Residual confounding, ascertainment bias.

CONCLUSIONS

Many individuals with CKD currently use the internet and smartphones and are interested in using mHealth in the future, but few use mHealth apps or have adequate eHealth literacy. mHealth technologies present an opportunity to engage individuals with CKD, especially members of racial or ethnic minority groups because those groups reported greater interest in using mHealth technology than the nonminority population. Further research is needed to identify strategies to overcome inadequate eHealth literacy.

Use of in-home activity monitoring technologies in older adult veterans with mild cognitive impairment: The impact of attitudes and cognition

BACKGROUND

As researchers incorporate in-home technologies to identify and track changes in older adults' cognitive and daily functioning that could lead to early interventions, the attitudes of older adults across the continuum from normal cognitive aging to mild cognitive impairment (MCI) must be assessed to ensure technology adoption and adherence in each unique group.

OBJECTIVE

This exploratory pilot study incorporated both quantitative and qualitative approaches to examine mild cognitive impairment (MCI) and cognitively intact older adults' attitudes (i.e., usability, acceptability, digital readiness, barriers) and adherence to in-home technologies after undergoing 7 months of in-home activity monitoring.

METHOD

Participants were 30 older adult veterans who were classified as cognitively intact (n = 15) or having mild cognitive impairment (MCI) (n = 15) and participated in a longitudinal aging and technology study that monitored their physical activity and computer use.

RESULTS

While MCI older adults endorsed reduced digital readiness (p =.041) and required more in-home technology maintenance visits (p =.041) from staff as compared to cognitively intact older adults, there was no difference in adherence to the study technology (p >.05). Usability and acceptability attitudes in the entire sample predicted adherence to the physical activity monitoring technology employed in the study (p =.008).

CONCLUSION

Findings highlight the potential gap between technology developers and older adult end users, and technologies designed specifically for older adults with MCI should be developed with direct input from older adults with MCI to promote usability and long-term adoption in this clinical population. Larger studies are needed to replicate and increase the generalizability of the current findings.

Passively-Measured Routine Home Computer Activity and Application Use Can Detect Mild Cognitive Impairment and Correlate with Important Cognitive Functions in Older Adulthood

BACKGROUND

Computer use is a cognitively complex instrumental activity of daily living (IADL) that has been linked to cognitive functioning in older adulthood, yet little work has explored its capacity to detect incident mild cognitive impairment (MCI).

OBJECTIVE

To examine whether routine home computer use (general computer use as well as use of specific applications) could effectively discriminate between older adults with and without MCI, as well as explore associations between use of common computer applications and cognitive domains known to be important for IADL performance.

METHODS

A total of 60 community-dwelling older adults (39 cognitively healthy, 21 with MCI) completed a neuropsychological evaluation at study baseline and subsequently had their routine home computer use behaviors passively recorded for three months.

RESULTS

Compared to those with MCI, cognitively healthy participants spent more time using the computer, had a greater number of computer sessions, and had an earlier mean time of first daily computer session. They also spent more time using email and word processing applications, and used email, search, and word processing applications on a greater number of days. Better performance in several cognitive domains, but in particular memory and language, was associated with greater frequency of browser, word processing, search, and game application use.

CONCLUSION

Computer and application use are useful in identifying older adults with MCI. Longitudinal studies are needed to determine whether decreases in overall computer use and specific computer application use are predictors of incident cognitive decline.

Group differences in health literacy are ameliorated in ehealth literacy

BACKGROUND

Heath literacy and eHealth literacy are skills that enable individuals to seek, understand and use information in ways which promote and maintain health. The present study examined group differences (ethnicity, immigration) in both literacies and whether there exists an association between the literacies and potential outcomes/gains in health behaviors, health care utilization, perceived health and perceived outcomes of Internet search.

METHODS

Participants included 819 Israeli men and women who responded to a nationally representative random-digital-dial (RDD) telephone survey. Respondents were veteran Jews, immigrants from the Former Soviet Union, and Palestinian Citizens of Israel.

RESULTS

Significant differences between the groups were found in health literacy, especially in higher ordered skills, so that the immigrant group was the lowest, after accounting for demographic variables. No significant group differences were found in eHealth literacy. Health literacy was found to be significantly associated with healthcare utilization, perceived health and perceived outcomes of Internet search while eHealth literacy was associated with perceived health and perceived outcomes of Internet search. No interaction was found between group and literacies in the prediction of the outcomes.

CONCLUSIONS

Immigration hampers health literacy but differences are ameliorated in eHealth literacy. Finding on association between literacies and outcomes replicated previous ones and the absence of moderation by group attests to the robustness of the models on health literacies.

Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary

Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization.

Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis.

Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals.

Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.

Efficacy and safety of a supplement combination on hand pain among people with symptomatic hand osteoarthritis an internet-based, randomised clinical trial the RADIANT study

OBJECTIVE

The RADIANT study aimed to investigate the efficacy and safety of a complementary medicine supplement combination in people with hand osteoarthritis (HOA).

