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Turnbull J, Prichard J, MacLellan J, Pope C. eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey. J Med Internet Res 2024; 26:e50376. [PMID: 38833297 PMCID: PMC11185907 DOI: 10.2196/50376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/21/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Xie L, Hu H, Lin J, Mo PKH. Psychometric validation of the Chinese digital health literacy instrument among Chinese older adults who have internet use experience. Int J Older People Nurs 2024; 19:e12568. [PMID: 37831059 DOI: 10.1111/opn.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/27/2023] [Accepted: 07/27/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION In this digital age, the Internet has become a major source of health information, and electronic health (eHealth) literacy becomes increasingly important for older individuals to properly use the extensive eHealth resources for self-care. A valid and reliable tool for assessing older people's eHealth literacy would help healthcare workers identify those disadvantaged groups in digital health and provide relevant health education. OBJECTIVES This study aimed to evaluate the psychometric properties of the Chinese version of DHLI in assessing eHealth literacy among older adults in China. METHODS A web-based, cross-sectional study was conducted among 277 Chinese older adults from September to November 2021. Two weeks after the first completion, 62 of them answered the C-DHLI again. The reliability (e.g. internal consistency and test-retest reliability), factorial structure and validity (i.e. content validity and convergent validity) of the C-DHLI were evaluated based on the survey data. RESULTS The results demonstrated good internal consistency (Cronbach's alpha: 0.94) and test-retest reliability (total intraclass correlation coefficient [ICC]: 0.94) of the C-DHLI. Principal component analysis revealed that the 18 items of C-DHLI loaded on three factors, accounting for 74.69% of the total variance; CFA supported its three-factor structure with good model fits. Convergent validity was examined by the significant associations between C-DHLI and C-eHEALS (r = 0.61), health literacy (r = 0.56), and whether having used the Internet for health information (ρ = 0.43) (ps <.001). A cut-off score of 45 was recommended for determining higher and lower literacy using the C-DHLI, with the area under curve of 0.82 (95% CI = 0.77-0.88). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The C-DHLI showed good psychometric performance in assessing eHealth literacy among Chinese older adults. The findings can support healthcare professionals to effectively measure eHealth literacy among older adults and conduct tailored eHealth interventions or training.
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Affiliation(s)
- Luyao Xie
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Huahua Hu
- Research Centre of Adolescent Psychology and Behaviour, School of Education, Guangzhou University, Guangzhou, China
| | - Jiaer Lin
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Quansah F, Ankomah F, Agormedah EK, Ntumi S, Hagan JE, Srem‐Sai M, Dadaczynski K, Okan O, Schack T. A cross-sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well-being in Ghana. Health Sci Rep 2023; 6:e1095. [PMID: 36778775 PMCID: PMC9898839 DOI: 10.1002/hsr2.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background Mental health concerns of university students are gaining more attention since the emergence of the coronavirus disease. Consequently, scholars in education, health and psychology-related fields have attributed the dwindling subjective well-being (SWB) of students to their low levels of digital health literacy (DHL). However, little attention has been paid to an important variable like pocket money (PM) which might serve as a buffer against reduced levels of SWB. In this study, we explored the dynamics of PM and its linkage with DHL and SWB among university students in Ghana. Methods With a cross-sectional design, a convenient sample of 1160 students was obtained from the University of Education, Winneba, Ghana. The COVID-DHL and WHO-5 Well-being instruments were used for the data collection for a 2 months period (February-March, 2021). Chi-square test, multivariate regression, simple linear regression, and PROCESS mediation analyses were performed with the use of SPSS software version 25. Results The study found that while most of the students were financially supported by their parents (n = 715, 61.6%), a larger proportion of them reported that their PM was either less sufficient or not sufficient (n = 550; 76.9%). Findings revealed a positive relationship between PM and SWB (B = -36.419, p < 0.001; B = -13.146, p = 0.012; B = -10.930, p = 0.043), with this relationship mediated by DHL (B = -1.139, confidence interval [CI] [-2.073, -0.263] vs. -2.300, CI [-4.290, -0.532] vs. -8.366, CI [-14.863, -1.908]). Conclusions Students with little to insufficient PM were vulnerable to mental health problems, although this could be buffered by the high DHL levels. In practical terms, not only should the PM of university students be increased, but the sources of PM should be complemented since the sufficiency level of PM was associated with the source of finance. More importantly, parents should be empowered through job creation so that sufficient levels of PM can be provided to university students.
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Affiliation(s)
- Frank Quansah
- Department of Educational FoundationsUniversity of EducationWinnebaGhana
| | - Francis Ankomah
- Department of Education and PsychologyUniversity of Cape CoastCape CoastGhana
- Department of EducationSDA College of EducationAsokore‐KoforiduaGhana
| | - Edmond Kwesi Agormedah
- Department of Business & Social Sciences EducationUniversity of Cape CoastCape CoastGhana
| | - Simon Ntumi
- Department of Educational FoundationsUniversity of EducationWinnebaGhana
| | - John Elvis Hagan
- Department of Health, Physical Education, and RecreationUniversity of Cape CoastCape CoastGhana
- Department of Sports Science, Neurocognition and Action‐Biomechanics‐Research Group, Faculty of Psychology and Sports ScienceBielefeld UniversityBielefeldGermany
| | - Medina Srem‐Sai
- Department of Health, Physical Education, Recreation and SportsUniversity of EducationWinnebaGhana
| | - Kevin Dadaczynski
- Department of Health ScienceFulda University of Applied SciencesFuldaGermany
- Department of Nursing and Health Science, Centre for Applied Health ScienceLeuphana University LueneburgLueneburgGermany
| | - Orkan Okan
- Department of Sports and Health ScienceTechnical University MunichMunichGermany
| | - Thomas Schack
- Department of Sports Science, Neurocognition and Action‐Biomechanics‐Research Group, Faculty of Psychology and Sports ScienceBielefeld UniversityBielefeldGermany
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Rosário R, Fronteira I, Martins MRO, Augusto C, Silva MJ, Messer M, Martins S, Duarte A, Ramos N, Rathmann K, Okan O, Dadaczynski K. Infodemic Preparedness and COVID-19: Searching about Public Health and Social Measures Is Associated with Digital Health Literacy in University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12320. [PMID: 36231618 PMCID: PMC9566089 DOI: 10.3390/ijerph191912320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED We aimed to evaluate the associations between information searching about public health and social measures (PHSM) and university students' digital health literacy (DHL) related to the new coronavirus (SARS-CoV-2) and COVID-19. METHODS This cross-sectional study included 3,084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5). Sociodemographic data, DHL questionnaire and online information concerning PHSM were gathered. Cox proportional hazards models were performed. RESULTS Students who searched for personal protective measures achieved in shorter time sufficient "evaluating reliability" (HR = 1.4; 95% CI = 1.1; 1.7) and "determining relevance" (HR = 1.5; 95% CI = 1.2; 1.8). Searching for surveillance and response measures was associated with sufficient "determining relevance" (HR = 1.4; 95% CI = 1.1; 1.9). Finally, those students who searched for environmental, economic and psychosocial measures achieved in shorter time "determining relevance" (HR = 1.2; 95% CI = 1.0; 1.4). CONCLUSIONS Searching for PHSM was significantly associated with an increased likelihood of achieving sufficient DHL subscales in a shorter time. Further studies are needed, including developing strategies to increase the availability of high-quality information concerning public health and social measures and to improve (digital) health literacy.