METHOD

This was an internet-based, double-blind, randomised, placebo-controlled trial. Participants aged over 40 years with symptomatic HOA with radiographic confirmation (Kellgren Lawrence grade ≥ 2) throughout Australia were recruited and randomly assigned (1:1) to receive either a supplement combination composed of Boswellia serrata extract 250 mg/day, pine bark extract 100 mg/day, methylsulfonylmethane 1,500 mg/day and curcumin 168 mg/day or placebo for 12 weeks. The primary outcome was change in hand pain assessed using a visual analogue scale (VAS 0-100) from baseline to week 12. A range of secondary outcomes and additional measures were recorded. Adverse events were monitored weekly.

RESULTS

One hundred and six participants were included with mean age 65.6 years and 81% were women. 45% of the participants were graded as KLG 4, 40% KLG three and 39 (37%) had erosive OA. There was no significant difference in pain VAS reduction between groups. The adjusted between group difference in means (95%CI) was 5.34 (-2.39 to 13.07). Five participants (10%) in the supplement combination group discontinued study treatment due to AE vs four participants (7%) in the placebo group.

CONCLUSION

There were no significant differences in symptomatic relief between the two groups over 12 weeks. These findings do not support the use of the supplement combination for treating hand pain in people with HOA.

REGISTRATION

Prospectively registered (Australian New Zealand Clinical Trials Registry ACTRN12619000835145, 31/05/2019).

Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study

Background

As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional.

Objective

This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys.

Methods

Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting.

Results

A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement.

Conclusions

HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need.

Understanding older adults’ use of social technology and the factors influencing use

Having access and skills to use social technology, i.e. social internet use, social media and social applications, are considered as being vital to online social connection. Whilst evidence exists around facilitators and barriers to general technology use, evidence is limited with regards to the motivators, skills and tangible offline benefits older technology users experience with social technology. Therefore, this study used a qualitative, exploratory method to understand older adults’ experiences of using social technology to connect with others. Semi-structured interviews were conducted with 20 older adults (65+ years) across England, Scotland and Wales. Despite having access to social technology for social connection, and using this technology regularly, multiple barriers impacted motivators and skills for use, namely perceived self-efficacy and fear, the culture of online communication, absence of social capital and physical functioning. Some of these barriers of social technology use are reminiscent of barriers of wider technology use and emphasise the importance of addressing these barriers for digital exclusion, as well as social connection. However, some of these barriers were specific to social technology use and should be considered when providing guidance or interventions to increase older adults’ online social connection. Social connection was a clear tangible outcome to social technology use, and individuals discussed the benefits of using social technology, particularly visual communication tools, for online connection.

eHealth Literacy of Medical and Health Science Students and Factors Affecting eHealth Literacy in an Ethiopian University: A Cross-Sectional Study

BACKGROUND

eHealth literacy is individual's ability to look for, understand, and evaluate health information from electronic sources. Integrating eHealth literacy to the health system could help lower health care costs and ensure health equity. Despite its importance, the eHealth literacy level in Ethiopia has not been studied on medical and health science students, who are important parties in the health system. Understanding their level of eHealth literacy augments practice of health care, efficiency in education, and use of eHealth technologies.

OBJECTIVE

This research study aims to determine eHealth literacy level and identify its associated factors among medical and health science students in University of Gondar (UoG).

METHODS

An institution-based cross-sectional study was conducted from March to May 2019 among undergraduate medical and health science students in the UoG. Stratified multistage sampling was used. The eHealth literacy scale was used to measure eHealth literacy. A binary logistic regression model was fitted to measure association between eHealth literacy and the independent variables.

RESULTS

A total of 801 students participated in this study with a 94.6% of response rate. The majority (60%) were male and previously lived-in urban areas (68%). The mean eHealth literacy score was 28.7 and 60% of the participants possessed high eHealth literacy. Using health-specific Web sites (adjusted odds ratio [AOR] = 2.84, 95% confidence interval [CI]: 1.86-4.33), having higher Internet efficacy (AOR = 2.26, 95% CI: 1.56-3.26), perceived usefulness of the Internet (AOR = 3.33, 95% CI: 1.95-5.69), medical app use (AOR = 1.70, 95% CI: 1.13-2.55), being female (AOR = 1.55, 95% CI: 1.08-2.22), and being health informatics student (AOR = 2.02, 95% CI: 1.149-3.148) affect a high eHealth literacy level.

CONCLUSION

The level of eHealth literacy in this study was moderate. Using specific reputable health Web sites, using smartphone medical applications, and Internet efficacy determine eHealth literacy significantly.

The Use of Online Health-Management Tools and Health Care Utilization Among Older Americans

BACKGROUND AND OBJECTIVES

The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States.

RESEARCH DESIGN AND METHODS

The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)'s supplemental module (Health Behaviors) and the RAND version of the HRS fat file.

RESULTS

Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p < .05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p < .05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p < .05).

DISCUSSION AND IMPLICATIONS

While more research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults.