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Affiliation(s)
- Rafaela Rosário
- School of Nursing, University of Minho, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Inês Fronteira
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal
| | - Maria R. O. Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal
| | - Cláudia Augusto
- School of Nursing, University of Minho, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Maria José Silva
- School of Nursing, University of Minho, 4710-057 Braga, Portugal
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Melanie Messer
- Department of Nursing Science II, Faculty I, Trier University, 54296 Trier, Germany
| | - Silvana Martins
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Ana Duarte
- School of Nursing, University of Minho, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
- Nursing Research Centre, University of Minho, 4710-057 Braga, Portugal
| | - Neida Ramos
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal
| | - Katharina Rathmann
- Department of Health Science, Fulda University of Applied Sciences, 36037 Fulda, Germany
| | - Orkan Okan
- Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
| | - Kevin Dadaczynski
- Department of Health Science, Fulda University of Applied Sciences, 36037 Fulda, Germany
- Center for Applied Health Science, Leuphana University of Lueneburg, 21335 Lueneburg, Germany
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Agormedah EK, Quansah F, Ankomah F, Hagan JE, Srem-Sai M, Abieraba RSK, Frimpong JB, Schack T. Assessing the validity of digital health literacy instrument for secondary school students in Ghana: The polychoric factor analytic approach. Front Digit Health 2022; 4:968806. [PMID: 36213522 PMCID: PMC9539653 DOI: 10.3389/fdgth.2022.968806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Abstract
The emergence of the coronavirus pandemic resulted in the heightened need for digital health literacy among the youth of school-going age. Despite the relevance of digital health literacy among the general public (including students), it appears the measurement of digital health literacy is still a challenge among researchers. Recently, Dadackinski and colleagues adapted existing digital health literacy measures to fit the COVID-19 situation. Since this development, the instrument has been widely used with few validation studies with none in Africa and specifically, in Ghana. The purpose of the study was to assess the validity of the digital health literacy instrument (DHLI) for secondary school students in Ghana using the polychoric factor analysis. We sampled 1,392 students from secondary schools in Ghana. The digital health literacy instrument was administered to the respondents, thereof. The study confirmed the four latent structure of the DHLI. Further, sufficient validity evidence was found regarding the construct validity of the DHLI. The findings from the study support the validity of the DHLI and its utility within the Ghanaian context. With the growing need for digital health literacy among younger people globally, the DHLI provides sufficient grounds for scaling them based on their level of literacy. There is a need for the instrument to be adapted and re-validated in Ghana and among different populations to widen its reproducibility.
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Affiliation(s)
- Edmond Kwesi Agormedah
- Department of Business / Social Sciences Education, University of Cape Coast, Cape Coast, Ghana
| | - Frank Quansah
- Department of Educational Foundations, University of Education, Winneba, Ghana
| | - Francis Ankomah
- Department of Education and Psychology, University of Cape Coast, Cape Coast, Ghana
- Department of Education, SDA College of Education, Koforidua, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
- Correspondence: John Elvis Hagan
| | - Medina Srem-Sai
- Department of Health, Physical Education, Recreation and Sports, University of Education, Winneba, Ghana
| | | | - James Boadu Frimpong
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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Validation of the COVID-19 Digital Health Literacy Instrument in the Italian Language: A Cross-Sectional Study of Italian University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106247. [PMID: 35627789 PMCID: PMC9140816 DOI: 10.3390/ijerph19106247] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
The Coronavirus Disease 19 (COVID-19) pandemic and the associated “infodemic” have shown the importance of surveillance and promotion of health literacy, especially for young adults such as university students who use digital media to a very high degree. This study aimed to assess the validity and reliability of the Italian version of the COVID-19 adapted version of the Digital Health Literacy Instrument (DHLI). This cross-sectional study is part of the COVID-19 University Students Survey involving 3985 students from two Italian universities. First, item analysis and internal consistency were assessed. Then, Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were performed comparing different models. The Italian DHLI showed good psychometric characteristics. The protecting privacy subscale was excluded, given the criticalities presented in the validation process. CFA confirmed the four-factor structure, also including a high-order factor. This result allows using the scale to measure a global level of digital health literacy and consider its levels separately for each construct component: searching the web for information, evaluating reliability, determining personal relevance, and adding self-generated content.