Internet-of-Things Smart Home Technology to Support Aging-in-Place: Older Adults' Perceptions and Attitudes

The purpose of the current study was to examine older adults' perceptions of Internet-of-Things (IoT) smart home devices as part of a real-world feasibility study and describe what factors affect adoption of these technologies. A total of 37 community-dwelling older adults enrolled in the 2-month study. Participants chose among different IoT devices to be installed in their home for the study period. Semi-structured interviews to explore perceptions of the technology were conducted. Older adults have unique preferences for specific types of IoT devices and their functionalities. Similarly, there were different degrees of acceptability across devices. In general, older adults had a positive attitude toward IoT smart home technologies to support their health management. Emergency preparedness was a key benefit of IoT devices identified by many older adults. In addition, convenience of a voice interface provided by a smart speaker was appreciated among participants. Older adults seemed to weigh the benefits and actual need for having the devices against potential infringements on privacy. Nurses and system designers should consider ethical and practical challenges related to the interconnected services of the IoT domain for older adults. [Journal of Gerontological Nursing, 47(4), 15-21.].

The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II to Assess the Use of the Apple Watch in Older Emergency Department Patients With Falls: Protocol for a Mixed Methods Study

Background

Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed; the device could also be used to objectively collect data on gait, fitness, and falls as part of clinical trials. However, little is known about the ease of use of this technology among older adult ED patients, a population at high risk of recurrent falls.

Objective

The goal of this study—the Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II—is to examine the feasibility, acceptability, and usability of the Apple Watch Series 4 paired with the iPhone and our research app Rhode Island FitTest (RIFitTest) among older adult ED patients seeking care for falls.

Methods

We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically, with or without telephone assistance from the research staff, to assess gait, fitness, and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semistructured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics.

Results

Recruitment began in December 2019 and was on pause from April 2020 until September 2020 due to the COVID-19 pandemic. Study recruitment will continue until 30 participants are enrolled. This study has been approved by the Rhode Island Hospital Institutional Review Board (approval 1400781-16).

Conclusions

GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology: older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs.

Trial Registration

ClinicalTrials.gov NCT04304495; https://clinicaltrials.gov/ct2/show/NCT04304495

International Registered Report Identifier (IRRID)

DERR1-10.2196/24455

Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry: an electronic health record study

OBJECTIVES

The recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications.

DESIGN AND SETTING

The Clinical Record Interactive Search tool was used to examine deidentified electronic health records of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing.

PARTICIPANTS

All patients receiving care from SLaM between 7 January 2019 and 20 September 2020 (around 37 500 patients per week).

OUTCOME MEASURES

(i) The number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per week.(ii) Prescribing of antipsychotic and mood stabiliser medications per week.

RESULTS

Following the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared with that in the previous year (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts significantly increased (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite this change in the type of patient contact, antipsychotic and mood stabiliser prescribing remained at similar levels.

CONCLUSIONS

The COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in psychiatric prescribing. Nevertheless, further work is needed to ensure that older patients are able to access mental healthcare remotely.

Innovations in self care and close care made during COVID 19 pandemic: a narrative review

Purpose

Previously, health self-care and informal or “close-care” for family and friends were receiving increasing attention, but became more important during the COVID-2019 pandemic. Sometimes, this was because formal services became less physically accessible to patients and were overburdened by patients ill with COVID-2019. The purpose of this paper is to give an overview of this phenomenon and consider the implications for clinical governance.

Design/methodology/approach

A five-step search and narrative review method were used, and case examples were selected to illustrate some of these developments.

Findings

Examples discovered and described include innovations in websites, social media support groups, systems for matching volunteers to people needing of help, computer and mobile phone applications, digital devices and virtual health rooms run by peer volunteers to help others to learn and use digital technologies.

Originality/value

In response to their health self-care needs not being met, some patients and carers and their associations developed new digital technologies or adapted existing ones. This use and their innovation separate from health care have been largely unreported in the scientific and professional literature. This is the first review of grey literature and other reports of this growing phenomena.

Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study

Background

During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet.

Objective

The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs).

Methods

We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs.

Results

The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009).

Conclusions

This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills.

A Pilot Study of a Chronic Pain Self-Management Program Delivered by Community Health Workers to Underserved African American Older Adults

OBJECTIVE

African American older adults living in disadvantaged communities are disproportionately burdened by disabling pain. To address their needs, we tested the feasibility and potential effects of a cognitive-behavioral chronic pain self-management program delivered by community health workers.

DESIGN

A single-group, pre-post evaluation of the STEPS-2 (Seniors using Technology to Engage in Pain Self-management) intervention, in which participants learned pain-management skills through web-based videos. They were also given wearable activity trackers to facilitate incremental increases in walking. In weekly telephone calls, community health workers helped participants apply skills and set goals.

SUBJECTS/SETTING

Thirty-one adults in Detroit, Michigan (97% African American, 97% female, mean 68.7 years), with chronic musculoskeletal pain.

METHODS

Participants completed telephone surveys at baseline and eight weeks. We measured changes in PROMIS pain interference and pain intensity, as well as Patient Global Impression of Change in pain and functioning. Feasibility indicators included participant engagement and satisfaction, and fidelity to session protocols by community health workers.

RESULTS

Participants on average completed 6.6/7 sessions, and 100% agreed or strongly agreed that they improved their understanding of pain management. Average community health worker fidelity score was 1.79 (0 to 2 scale). Pain interference decreased from baseline to post-program (T-score 61.6 to 57.3, P=.000), as did pain intensity (0 to 10 scale, 6.3 to 5.1, P=.004). Approximately 90% of participants reported that pain and function were at least "a little better" since baseline.

CONCLUSIONS

An intervention combining mobile health tools with support from community health workers holds promise for improving pain outcomes among underserved older adults.

Converting a Geriatrics Clinic to Virtual Visits during COVID-19: A Case Study

Background:

To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic.

Design:

An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits.

Setting:

Veteran’s Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment.

Intervention:

Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19.

Measurements:

Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings.

Results:

Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication.

Conclusion:

During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.

Quality of Life in Brain Tumor Patients and Their Relatives Heavily Depends on Social Support Factors during the COVID-19 Pandemic

Simple Summary

The COVID-19 pandemic has been associated with increased mortality worldwide. Cancer patients are among those at enhanced risk while already suffering from decreased quality of life (QoL) due to their disease. In the present study, we investigated QoL in 100 brain tumor patients and relatives across a twelve-week timespan during the first COVID-related lockdown (04–07/2020) in detail. Compared to the general population, both patients and relatives showed significant distress, anxiety, and depression, with patients more at risk. QoL within a family—between patients and relatives—was correlated. While QoL did not change over time, acceptance of lockdown measures decreased towards the end of the study period. Finally, QoL was strongly associated with the number of weekly social contacts. These findings shed light on the psychosocial situation of a vulnerable cancer population during the COVID pandemic and indicate the need for targeted psychosocial interventions in these patients and their relatives.

Abstract

The COVID-19 pandemic is associated with significant morbidity, mortality, and restrictions on everyday life worldwide. This may be especially challenging for brain tumor patients given increased vulnerability due to their pre-existing condition. Here, we aimed to investigate the quality of life (QoL) in brain tumor patients and relatives in this setting. Over twelve weeks during the first wave of the pandemic (04–07/2020), brain tumor patients and their families from two large German tertiary care centers were asked to complete weekly questionnaires for anxiety, depression, distress, and well-being. Information regarding social support and living conditions was also collected. One hundred participants (63 patients, 37 relatives) completed 729 questionnaires over the course of the study. Compared to relatives, patients showed more depressive symptoms (p < 0.001) and reduced well-being (p = 0.013). While acceptance of lockdown measures decreased over time, QoL remained stable. QoL measures between patients and their families were weakly or moderately correlated. The number of social contacts was strongly associated with QoL. Age, living conditions, ongoing therapy, employment, and physical activity were other predictors. QoL is correlated between patients and their families and heavily depends on social support factors, indicating the need to focus on the entire family and their social situation for QoL interventions during the pandemic.

Going Remote-Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study

BACKGROUND

The COVID-19 pandemic necessitated "going remote" with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor.

OBJECTIVE

Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations.

METHODS

We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention-a medication management app-and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data.

RESULTS

In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications.

CONCLUSIONS

The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858.

Size matters: locality of residence and media use in later life

Various factors determine the use of media in later life. Nevertheless, spatial inequalities among older media users have been accorded little attention in academic research. This study aimed to explore differences in variety (number) and intensity (duration) of both traditional and new media use among older adults residing in various types of localities. Data were obtained from the second wave of the ACT (Ageing + Communication + Technology) cross-national survey, comprising 7,927 internet users aged 60 and over from seven countries. The statistical analyses used in the study were chi-square and analysis of variance tests, and linear regression as a multivariate technique. The results indicated that spatial differences concern variety of media use to a greater extent than its intensity, especially with regard to use of traditional media via new devices. Overall, residents of large cities exhibited greater variety and intensity of media use than did their counterparts from smaller localities, especially rural ones. These findings supported the social stratification hypothesis – according to which individuals from more-privileged social backgrounds have better media literacy, use media to a greater extent and benefit from its use more than people from disadvantaged groups. The findings should be considered by practitioners and policy makers.

Oral health promotion apps: an assessment of message and behaviour change potential

BACKGROUND

Oral health worldwide needs improving: untreated dental caries is the most common health condition affecting people globally. Mobile applications (apps) have potential to provide preventative oral health interventions. This study aimed to investigate the quality of available oral health promotion apps, assessing information provided and the barriers to oral health addressed using psychological frameworks.

METHODS

A content assessment of oral health promotion apps targeted at adults in the UK iTunes store was conducted. The quality of 22 apps was assessed against 3 objective indices derived from the Delivering Better Oral Health toolkit, Theoretical Domains Framework and Behaviour Change Technique Taxonomy. Index scores were calculated and descriptive analyses were completed.