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Digital Health Literacy Related to COVID-19: Validation and Implementation of a Questionnaire in Hispanic University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074092. [PMID: 35409778 PMCID: PMC8998561 DOI: 10.3390/ijerph19074092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/25/2023]
Abstract
Digital health literacy influences decision-making in health. There are no validated instruments to evaluate the digital literacy about COVID-19 in Spanish-speaking countries. This study aimed to validate the Digital Health Literacy Instrument (DHLI) about COVID-19 adapted to Spanish (COVID-DHLI-Spanish) in university students and to describe its most important results. A cross-sectional study was developed with 2318 university students from Spain, Puerto Rico, and Ecuador. Internal consistency was measured with Cronbach’s alpha and principal component analysis. Construct validity was analyzed using Spearman’s correlations and the Kruskal−Wallis test. The internal consistency of the questionnaire was good for the global scale (Cronbach’s alpha 0.69, 95% CI 0.67) as well as for its dimensions. A total of 51.1% (n = 946) of students had sufficient digital literacy, 40.1% (n = 742) had problematic digital literacy, and 8.8% (n = 162) had inadequate digital literacy. The DHLI was directly and significantly correlated with age, subjective social perception, sense of coherence, and well-being (p < 0.001). The average digital literacy was higher in men than in women, in students older than 22 years, and in those with greater satisfaction with online information (p < 0.001). The COVID-DHLI-Spanish is useful for measuring the digital literacy about COVID-19 in Spanish-speaking countries. This study suggests gaps by gender and socioeconomic perception.
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Chun H, Park EJ, Choi SK, Yoon H, Okan O, Dadaczynski K. Validating the Digital Health Literacy Instrument in Relation to COVID-19 Information (COVID-DHL-K) among South Korean Undergraduates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063437. [PMID: 35329126 PMCID: PMC8950100 DOI: 10.3390/ijerph19063437] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023]
Abstract
Digital health literacy is crucial in accessing and applying health information in the COVID-19 pandemic period. Young college students are exposed daily to digital technologies, and they have further increased the use of digital information during the COVID-19 period. This study aimed to adapt DHLI into Korean and to assess the psychometric properties, during the COVID-19 pandemic period. A cross-sectional, nationwide, and web-based survey was conducted among 604 Korean undergraduates from 23 December 2020 to 8 January 2021. On the basis of the Digital Health Literacy Instrument (DHLI) by the Global COVID HL Network, the Korean questionnaire was developed by group translation, expert reviews, and forward-backward translation for validation. The scale reliability and validity were examined using Cronbach's alpha and confirmatory factor analysis. Results support the theoretical and empirical four-factor structure (search, express, evaluate, use) in the coronavirus-related DHL among Korean University students. Internal reliability of the overall scale was high (Cronbach's α = 0.908). The four-factor model was supported by confirmatory factor analysis (GFI = 0.972, CFI = 0.984, TLI = 0.978, RMSEA = 0.045). This study revealed that the COVID-DHL-K is a valid and reliable measure with appropriate psychometric characteristics.
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Affiliation(s)
- Heeran Chun
- Department of Health Administration, Jungwon University, Chungbuk 28024, Korea;
- Correspondence:
| | - Eun-Ja Park
- Korea Institute for Health Social Affairs, Sejong 30147, Korea;
| | - Seul Ki Choi
- Graduate School of Urban Public Health, University of Seoul, Seoul 02504, Korea;
| | - Hyeran Yoon
- Department of Health Administration, Jungwon University, Chungbuk 28024, Korea;
| | - Orkan Okan
- Department of Sports and Health Sciences, Technical University Munich, 80809 Munich, Germany;
| | - Kevin Dadaczynski
- Department of Nursing and Health Science, Fulda University of Applied Sciences, 36037 Fulda, Germany;
- Center for Applied Health Sciences, Leuphana University Lueneburg, 21335 Lueneburg, Germany
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