RESULTS

On average, four Delivering Better Oral Health messages, seven Theoretical Domains Framework components and eight Behaviour Change Technique Taxonomy components were addressed per app. The most common components were: 'take at least two minutes to brush' for the Delivering Better Oral Health index, 'goals' and 'intentions' for the Theoretical Domains Framework index and 'goal setting (behaviour)' for the Behaviour Change Technique Taxonomy index.

CONCLUSION

The quality of information available in oral health apps requires improvement with the majority addressing only a few barriers to oral health. Currently, there is no recognized scale for evaluating oral health apps: this study provides a suggested method for future app evaluation. There is opportunity for a new app to be created based on health behaviour change theory which includes all the Delivering Better Oral Health messages.

Goals of care conversations and telemedicine

Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.

Attitudes and Perceptions Toward Healthcare Technology Adoption Among Older Adults in Singapore: A Qualitative Study

Smart Nation is a key initiative of Singapore to move toward digitalization of its industries including healthcare. The complex negotiations of aging amid Smart Nation are addressed in this paper, where we study the challenges faced to adapt the elderly for the digital revolution while ensuring dignified aging. While the healthcare industry accelerates its study and use of health technologies to improve diagnostics, treatment, and the quality of life of those in the aging category, the elderly socially construct these technological insertions that challenge the dominant understandings of what these technologies can do for their health outcomes. The study reveals re-constructions of these technological insertions through the voice of the elderly in their negotiations with health technologies in their everyday lives. Here, narratives reveal key themes that proliferate technology negotiation as barriers to everyday lived experiences.

Measurement of Digital Literacy Among Older Adults: Systematic Review

Background

Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations.

Objective

This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission’s Digital Competence (DigComp) Framework.

Methods

Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use.

Results

Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ≥50 years (10/27) or ≥60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework’s elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including “digital content creation” and “safety.”

Conclusions

The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like “digital content creation” and “safety” that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged.

Adequacy of Web-Based Activities as a Substitute for In-Person Activities for Older Persons During the COVID-19 Pandemic: Survey Study

BACKGROUND

Senior centers and other types of clubs provide activities for older adults to address boredom, social isolation, and loneliness. Due to the COVID-19 pandemic, most of these activities have been cancelled. A limited range of web-based activities have been offered as alternatives. However, the effectiveness of these web-based group activities for older adults has scarcely been researched.

OBJECTIVE

We aimed to understand the extent to which web-based activities for older adults provide an adequate substitute for in-person activities.

METHODS

In this telephone survey, we interviewed 105 older adults in Israel who had been offered the opportunity to participate in web-based activities after routine activities closed due to the COVID-19 pandemic. Of the total sample, 49/105 (46.7%) participated in the activities and 56/105 (53.3%) did not. We inquired about the respondents' background characteristics, satisfaction with the activities, and reasons for participation or nonparticipation.

RESULTS

The respondents who participated in the web-based activities tended to be highly satisfied with at least some of them. They rated the enjoyment derived from the content of the activity as the most important motivator, followed by maintaining a routine and by enjoying the group and the presence of others. Over 50% of the participants (28/49, 57%) wished to continue with the exercise programming after the end of the COVID-19 pandemic, and 41% (20/49) wished to continue with the web-based lectures. Participants were more likely to report partaking in alternative activities than nonparticipants (P=.04). The most common reasons cited by nonparticipants were being unaware of the web-based program (24/56, 43%) despite a notification having been sent to the entire sample, lack of interest in the content (18/56, 32%), and technical issues (13/56, 23%), such as not owning or being able to fully use a computer. Both participants and nonparticipants were interested in a wide range of topics, with many being very particular about the topics they wished to access. Approximately half expressed willingness to pay for access; those who were willing to pay tended to have more years of education (P=.03).

CONCLUSIONS

Our findings suggest a need for web-based activities for countering boredom and feelings of isolation. The main factors that influence the use, efficacy, and sustainability of online activities are access, motivational and need-fulfilling factors, and whether the activities are sufficiently tailored to individuals' preferences and abilities. Challenges in substituting in-person services are promoting social relationships that are currently not sufficiently incorporated into most web-based programs, accommodating a wider range of topics, and increasing the accessibility of current programs to older adults, especially those who are homebound, both during and after the COVID-19 pandemic.

Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality

AIMS

To examine the factorial validity of the eHealth Literacy Scale among hospital nurses and to investigate the associations of its components with health-promoting behaviours and nursing performance quality.

DESIGN

This cross-sectional study used survey data of 484 Korean hospital nurses, which were collected between March-May 2016.

METHODS

The three-factor structure was tested using confirmatory factor analyses. Multiple linear regression was conducted to test associations of the three components' scores with health-promoting behaviours and self-rated nursing performance quality.

RESULTS

The eHealth Literacy Scale supported a three-factor structure: awareness of internet health resources (awareness), having skills needed to access resources (skills), and the ability to evaluate the quality of internet health resources (evaluation). All the three components were significantly associated with higher quality of nursing performance and better interpersonal relations. Stress management, spiritual growth, and health responsibility were linked with evaluation or skills but physical activity and nutrition were not.

CONCLUSION

Strategies to enhance eHealth literacy among nurses could improve nurses' health and further patient care. Training to build nurses' self-efficacy to evaluate internet health information could improve eHealth literacy and should be developed and examined.

IMPACT

To improve nurses' health and patient care, training programs to build nurses' self-efficacy to access and evaluate internet health information should be developed.

Digital Health Information Disparities in Older Adults: a Mixed Methods Study

Important health information including disease prevention and chronic disease self-management is increasingly packaged for digital use. The purpose of this sequential explanatory mixed methods study was to describe the extent of computer ownership, Internet access, and digital health information use in an ethnically diverse sample of older adults, comparing ownership, access, and use of digital health information (DHI) across ethnic groups and identifying the factors associated with them quantitatively. Significant differences in computer ownership, Internet access, and DHI use were found across ethnic groups (African American, Afro-Caribbean, Hispanic American, and European American). Logistic regression identified older age, less education, lower income, and minority group membership as significant predictors of limited DHI use. Older African Americans were one-fifth as likely to own a computer than were European Americans; Hispanic Americans were one-half as likely to have access to the Internet. We then conducted a series of focus groups which highlighted differences across ethnic groups. Participants in the African American/Afro-Caribbean group expressed frustration with lack of access to DHI but appreciation for alternative sources of information. Hispanic Americans critiqued information received from providers and drug inserts, some suggesting that a positive attitude and trust in God also contributed to getting well. European American participants evaluated various DHI websites, looking to providers for help in applying information to their personal situation. As the development and use of DHI continue, parallel efforts to increase access to DHI among economically disadvantaged and minority older adults are critical to prevent further disfranchisement.

The relationship among social capital, eHealth literacy and health behaviours in Chinese elderly people: a cross-sectional study

Background

Social capital has been linked to health behaviours, but the underlying mechanism is unclear. Previous studies have found that health literacy played the role of a mediator in the relationships among social capital, individual physical activity and nutrition. But it is not clear whether eHealth literacy mediates the impact of social capital on health behaviours. Therefore, our research aimed to explore the relationships among social capital (structural and cognitive social capital), eHealth literacy, and the health behaviours of elderly people, and to analyse the mediating effect of eHealth literacy, while providing a theoretical basis for a health behaviour intervention for elderly people.

Methods

From January to February 2019, we conducted a cross-sectional survey of 1201 Chinese people aged over 60 years using the Chinese Shortened Social Capital Scale (contains two subscales of structural social capital and cognitive social capital), eHealth Literacy Scale, and Health-Promoting Lifestyle Profile. We used structural equation modelling to test a hypothetical mediation model.

Results

The mean scores of social capital was 72.07 (SD = 13.03), 17.24 (SD = 9.34) for eHealth literacy, and 112.23 (SD = 23.25) for health behaviours. Social capital and eHealth literacy were significantly correlated with health behaviours, and social capital and structural social capital were significantly correlated with eHealth literacy. Lastly, eHealth literacy mediated the relationship between structural social capital and health behaviours.

Conclusions

eHealth literacy was an important mediating factor for elderly people’s structural social capital and health behaviours. Therefore, social capital and eHealth literacy must be considered when designing and implementing health behaviour intervention programmes for elderly people.

Understanding Technology Preferences and Requirements for Health Information Technologies Designed to Improve and Maintain the Mental Health and Well-Being of Older Adults: Participatory Design Study

Background

Worldwide, the population is aging rapidly; therefore, there is a growing interest in strategies to support and maintain health and well-being in later life. Although familiarity with technology and digital literacy are increasing among this group, some older adults still lack confidence in their ability to use web-based technologies. In addition, age-related changes in cognition, vision, hearing, and perception may be barriers to adoption and highlight the need for digital tools developed specifically to meet the unique needs of older adults.

Objective

The aim of this study is to understand the use of technology by older adults in general and identify the potential barriers to and facilitators of the adoption of health information technologies (HITs) to support the health and well-being of older adults to facilitate implementation and promote user uptake. In addition, this study aims to co-design and configure the InnoWell Platform, a digital tool designed to facilitate better outcomes for people seeking mental health services, to meet the needs of adults 50 years and older and their supportive others (eg, family members, caregivers) to ensure the accessibility, engagement, and appropriateness of the technology.

Methods

Participants were adults 50 years and older and those who self-identified as a supportive other (eg, family member, caregiver). Participants were invited to participate in a 3-hour participatory design workshop using a variety of methods, including prompted discussion, creation of descriptive artifacts, and group-based development of user journeys.

Results

Four participatory design workshops were conducted, including a total of 21 participants, each attending a single workshop. Technology use was prevalent, with a preference indicated for smartphones and computers. Factors facilitating the adoption of HITs included personalization of content and functionality to meet and be responsive to a consumer’s needs, access to up-to-date information from reputable sources, and integration with standard care practices to support the relationship with health professionals. Concerns regarding data privacy and security were the primary barriers to the use of technology to support mental health and well-being.

Conclusions

Although HITs have the potential to improve access to cost-effective and low-intensity interventions at scale for improving and maintaining mental health and well-being, several strategies may improve the uptake and efficacy of technologies by the older adult community, including the use of co-design methodologies to ensure usability, acceptability, and appropriateness of the technology; support in using and understanding the clinical applications of the technology by a digital navigator; and ready availability of education and training materials.

E-Government and Digital Inequality

The second level digital divide is generated by a combination of two factors. Firstly, the adoption of advantageous internet uses is strongly related to internet users’ material and educational resources. The higher the level of these resources, the higher the probability that advantageous internet uses will be adopted. Secondly, internet users’ offline resources have an influence on their digital skills. On the other hand, and according to the third level digital divide, advantageous internet use in not beneficial per se. In order to obtain tangible benefits from it, an adequate level of digital skills is required. In this paper, the Spanish case is used to study second and third level digital divides in relation to e-government. Results show the importance of educational and online resources, as well as higher levels of digital skills, in enhancing the probability of being able to use the internet to interact with the public administration and with government agencies. These results raise important questions in terms of digital citizenship and the democratic divide

Internet Use and Depressive Symptoms Among Older Adults in China

This study investigated the effect of using the Internet on depression symptoms of older Chinese, based on 7,801 adults aged over 60 years from the 2018 China Family Panel Studies. Results showed that the elderly who used the Internet reported lower depression scores, and the more frequent they use Internet, the lower their depression scores. Moreover, using the Internet for social contact and entertainment decreased the depression scores of the older adults, but when using Internet for learn, work, and commercial activity, the relief of depressive symptoms disappeared. Therelief of depression symptoms through Internet use were heterogeneous among different groups: the elderly aged 60-70, women, rural residents, and those with lower education attainment. Moreover, Internet use decreased the depression scores by increasing the frequency of contact with their children and increasing the importance of their enjoyment of life. According to the relief of depression by using Internet reasonably, policies should be designed to ensure that all ages could have easy access to the Internet.

A Question of Access: Exploring the Perceived Benefits and Barriers of Intelligent Voice Assistants for Improving Access to Consumer Health Resources Among Low-Income Older Adults

Intelligent voice assistants (IVAs) such as Amazon Echo and Google Home present a promising opportunity to improve access to consumer health information and resources for older adults. However, researchers know little about older adults’ opinions of using IVAs for these potentially critical tasks, particularly those with already limited access. In this paper, we explore older adults’ views about IVAs for consumer health and wellness information with the goal of better understanding what they envision as benefits and barriers of using such technology in the future. We shared an IVA prototype with ten older adults (60 years of age or older). We interviewed them about how a similar system might impact their access to consumer health information. Participants saw the potential for IVAs to improve their search experiences and support them with other health tasks. However, participants were also concerned about adopting an IVA for health due to access barriers, confidentiality risks, and concerns about receiving trusted information. Based on our findings, we discuss considerations for designing IVAs for underserved, older adult populations.

Predictors of Internet Use Among Older Adults With Diabetes in South Korea: Survey Study

Background

Internet access in Korea has grown dramatically over the past two decades. However, disparities in internet use, referred to as the second level of the digital divide, persist.

Objective

This study aims to examine opportunity, motivation, and health variables that indicate internet use among older adults with diabetes.

Methods

Data were sourced from a nationally representative sample of people 65 years and older with diabetes (N=1919). Logistic regression was used to explore potential differences in predictor variables between internet users and nonusers.

Results

Only 306 of the 1919 (15.95%) participants in the sample used the internet. They were more likely to be younger (odds ratio [OR] 0.89, 95% CI 0.87-0.92), well-educated (OR 1.20, 95% CI 1.16-1.26), and able to afford leisure expenditures (OR 1.02, 95% CI 1.01-1.04). Additionally, they had more information and communications technology (ICT) training experience, were motivated to learn, volunteered, and reported good physical and cognitive function. Participation in ICT education and better health more positively correlated with a higher rate of internet use than did years of education or economic standing in older adults with diabetes.

Conclusions

To support older adults with diabetes in the internet age, policies and health care providers should focus on digital competency training as well as physical and cognitive function.

Integrating Key User Characteristics in User-Centered Design of Digital Support Systems for Seniors' Physical Activity Interventions to Prevent Falls: Protocol for a Usability Study

Background

The goal of user-centered design (UCD) is to understand the users’ perspective and to use that knowledge to shape more effective solutions. The UCD approach provides insight into users’ needs and requirements and thereby improves the design of the developed services. However, involving users in the development process does not guarantee that feedback from different subgroups of users will shape the development in ways that will make the solutions more useful for the entire target user population.

Objective

The aim of this study was to describe a protocol for systematic analysis and prioritization of feedback from user subgroups in the usability testing of a digital motivation support for fall-preventive physical activity (PA) interventions in seniors (aged 65 years and older). This protocol can help researchers and developers to systematically exploit feedback from relevant user subgroups in UCD.

Methods

Gender, PA level, and level of technology experience have been identified in the literature to influence users’ experience and use of digital support systems for fall-preventive PA interventions in seniors. These 3 key user characteristics were dichotomized and used to define 8 (ie, 2³) possible user subgroups. The presented method enables systematic tracking of the user subgroups’ contributions in iterative development. The method comprises (1) compilation of difficulties and deficiencies in the digital applications identified in usability testing, (2) clustering of the identified difficulties and deficiencies, and (3) prioritization of deficiencies to be rectified. Tracking user subgroup representation in the user feedback ensures that the development process is prioritized according to the needs of different subgroups. Mainly qualitative data collection methods are used.

Results

A protocol was developed to ensure that feedback from users representing all possible variants of 3 selected key user characteristics (gender, PA level, and level of technology experience) is considered in the iterative usability testing of a digital support for seniors’ PA. The method was applied in iterative usability testing of two digital applications during spring/summer 2018. Results from the study on the users’ experiences and the iterative modification of the digital applications are expected to be published during 2021.

Conclusions

Methods for systematic collection, analysis, and prioritization of feedback from user subgroups might be particularly important in heterogenous user groups (eg, seniors). This study can contribute to identifying and improving the understanding of potential differences between user subgroups of seniors in their use and experiences of digital support for fall-preventive PA interventions. This knowledge may be relevant for developing digital support systems that are appropriate, useful, and attractive to users and for enabling the design of digital support systems that target specific user subgroups (ie, tailoring of the support). The protocol needs to be further used and investigated in order to validate its potential value.

International Registered Report Identifier (IRRID)

RR1-10.2196/20061

Relationship Between Levels of Digital Health Literacy Based on the Taiwan Digital Health Literacy Assessment and Accurate Assessment of Online Health Information: Cross-Sectional Questionnaire Study

BACKGROUND

The increasing amount of health information available on the internet makes it more important than ever to ensure that people can judge the accuracy of this information to prevent them from harm. It may be possible for platforms to set up protective mechanisms depending on the level of digital health literacy and thereby to decrease the possibility of harm by the misuse of health information.

OBJECTIVE

This study aimed to create an instrument for digital health literacy assessment (DHLA) based on the eHealth Literacy Scale (eHEALS) to categorize participants by level of risk of misinterpreting health information into high-, medium-, and low-risk groups.

METHODS

This study developed a DHLA and constructed an online health information bank with correct and incorrect answers. Receiver operating characteristic curve analysis was used to detect the cutoff value of DHLA, using 5 items randomly selected from the online health information bank, to classify users as being at low, medium, or high risk of misjudging health information. This provided information about the relationship between risk group for digital health literacy and accurate judgement of online health information. The study participants were Taiwanese residents aged 20 years and older. Snowball sampling was used, and internet questionnaires were anonymously completed by the participants. The reliability and validity of DHLA were examined. Logistic regression was used to analyze factors associated with risk groups from the DHLA.

RESULTS

This study collected 1588 valid questionnaires. The online health information bank included 310 items of health information, which were classified as easy (147 items), moderate (122 items), or difficult (41 items) based on the difficulty of judging their accuracy. The internal consistency of DHLA was satisfactory (α=.87), and factor analysis of construct validity found three factors, accounting for 76.6% of the variance. The receiver operating characteristic curve analysis found 106 people at high risk, 1368 at medium risk, and 114 at low risk of misinterpreting health information. Of the original grouped cases, 89.6% were correctly classified after discriminate analysis. Logistic regression analysis showed that participants with a high risk of misjudging health information had a lower education level, lower income, and poorer health. They also rarely or never browsed the internet. These differences were statistically significant.

CONCLUSIONS

The DHLA score could distinguish those at low, medium, and high risk of misjudging health information on the internet. Health information platforms on the internet could consider incorporating DHLA to set up a mechanism to protect users from misusing health information and avoid harming their health.

Who gets to learn in a pandemic? Exploring the digital divide in remote learning during the COVID-19 pandemic in Nigeria

This study investigates the digital divide in access to remote learning for children in Nigeria, as a result of the COVID-19 pandemic. The data used in this study is from a survey conducted by The Education Partnership (TEP) Centre and the Nigerian Economic Summit Group (NESG), which sampled 557 students and 626 parents living in Nigeria. From the survey, we found: a relationship between the socioeconomic status and the digital divide in accessing remote learning, significant differences in students' access to remote learning opportunities during the pandemic, and significant differences in access to digital tools between students in government schools and their private school counterparts. We also found a statistically significant association between parental level of education and the ability to support children's remote learning during the pandemic.

eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review

BACKGROUND

Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases.

OBJECTIVE

This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies.

METHODS

A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review.

RESULTS

The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools.

CONCLUSIONS

This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements.