Self-reported eHealth literacy among undergraduate nursing students in South Korea: a pilot study

Nursing Students' Attitudes Toward Technology: Multicenter Cross-Sectional Study

BACKGROUND

The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency.

OBJECTIVE

This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes.

METHODS

Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences.

RESULTS

In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=-0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=-0.196; ρSwedish=-0.262; ρPolish=-0.133) and with the perceived skill in using computer devices (P<.001; ρall=-0.209; ρSwedish=-0.347; ρPolish=-0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively).

CONCLUSIONS

This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14643.

National survey on understanding nursing academics' perspectives on digital health education

AIM

This study explored the knowledge and confidence levels of nursing academics in teaching both the theories and practical skills of digital health in undergraduate nursing programs.

DESIGN

A cross-sectional study.

METHODS

A structured online survey was distributed among nursing academics across Australian universities. The survey included two sections: (1) the participants' demographics and their nursing and digital health teaching experience; (2) likert scales asking the participants to rate their knowledge and confidence to teach the theories and practical skills of four main themes; digital health technologies, information exchange, quality and digital professionalism.

RESULTS

One hundred and nineteen nursing academics completed part one, and 97 individuals completed part two of the survey. Only 6% (n = 5) of the participants reported having formal training in digital health. Digital health was mainly taught as a module (n = 57, 45.9%), and assessments of theory or practical application of digital health in the nursing curriculum were uncommon, with 79 (69.9%) responding that there was no digital health assessment in their entry to practice nursing programs. Among the four core digital health themes, the participants rated high on knowledge of digital professionalism (22.4% significant knowledge vs. 5.9% no knowledge) but low on information exchange (30% significant knowledge vs. 28.3% no knowledge). Statistically significant (p < .001) associations were found between different themes of digital health knowledge and the level of confidence in teaching its application. Nursing academics with more than 15 years of teaching experience had a significantly higher level of knowledge and confidence in teaching digital health content compared with those with fewer years of teaching experience.

CONCLUSION

There is a significant gap in nursing academics' knowledge and confidence to teach digital health theory and its application in nursing. Nursing academics need to upskill in digital health to prepare the future workforce to be capable in digitally enabled health care settings.

IMPLICATIONS FOR THE PROFESSION

Nursing academics have a limited level of digital knowledge and confidence in preparing future nurses to work in increasingly technology-driven health care environments. Addressing this competency gap and providing sufficient support for nursing academics in this regard is essential.

IMPACT

What problem did the study address? Level of knowledge and confidence among nursing academics to teach digital health in nursing practice. What were the main findings? There is a significant gap in nursing academics' knowledge and confidence to teach digital health theory and its application in nursing. Where and on whom will the research have an impact? Professional nursing education globally.

REPORTING METHOD

The STROBE guideline was used to guide the reporting of the study.

PATIENT OR PUBLIC CONTRIBUTION

The call for participation from nursing academics across Australia provided an introductory statement about the project, its aim and scope, and the contact information of the principal researcher. A participant information sheet was shared with the call providing a detailed explanation of participation. Nursing academics across Australia participated in the survey through the link embedded in the participation invite.

Nursing students' preparedness for the digitalised clinical environment in Australia: An integrative review

AIM

The aim of this integtrative review is to examine the literature on nursing students preparedness for the digitalised clinical setting.

BACKGROUND

Digital literacy skills ensure nursing students can provide quality and safe care to patients in a digitalised clinical setting.

DESIGN

Integrative review of the literature.

METHODS

The integrative review of the literature incorporated Whittemore and Knafl's (2005) framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2021 statement. A review of the literature comprised of a search of the following databases: ERIC, Scopus, CINAHL, Medline, Cochrane Library and Google Scholar from 2010-2022. Data were critically appraised using the Critical Appraisal Skills Programme (CASP), the Mixed Method Tool (MMAT) and Joanna Biggs Institute (JBI).

RESULTS

The literature reported on nine studies from 2010 to 2022. The four themes identified using Braun and Clarke's thematic analysis were curriculum design, education and training, digital literacy level and professional digital literacy competency standard framework. Major findings include the need for the development and integration of a professional digital literacy competency standard framework embedded into nursing curricula to equip nursing students with appropriate digital literacy skills to navigate digitalised healthcare settings.

CONCLUSION

Current registered nurses and preregistration nurses are required to be upskilled with the understanding and knowledge of health informatics and its role in the clinical setting. This will enable future registered nurses to keep up with the rapidly evolving technological clinical environment.

Profiles of digital health literacy among university students and its association with mental health during the COVID-19 pandemic: A latent profile analysis

Objective

Investigating the digital health literacy of university students can facilitate their effective acquisition of health information and adoption of appropriate protective behaviors. This study aims to explore the subtypes of digital health literacy among university students during the COVID-19 pandemic and their association with mental health outcomes.

Methods

From 17 November to 14 December 2022, a stratified random sampling approach was used to conduct an online questionnaire survey on digital health literacy, fear of COVID-19, and depression status among students at Jilin University, China. A total of 1060 valid responses were obtained in the survey. Latent profile analysis identified subtypes of digital health literacy and linear regression analyses were used to examine the association of digital health literacy to the mental health outcome.

Results

Three latent profiles were identified: Profile 1-low digital health literacy (n = 66, 6.23%), Profile 2-moderate digital health literacy (n = 706, 66.60%), and Profile 3-high digital health literacy (n = 288, 27.17%). Results from linear regression demonstrated a negative correlation between digital health literacy and fear of COVID-19 (B = -2.954, P < 0.001) as well as depression (B = -2.619, P < 0.001) among university students.

Conclusions

This study indicated that the majority of university students exhibit a moderate level of digital health literacy during the COVID-19 pandemic. Additionally, the study validates a negative correlation between digital health literacy and mental health among university students.

Self-Reported eHealth literacy among nursing students in Sweden and Poland: The cross-sectional multicentre study

This study aimed to provide an understanding of nursing students' self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman's Rank Correlation Coefficient, Mann-Whitney U, and Kruskal-Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

A multimethod study of NHS 111 online

Background

NHS 111 online offers 24-hour access to health assessment and triage.

Objectives

This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage.

Design

Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not.

Results

NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations.

Conclusions

Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities.

Limitations

This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide.

Future work

Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued.

Study registration

This study is registered at the research registry (UIN 5392).

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.

Perceived and performed electronic health literacy of medical sciences students

BACKGROUND

Evidence indicates that perceived skills for searching the Internet for health information may differ from actual skills in searching, finding, and appraising health information.

OBJECTIVES

This study investigated the perceived and performed eHealth literacy of medical sciences students, as well as the relationships between those literacies.

METHODS

This study enrolled 228 medical sciences students (convenience sample) in Iran. The study tools include the eHEALS literacy scale for the perceived eHealth literacy and a questionnaire designed by the authors to assess performed eHealth literacy (skills around access, understanding, appraising, applying, and generating information). Data were analysed using descriptive statistics and the Pearson correlation coefficient.

RESULTS

In general, over 70% of students perceived their skills of access and appraisal as good/very good, correlating with their estimated performance. Students perceived they were less confident in some appraisal skills (e.g., using information from the Internet to make health decisions) than others. Performed skills in information generation were mostly poor or very good; performed application skills generally good/very good.

CONCLUSIONS

The eHEALS score scales with actual skills (access and appraisal). Support is necessary for students in particular types of appraisal skills.

Factors influencing the e-health literacy in cancer patients: a systematic review

PURPOSE

As Internet technology evolves, electronic health (e-health) literacy gradually becomes a key factor in healthy behaviors and health-related decision-making. However, little is known about the influencing factors of e-health literacy among cancer survivors. Thus, the objective of this study was to systematically review the status quo, assessment tools, and influencing factors of e-health literacy in cancer patients.

METHODS

We conducted a comprehensive search in several databases, including PubMed, MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese BioMedical Literature Database, and Chinese Science and Technology Journal Database between January 2000 and December 2021.

RESULTS

A total of nine articles were included in this review, all of which were cross-sectional studies. Following the JBI critical appraisal tool, seven of them were rated as high quality. The e-Health Literacy Scale (eHEALS) was the most commonly used measurement for e-health literacy in cancer patients. The level of e-health literacy in cancer survivors was not high, which was associated with a variable of factors. The behavioral model of health services use was adopted to summarize related influencing factors. From an individual's perspective, predisposing characteristics and enabling resources were the most significant factors, without factors related to needs characteristics.

CONCLUSION

The study has identified the influencing factors of e-health literacy among cancer survivors, including age, gender, domicile place, education level, information-seeking behavior, and social support. In the future, e-health literacy lectures need to be carried out for elderly cancer patients, especially those who live in rural areas and have no access to the Internet. Families and friends of cancer survivors should also be encouraged to offer them more support.

IMPLICATIONS FOR CANCER SURVIVORS

These findings of this review provide novel insights for both family members and medical workers to improve e-health literacy in cancer patients. Further research is required to develop easy-to-use electronic health information acquisition devices and establish propagable e-health literacy intervention programs for cancer survivors.

Predictors of eHealth literacy levels among nursing students: A descriptive and correlational study

AIM

The aim of the present study was to determine the eHealth literacy levels of nursing students and to predict the influencing factors of eHealth literacy.

BACKGROUND

It is essential for nursing students, as the future workforce of the nursing profession, to have proficient ehealth literacy skills.

DESIGN

This study was conducted as a descriptive and correlational study.

METHODS

The sample consisted of 1059 nursing students at nursing departments of two state universities in Ankara, Turkey. The data were collected by a questionnaire and the eHealth Literacy Scale. Multiple linear regression analysis was used to evaluate the data.

RESULTS

The mean age of the students was 21.14 ± 1.62 years and 86.2% were female. The mean eHealth literacy score of the students was 29.28 ± 4.73. T Fourth year students had higher eHealth literacy scores than those in any other year of study (p < 0.001). Students who use the Internet frequently and always, those who search for health-related information on the Internet, those who find accessing health information on the Internet important, and those who find the Internet useful when making health-decisions had significantly high eHealth literacy scores (p < 0.05).

CONCLUSIONS

The present study revealed that the majority of the nursing students displayed a moderate eHealth literacy level. Academic level, frequency of Internet use, and search for health-related information on the Internet impacted the eHealth literacy of the students. Therefore, eHealth literacy concepts should be integrated into nursing curricula to improve nursing students' skills in using information technology and to increase their health literacy level.

The potential of eHealth for cancer patients-does COVID-19 pandemic change the attitude towards use of telemedicine services?

BACKGROUND

Internet penetration worldwide has increased rapidly over the recent years. With this growth, modern information and communication technologies (ICT) have become increasingly important. They do not only change daily life but also patient-physician interaction and health related information search, which can be summarized as electronic Health (eHealth). eHealth was already known before the emergence of the coronavirus disease 2019 (COVID-19), but this pandemic substantially challenged health systems, physicians and hospitals so profoundly that new services and methods of patient-physician interaction had to be implemented rapidly. This study investigates the attitude of cancer patients towards eHealth and the potential impact of COVID-19 on its use.

METHODS AND FINDINGS

The study was a multicentered study carried out at the university hospitals Bonn and Aachen. Patients were asked to answer a structured questionnaire in the time span between September 2019 and February 2021. Due to the COVID-19 pandemic, no patients were addressed between March 2020 and July 2020. The questionnaire focused on socio-demographic data, the dissemination of internet-enabled devices, the patients' attitude towards eHealth and the use of modern ICT in daily life and for health-related information search. In total, 280 patients have filled the questionnaire of which 48% were female and 52% were male. Men have a slightly more positive attitude towards the overall potential of eHealth than women which was shown by a significant influence for receiving medical information via e-mail. Hematological-oncological patients with a higher education level reported a significantly higher willingness to send personal health information to their physician and health insurance. A frequency of medical consultation of more than 5 times during the previous year has a significantly positive impact regarding the use of online communication, online video consultation and treatment quality. Younger patients have more concerns about data security than older patients. The study shows a different attitude towards the influence of eHealth on the patient-physician relationship in different therapy situations. While there were no significant changes in patients' attitude towards eHealth after the start of the COVID-19 pandemic, there was a trend towards an increasingly embracing attitude in patients, who answered the questionnaire during COVID-19 pandemic situation.

CONCLUSIONS

Overall, cancer patients had a positive attitude towards eHealth and the dissemination of internet-enabled devices was high. The study shows that the potential of eHealth is high among hematological-oncological patients. Further eHealth technologies and especially telemedically supported care processes should be implemented to improve patient-physician interaction and cross-sectoral care. COVID-19 pandemic led to a fast initiation and acceleration of new structures and routines for physicians, hospitals and patients. These new processes should be used to promote digitalization in hematological and oncological telemedicine. To successfully implement new eHealth technologies, future research should focus on patients' concerns about data privacy and data availability especially in the context of exchange of medical information in cross sectoral and interdisciplinary care processes.

eHealth literacy, internet use and health-related behaviour among health sciences students: a cross sectional study

BACKGROUND

Health sciences students should have the necessary skills required to find health information from online resources.

OBJECTIVE

To assess the eHealth Literacy Scale (eHEALS) and its association with internet use for health-related purposes, self-perceived health and health-related behaviour.

METHODS

A cross-sectional study was conducted in a sample of 528 health sciences students. Sociodemographic data, questions related to internet use for health-related purposes, self-perceived health and health-related behaviour, and the eHEALS tool were collected.

RESULTS

The overall mean eHEALS score was 3.19 ± 0.78. Students who consider access to health resources on the internet to be very important had the highest eHEALS scores (p = 0.015). There were significant differences between the participants' perceptions of the usefulness of the internet with regard to making health decisions (p < 0.001), the accuracy of information on the internet (p = 0.001) and the eHEALS scores.

CONCLUSIONS

Health sciences students have a moderate level of eHealth literacy. Positive attitude towards internet use and positive self-perception of health are the most relevant factors associated with eHealth literacy.

IMPACT STATEMENT

As future healthcare providers, students need to develop eHealth literacy skills in order to find reliable health information. A positive attitude towards internet use and a positive self-perception of health are factors associated with eHealth literacy. Educators should promote training programmes that ensure students are acquiring suitable skills in eHealth literacy.

Electronic health literacy and its association with lifestyle behavior among undergraduate students: A cross-sectional survey

Background

This study aims to assess healthy lifestyle behaviors among undergraduate students and determine the association between electronic health literacy with lifestyle behavior among undergraduate Jordanian university students.

Methods

A descriptive cross-sectional design was used. The study recruited 404 participants utilizing undergraduate students from public and private universities. The e-Health literacy scale was used to assess the level of health information literacy among university students.

Results

Data were collected from 404 participants who reported very good health status, the majority of the participants were female 57.2% with an average age of 19.3 years. The results showed that participants had good health behavior in terms of exercise, taking breakfast, smoking status, and sleeping status. The results have shown an inadequate level of e-Health literacy 16.61 (SD = 4.10) out of 40. The vast majority of students, in terms of their attitudes toward the Internet, thought that Internet health information was very useful/useful (95.8%). Also, they thought that online health information was very important /important (97.3%). The results showed that students who were attending public universities had higher e-Health literacy scores rather than those who were attending private universities, t (402) = 1.81, p = .014. The mean e-Health literacy score for nonmedical students was higher than those for medical students (p = .022).

Conclusion

The study's findings provide important insights into the health behaviors and electronic health literacy of undergraduate students in Jordanian universities, and offer valuable guidance for future health education programs and policies aimed at promoting healthy lifestyles in this population.

eHealth Literacy of Australian Undergraduate Health Profession Students: A Descriptive Study

Rapid growth in digital health technologies has increased demand for eHealth literacy of all stakeholders within health and social care environments. The digital future of health care services requires the next generation of health professionals to be well-prepared to confidently provide high-quality and safe health care. The aim of this study was to explore the eHealth literacy of undergraduate health profession students to inform undergraduate curriculum development to promote work-readiness. A cross-sectional survey was undertaken at an Australian university using the seven-domain eHealth Literacy Questionnaire (eHLQ), with 610 students participating. A one-way Multivariate Analysis of Variance (MANOVA) with follow-up univariate analysis (ANOVA) was used to determine if there were differences in eHLQ scores across 11 sociodemographic variables. Students generally had good knowledge of health (Scale 2); however, they had concerns over the security of online health data (Scale 4). There were also significant differences in age and ownership of digital devices. Students who were younger reported higher scores across all seven eHLQ scales than older students. This research provided an understanding of eHealth literacy of health profession students and revealed sub-groups that have lower eHealth literacy, suggesting that digital health skills should be integrated into university curriculums, especially related to practice-based digital applications with special focus to address privacy and security concerns. Preparation of health profession students so they can efficiently address their own needs, and the needs of others, is recommended to minimise the digital divide within health and social care environments.

Testing the Effectiveness of an Animated Decision Aid to Improve Recruitment of Control Participants in a Case-Control Study: Web-Based Experiment

BACKGROUND

Participation in case-control studies is crucial in epidemiological research. The self-sampling bias, low response rate, and poor recruitment of population representative controls are often reported as limitations of case-control studies with limited strategies to improve participation. With greater use of web-based methods in health research, there is a further need to understand the effectiveness of different tools to enhance informed decision-making and willingness to take part in research.

OBJECTIVE

This study tests whether the inclusion of an animated decision aid in the recruitment page of a study website can increase participants' intentions to volunteer as controls.

METHODS

A total of 1425 women were included in a web-based experiment and randomized to one of two experimental conditions: one in which they were exposed to a simulated website that included the animation (animation; n=693, 48.6%), and one in which they were exposed to the simulated website without the animation (control; n=732, 51.4%). The simulated website was adapted from a real website for a case-control study, which invites people to consider taking part in a study that investigates differences in purchasing behaviors between women with and without ovarian cancer and share their loyalty card data collected through 2 high street retailers with the researchers. After exposure to the experimental manipulation, participants were asked to state (1) their intention to take part in the case-control study, (2) whether they would be willing to share their loyalty card for research, and (3) their willingness to be redirected to the real website after completing the survey. Data were assessed using ordinal and binary logistic regression, reported in percentages (%), adjusted odds ratio (AOR), and 95% confidence intervals.

RESULTS

Including the animation in the simulated website did not increase intentions to participate in the study (AOR 1.09; 95% CI 0.88-1.35) or willingness to visit the real study website after the survey (control 50.5% vs animation 52.6%, AOR 1.08; 95% CI 0.85-1.37). The animation, however, increased the participants' intentions to share the data from their loyalty cards for research in general (control 17.9% vs animation 26%; AOR 1.64; 95% CI 1.23-2.18).

CONCLUSIONS

While the results of this study indicate that the animated decision aid did not lead to greater intention to take part in our web-based case-control study, they show that they can be effective in increasing people's willingness to share sensitive data for health research.

The mediating effects of digital literacy and self-efficacy on the relationship between learning attitudes and Ehealth literacy in nursing students: A cross-sectional study

BACKGROUND

eHealth literacy (eHL) is considered an important competency among healthcare providers in healthcare systems, especially following the introduction of information and communication technologies.

OBJECTIVES

This study aimed to identify the relationship and direction of factors affecting nursing students' eHL in an online learning environment.

DESIGN

A cross-sectional study.

SETTINGS

Three nursing colleges located in Gyeonggi-do and Gangwon-do in Korea.

PARTICIPANTS

Participants were 259 nursing students aged 18-29 years who lived in the Seoul metropolitan area.

METHODS

Self-reported data on variables including attitudes toward online learning, digital literacy, self-efficacy, and eHL, were collected and analyzed using an independent t-test and one-way analysis of variance. The mediating effects were verified through the bootstrapping method using the PROCESS macro for SPSS.

RESULTS

The results indicated that although attitudes toward online learning affected digital literacy, they did not directly influence eHL. Additionally, digital literacy and self-efficacy were also found to be associated with eHL and mediate the relationship between online learning attitudes and eHL.

CONCLUSIONS

As online nursing education rapidly becomes commonplace due to the COVID-19 pandemic, attitudes toward online learning, digital literacy, and self-efficacy must be improved to enhance eHL.

Cross-cultural adaptation and psychometric properties of the Sinhala version of electronic health literacy scale: A cross-sectional validation study

eHealth Literacy Scale (eHEALS) is the most widely used, valid and reliable tool to assess eHealth literacy skills, but no culturally appropriate tool exists to assess these skills among Sinhala-speaking Sri Lankans, including health professionals. This study aimed to cross-culturally adapt the original eHEALS from English to Sinhala and evaluate its psychometric properties. The study was conducted in two phases. The first phase involved translation and cross-cultural validation of the questionnaire. The second phase involved a cross-sectional survey conducted online among 268 health science students from a state university in Sri Lanka to confirm the psychometric properties of the questionnaire. An analysis of test-retest reliability was conducted with a subset of 72 students. The pre-final version of Sinhala eHEALS (Si-eHEALS) was developed following the cross-cultural adaptation process. The mean score of Si-eHEALS was 28.51±4.87. A satisfactory level of internal consistency was achieved (Cronbach’s alpha = 0.91). The test-retest reliability was acceptable (intraclass correlation coefficient -.776). Content validity index of Si-eHEALS was.97. The principal component analysis supported the unidimensionality of the scale, explaining 61.2 variance. There was a significant positive association between Si-eHEALS score with academic year (r_s = .146, p = .017), self-rated internet skills (r_s = .122, p = .046), usefulness of internet in health decision making (r_s = .212, p < .001) and importance of ability to access health resources on the internet (r_s = .230, p < .001), confirming concurrent validity. No significant difference based on gender (U = 5854, p = .550) and degree program (X²(2) = 2.965, p = .564) was found, confirming discriminant validity. In line with many previous validation studies, our study demonstrated good psychometric properties for Si-eHEALS. Si-eHEALS is a valid and reliable tool that assesses eHealth literacy in Sinhala speaking Sri Lankans, particularly health professionals.

Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic

Background

This study investigates university students’ digital health literacy and web-based information-seeking behaviours during the early stages of the COVID-19 pandemic in England. It compares undergraduate and postgraduate students in non-health related subjects with health care students, many of whom were preparing for, or working in, frontline roles. The survey was conducted as part of a wider study by the COVID-HL research consortium.

Methods

A cross-sectional study was conducted among n = 691 university students aged ≥18 years from 25 universities across England using an adapted digital survey developed by COVID-HL. Data were collected regarding sociodemographic characteristics and specific measures drawn from the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI). These had been adapted for use in an English setting and to the specific context of the COVID-19 pandemic. Other data collected included students’ anxiety or worries about the future using the Dark Future Scale as well as behaviours in online information-seeking. Data were analysed using correlations to test for relationships between constructs and also between group comparisons to test for differences between students studying health and non-health related subjects.

Results

Across digital health literacy dimensions, there was no significant difference between students studying health-related subjects and other students. Health care students did report greater difficulties in relation to how to behave online. They also relied less on public body sources for information about the pandemic. A significant difference was found between the two student populations in relation to their anxiety about the future with health care students reporting fewer fears about the future.

Conclusions

Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with evaluating online information which may frustrate public health efforts. This could be addressed by ensuring health students’ curriculum in particular encompasses digital health literacy.

Predictors of eHealth Literacy and Its Associations with Preventive Behaviors, Fear of COVID-19, Anxiety, and Depression among Undergraduate Nursing Students: A Cross-Sectional Survey

Background: The infodemic has been co-existing with the COVID-19 pandemic with an influx of misinformation and conspiracy theories. These affect people’s psychological health and adherence to preventive measures. eHealth literacy (eHEALS) may help with alleviating the negative effects of the infodemic. As nursing students are future healthcare professionals, having adequate eHEALS skills is critically important in their clinical practice, safety, and health. This study aimed to (1) explore the eHEALS level and its associated factors, and (2) examine the associations of eHEALS with preventive behaviors, fear of COVID-19 (FCV-19S), anxiety, and depression among nursing students. Methods: We surveyed 1851 nursing students from 7 April to 31 May 2020 from eight universities across Vietnam. Data were collected, including demographic characteristics, eHEALS, adherence to preventive behaviors (handwashing, mask-wearing, physical distancing), FCV-19S, anxiety, and depression. Linear and logistic regression analyses were performed appropriately to examine associations. Results: The mean score of eHEALS was 31.4 ± 4.4. The eHEALS score was significantly higher in males (unstandardized regression coefficient, B, 0.94; 95% confidence interval, 95% CI, 0.15 to 1.73; p = 0.019), and students with a better ability to pay for medication (B, 0.79; 95% CI, 0.39 to 1.19; p < 0.001), as compared to their counterparts. Nursing students with a higher eHEALS score had a higher likelihood of adhering to hand-washing (odds ratio, OR, 1.18; 95% CI, 1.15 to 1.22; p < 0.001), mask-wearing (OR, 1.15; 95% CI, 1.12 to 1.19; p < 0.001), keeping a safe physical distance (OR, 1.20; 95% CI, 1.15 to 1.25; p < 0.001), and had a lower anxiety likelihood (OR, 0.95; 95% CI, 0.92 to 0.99; p = 0.011). Conclusions: Nursing students who were men and with better ability to pay for medication had higher eHEALS scores. Those with higher eHEALS scores had better adherence to preventive measures, and better psychological health. The development of strategies to improve eHEALS of nursing students may contribute to COVID-19 containment and improve their psychological health.

Exploring the eHealth literacy and mobile health application utilisation amongst Malaysian pharmacy students

Introduction

Pharmacy students should be eHealth literate by being skilful in searching, evaluating and applying online health information. Mobile health applications should be utilised when making clinical decisions to achieve optimal patient care with the ever-changing pharmacy practice. This study aims to explore the eHealth literacy and mobile health application utilisation amongst pharmacy undergraduates.

Methods

A cross-sectional study was conducted from March to April 2021. An online survey, consisting of socio-demographic characteristics, Internet use, eHealth Literacy Scale and mobile health application utilisation, was distributed amongst pharmacy undergraduates in public and private universities in Malaysia. Data analysis included descriptive statistics, one-way analysis of variance test, Mann–Whitney U test and Kruskal–Wallis test

Results

A total of 415 participants completed the survey (response rate    =    82.5%). The median eHealth Literacy Scale score (out of 40) was 31.0    ±    3.0 (interquartile range). More than one-third of participants (34.7%) were found to have low eHealth literacy. Many lacked confidence in making health decisions from online information (42.4%) and skills in distinguishing between high-quality and low-quality health resources (35.2%). Only 70.4% of the participants had mobile health applications installed on their smartphones and/or tablets. Some students felt that they were neither knowledgeable nor skilful enough to utilise mobile health applications (24.8%), whereas 23.9% were unaware of the mobile health applications available.

Conclusion

In summary, the eHealth literacy of Malaysian pharmacy students can be further enhanced by incorporating eHealth literacy-focused programmes into the curriculum. Moreover, pharmacy students’ mobile health application utilisation can be improved through increased awareness and support from universities.

Nursing students' emotional work and its consequences following encounters with e-patients who present reliable or unreliable information; a scenario based cross sectional survey

BACKGROUND

Hochschild's theory of emotional work explains how people evoke or suppress emotions in order to adhere to social norms. An encounter with an e-patient who presents potentially unreliable medical information from the internet can lead to caregivers undergoing emotional work. This may have a negative impact on caregivers, such as mental exhaustion or professional dissatisfaction.

OBJECTIVES

To examine nursing students' emotional work and its consequences following an encounter with e-patients who present new information from reliable or unreliable internet websites.

DESIGN

A cross sectional study.

SETTINGS

A large university in the center of Israel.

PARTICIPANTS

376 nursing students (230 Jewish, 146 Arab) of a 4-year BA program.

METHODS

The study was scenario based describing an e-patient that presents information from a reliable/unreliable website. The students were asked about the emotions the situation evokes in them based on the Emotional Work Questionnaire. In addition, the questionnaire examined the emotional work techniques (surface versus deep acting) and the impact of emotional work on the students.

RESULTS

Deep acting emotional work was the most used emotional work technique. Arab students performed more deep acting emotional work compared to Jewish students (F(1,360) = 12.57, p < 0.001). Deep acting emotion work mediated the relationship between ethnicity and the impact of emotion work ((LLCI (-0.1018), ULCI (-0.0199)).

CONCLUSIONS

The training of nursing students should allow and encourage students' legitimacy to feel and express various emotions, even when they are contrary to expectations. Sharing others' (students', clinical instructors') feelings that arise in clinical situations is an essential aspect of clinical training. This training may lead to effective emotional management in different situations and allow students to receive help and support that will enable them to develop good coping skills during their studies which will benefit them later in their professional career.

Telehealth in Nursing Education: A Systematic Review

BACKGROUND

Telehealth encompasses a broad variety of technologies and methods to deliver virtual medical, health, and education services. This systematic review examined the research completed in the past 10 years to determine the prevailing state of the science related to nursing education and telehealth.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. The criteria for inclusion were nursing education research related to telehealth in an academic setting.

RESULTS

A total of 13 articles met the inclusion criteria. A lack of rigorous research design, valid and reliable instrumentation, and measurable outcomes were noted.

CONCLUSION

This review found a lack of research focused on nursing education associated with telehealth. One article validating 14 nursing telehealth entrustable professional activities with 52 corresponding competencies was found to have the potential to guide curricular integration, measure outcomes, and build a program of telehealth nursing education research. [J Nurs Educ. 2021;60(11):633-635.].

Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study

Background

eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs.

Objective

This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory.

Methods

This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses.

Results

The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs.

Conclusions

Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.

Is Electronic Health Literacy Associated with Learning Outcomes among Medical Students in the First Clinical Year?: A Cross-Sectional Study

Medical students tend to use the internet as a primary resource when seeking health information. This study aims to assess the patterns of internet use, eHL level, and learning outcomes with eHL among medical students at Chiang Mai University. A cross-sectional study was conducted among 88 medical students in the first clinical year. The eHL level was determined using the Thai version of the electronic Health Literacy Scale or eHEALS. The patient case report scores were obtained representing the learning outcome. Linear regression was used to identify factors influencing their eHL level and case report scores. Students recognized the importance and usefulness of the internet. The mean eHEALS score was 33.45. There was a lower degree of agreement on questions regarding internet usage, having skills to evaluate the resources, and confidence in using health information to make health decisions. The eHEALS score had no statistically significant association with most variables and case report scores, but with the longer time of internet use (p-value = 0.014). Although medical students perceived that they have high eHL levels, they report lower confidence in using the information. Including critical thinking skills for electronic health information in the medical curriculum could be useful.

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.].

Effectiveness of health literacy education for nursing students: A randomized controlled trial

AIM

The aim of this study was to determine the effect of health literacy education given to nursing students on health literacy level.

BACKGROUND

Health literacy has become an important issue in the field of health. Health literacy is an issue of interest to health professionals as well as individuals.

METHODS

The study was conducted as a randomized controlled trial. A total of 206 nursing students, 103 in the intervention and 103 in the control group, were included in the study. The intervention group received four weekly training sessions of health literacy education. The research was registered at ClinicalTrials.gov with the registration number NCT04868487.

RESULTS

On the baseline assessment, there were no statistically significant differences between the intervention and control group in terms of health literacy level (p > 0.05). In the 1st- week and 12th-week measurements, the health literacy level of the intervention group was significantly higher than control group (p < 0.05).

CONCLUSION

Health literacy education was effective in increasing the health literacy level of the students. Therefore, the concept of health literacy should be added to the nursing education curriculum.

The Relationship between E-Health Literacy and Health-Promoting Behaviors in Nursing Students: A Multiple Mediation Model

The availability of a wide range of online health-related information on the internet has made it an increasingly popular source of health information, particularly for people in their 20s. This study aimed to explore possible multistep and indirect pathways of association between e-health literacy and health-promoting behaviors through social media use for health information, online health information-seeking behaviors, and self-care agency among nursing students. The study included 558 nursing students from three different universities in South Korea. Data were collected using structured questionnaires from 2 August to 29 August, 2019. The results show that e-health literacy had a significant direct effect on health-promoting behaviors through the three mediators. Moreover, the overall model explained 46% of the total variance in health-promoting behaviors. Based on these findings, it is necessary to introduce interventions that improve e-health literacy and develop a strategy to promote healthy behaviors. It is also necessary to develop programs to improve e-health literacy competency in nursing students. Moreover, health interventions that improve health-promoting behaviors should be developed, and research to evaluate the effect of the interventions should be conducted.

Nurses' ehealth literacy and associations with the nursing practice environment

AIM

To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment.

BACKGROUND

Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health.

INTRODUCTION

High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses.

METHODS

The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed.

FINDINGS

In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information.

DISCUSSION

Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care.

CONCLUSION

This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation

PURPOSE

Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.

DESIGN/METHODOLOGY/APPROACH

Data from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.

FINDINGS

The study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.

ORIGINALITY/VALUE

To the authors' knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

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 effect of undergraduate nursing students' e-Health literacy on healthy lifestyle behaviour

e-Health literacy has become more important in promoting healthy lifestyles in recent years. The purpose of this study was to determine the effect of undergraduate nursing students' e-Health literacy on healthy lifestyle behaviours. This cross-sectional study was conducted during the 2016-2017 academic year at a Nursing Department in the Faculty of Health Sciences in Istanbul. The study population consisted of 232 undergraduate nursing students. The study sample was 205 students who volunteered to participate in the research. The data were collected using the Structured Questionnaire Form, the e-Health Literacy Scale in Adolescent and the Adolescent Lifestyle Profile Scale. The mean score of the e-Health Literacy Scale in Adolescent was 29.50 ± 5.02. The mean total score of the Adolescent Lifestyle Profile was 112.11 ± 14.66. There was a positive correlation between students' Internet attitudes and general health-promoting lifestyle (r = 0.273; p < 0.01), indicating the higher the students' e-Health literacy, the higher their levels of healthy lifestyle behaviours. The result showed that e-Health literacy is an important parameter in promoting healthy lifestyle behaviours of nursing students.

Association of eHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study

Background

Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan.

Objective

The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university.

Methods

A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses.

Results

The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001).

Conclusions

The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.

Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study

Background

The increasing number of people living with one or more chronic conditions imposes a growing demand on healthcare providers. One way to handle this challenge is by re-orientating the way care is provided, empower people and increase their ability to manage their condition. This requires, amongst other factors, sufficient level of health literacy (HL) and digital competences among both patients and the healthcare providers, who serve them. The focus of this study is the level of HL, digital literacy (DL), and eHealth literacy (eHL) in nursing students in Denmark.

The objective was to examine the level of these three literacies in entry- and graduate-level nursing students and examine sociodemographic characteristics and self-rated health (SRH) associations.

Methods

A cross sectional study was conducted among 227 students at entry-level and 139 students at graduate-level from a nursing program. The survey consisted of the health literacy questionnaire (HLQ (nine scales)), the eHealth Literacy Assessment toolkit (eHLA (seven scales)), the eHealth Literacy Questionnaire (eHLQ (seven scales)), questions soliciting sociodemographic data, and a single item assessing the students’ SRH. Pearson’s chi-square test and the Mann-Whitney test were used to examine the differences in HL, DL, and eHL and between groups, and Kendall’s tau-b test to examine correlations between SRH and HL, DL, and eHL.

Results

The level of HL, DL and eHL tended to be higher among graduate-level students than in entry-level students and was satisfactory. Age, sex, country of origin, and parents’ educational level and occupational background influenced students’ HL levels. SRH was higher in students at the graduate level. Amongst entry-level students, SRH was positively associated to seven HLQ, four EHLA and four eHLQ, amongst graduate-level students, SRH was positively associated to seven HLQ and six eHLQ.

Conclusions

Educators must be aware of how sociodemographic factors affects students’ literacies and increase learning opportunities by mixing students when planning activities. Considering the higher SRH in graduate-level students, HL, DL, and eHL levels indicate that current curricula and study activities are appropriate, but there is still room for improvement.

Factors influencing eHealth literacy among Korean nursing students: A cross-sectional study

Successful online learning depends on the supported learner's attitude, motivation, and self-efficacy, along with their ability to use the flexibility and convenience of digital technology. As information and communications technology is introduced in healthcare, eHealth literacy (eHL) is becoming increasingly essential in nursing education. This study aimed to identify the eHL levels and the factors affecting eHL among nursing students. A survey was conducted among 205 nursing students from two colleges in Korea. The collected data were analyzed using descriptive statistics, and the factors associated with the eHL of nursing students were examined using multiple regression analysis. The eHL of nursing students, measured using the eHealth literacy scale, was found to be higher than in previous studies. Factors affecting eHL of nursing students were academic level, digital literacy toward information and communications technology for learning, and self-efficacy for online education. These factors accounted for 38.8% of the variability in eHL among nursing students. In order to improve the eHL of nursing students, nursing education should consider a multidimensional approach toward developing digital literacy and self-efficacy among them.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

Perceived eHealth Literacy and Learning Experiences Among Japanese Undergraduate Nursing Students: A Cross-sectional Study

This study aimed to describe undergraduate nursing students' perceived eHealth literacy and learning experiences of eHealth literacy in Japan and to clarify the relationship between these factors. We conducted a self-administered online questionnaire survey using a convenience sample of 353 Japanese undergraduate nursing students selected from three universities. Participants completed the eHealth Literacy Scale and questionnaires on learning experiences of eHealth literacy and some demographic factors. Participants had moderate perceived eHealth (mean [SD], 24.52 [5.20]). More than half the participants responded that they had no learning experiences of health or science literacy. We observed a positive correlation between the total mean eHealth literacy and learning experiences scores. Undergraduate nursing students in Japan had slightly lower perceived eHealth literacy than nursing students in other countries, hospital nurses, and even patients. Of the 353 participants in this study, 69.4% did not know "where to find helpful health resources on the Internet," 80.2% of those lacked the skills "to evaluate health resources," and 68.9% could not "differentiate the quality of health resources on the Internet"; few of the participants perceived themselves as having any experience in learning the six domains of eHealth literacy. Very few reported learning about health (43.3%) and scientific (21.8%) literacy. The low perceived eHealth literacy among participants might reflect lack of knowledge and confidence in eHealth literacy as well as their own low level of health-promoting behaviors; this might influence the quality of health education of clients and their families. Nursing educators should address the lack of eHealth literacy among undergraduate nursing students.

Adapting the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) in a Sample of Greek and Cypriot Carers of People With Dementia: Reliability and Validation Study

BACKGROUND

As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills.

OBJECTIVE

This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers.

METHODS

The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored.

RESULTS

The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2).

CONCLUSIONS

eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/resprot.8080.

Analyzing Nursing Students' Relation to Electronic Health and Technology as Individuals and Students and in Their Future Career (the eNursEd Study): Protocol for a Longitudinal Study

Background

The nursing profession has undergone several changes in the past decades, and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, and primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective, it is of great importance that students are prepared for the new demands and needs of the patients. From a societal point of view, the society, health care included, is facing several challenges related to technological developments and digitization. Preparation for the next decade of nursing education and practice must be done, without the advantage of certainty. A training for not-yet-existing technologies where educators should not be limited by present practice paradigms is desirable. This study presents the design, method, and protocol for a study that investigates undergraduate nursing students’ internet use, knowledge about electronic health (eHealth), and attitudes to technology and how experiences of eHealth are handled during the education in a multicenter study.

Objective

The primary aim of this research project is to describe the design of a longitudinal study and a qualitative substudy consisting of the following aspects that explore students’ knowledge about and relation to technology and eHealth: (1) what pre-existing knowledge and interest of this area the nursing students have and (2) how (and if) is it present in their education, (3) how do the students perceive this knowledge in their future career role, and (4) to what extent is the education capable of managing this knowledge?

Methods

The study consists of two parts: a longitudinal study and a qualitative substudy. Students from the BSc in Nursing program from the Blekinge Institute of Technology, Karlskrona, Sweden, and from the Swedish Red Cross University College, Stockholm/Huddinge, Sweden, were included in this study.

Results

The study is ongoing. Data analysis is currently underway, and the first results are expected to be published in 2019.

Conclusions

This study presents the design of a longitudinal study and a qualitative substudy. The eHealth in Nursing Education eNursEd study will answer several important questions about nursing students’ attitudes toward and use of information and communications technology in their private life, their education, and their emerging profession. Knowledge from this study will be used to compare different nursing programs and students’ knowledge about and relation to technology and eHealth. Results will also be communicated back to nursing educators to improve the teaching of eHealth, health informatics, and technology.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14643

Assessing the eHealth literacy skills of family caregivers of medically ill elderly

Objectives

The purpose of current research is to assess the eHealth literacy level in the family caregivers of the elderly with hypertension and type-II diabetes.

Methods

A total of 160 caregivers completed the eHEALS questionnaire. The effect of participants' gender, education, and age on eHealth literacy was evaluated. For evaluation of the correlation between the accession of health information importance and the internet usefulness for decision-making, Spearman's correlation coefficient was applied.

Results

The participants eHealth literacy mean score was 26.163(SD=8.83). The age of participants had a meaningful impact on the level of eHealth literacy (t=6.074; P<0.001). Furthermore, among variant education levels in terms of eHealth literacy score significant differences existed (F=5.222; P=0.001).

Discussion

The family caregivers have a poor level of eHealth literacy. eHealth information is more important for family caregivers with a higher eHealth literacy, which may be due to their higher skills in obtaining health and medical information from the internet. Caregivers' age should be considered once recommending them for the internet using to obtain health information, as the age was an affecting factor.

Conclusion

Health centers and authorities in charge of the elderly health are recommended to train caregivers with proper skills to use online health information, such that the elderly enjoy the benefits, including improved care conditions and savings in terms of treatment costs and time.

The Reliability and Validity of the Telephone-Based and Online Polish eHealth Literacy Scale Based on Two Nationally Representative Samples

Adequate ehealth literacy is one of the key instruments safeguarding people against unreliable health-related information obtained from the Internet. This paper presents an assessment of the reliability and the validity of a Polish version of the ehealth literacy scale (Pl-eHEALS). The assessment was carried out on the basis of two nationally representative samples of the Polish population. In the first survey of adults at least 50 years old, the technique of computer-assisted telephone interviewing (CATI) was applied. In the second survey of young adult women (18-35 years old), the technique of computer-assisted web interviewing (CAWI) was used. The reliability and the validity of the Pl-eHEALS was analyzed. There were no floor or ceiling effects revealed in either sample. The Cronbach's alpha coefficients were 0.90 and 0.88, and Guttman split-half coefficients were 0.89 and 0.81, respectively. Exploratory factors analysis revealed single factor models in both cases. The sum of squared loadings in the first survey was 6.090 and accounted for 58.72% of the variance. In the second survey, the sum was 5.927 and was responsible for 55.06% of the variance. Hypothesis testing showed that, for older adults, higher ehealth literacy was prevalent in the respondents who used the Internet more frequently. Among young adult women, higher readiness to use the Internet as a primary source of health-related information and to undertake specific internet health-related activities was associated with higher ehealth literacy. The analysis reported in this paper confirmed the reliability and the validity of the instrument. It should be stressed that, prior to this study, there was no validated Polish version of the eHEALS that could be used with Polish-speaking respondents.

Electronic health-literacy skills among nursing students

BACKGROUND

The Internet has become a major source of health-related information. In order to provide better health services and health-care education to society, nurses should have acceptable electronic health (eHealth) literacy.

OBJECTIVE

The main aim was to measure eHealth-literacy skills among nursing students of Kathmandu Medical College Teaching Hospital, Nepal.

METHODS

A cross-sectional study was conducted among 152 Bachelor of Science nursing students at the hospital. Data were collected using the self-administered eHealth Literacy Scale. This is an eight-item tool that is assessed on 5-point likert scale to measure consumers' perceived skills at finding, evaluating, and applying eHealth information to health problems. Demographical and personal variables were collected to explore their relationship with eHealth literacy.

RESULTS

A total of 152 nursing students with mean age of 19.84±1.62 years participated in the study. While 44.7% perceived that they had average Internet skills, 65.1% found the Internet useful in helping them make decisions about their health. Nursing students had a moderate self-perceived level of eHealth literacy (median 3.69, IQR 0.87). Related factors included students' Internet skills, frequency of using the Internet for health related purposes, and self-perception of the usefulness and importance of the Internet.

CONCLUSION

This study represents a baseline reference for eHealth literacy among nursing students. Students have some basic necessary skills, while other skills still need to be improved. There is a need to pay attention to eHealth-literacy needs of nursing students.

Self-reported eHealth literacy skills among nursing students in Sri Lanka: A cross-sectional study

BACKGROUND

As nursing students are the future workforce in nursing, they should have the necessary skills to find, understand and apply health information available on electronic platforms into their practice.

OBJECTIVES

To assess eHealth literacy skills and associated factors among nursing students.

DESIGN

Cross-sectional survey.

SETTING

A Government School of Nursing, Sri Lanka.

PARTICIPANTS

A purposive sample of 440 nursing students.

METHOD

A self-administered questionnaire consisting of socio-demographic data, the questions related to the internet use and eHealth Literacy skills was used. In data analysis, descriptive statistics, the Mann-Whitney U test and Kruskal-Wallis H test were applied.

RESULTS

The sample consisted of 440 nursing students (420 females and 20 males). The mean eHealth literacy score was 28.02 (SD ± 4.60). Nearly half of the respondents (49.4%) reported inadequate eHealth literacy skills. The respondents reported comparatively poor skills in differentiating high-quality health resources from low-quality health resources on the internet and the ability to use information from the internet to make health decisions. The majority viewed that including information technology (IT) as a subject into the nursing curriculum was very (50.7%) or absolutely (33.6%) important. The influencing factors of eHealth literacy skills of nursing students were self-rated internet skills (P = < 0.001), perception towards using the internet in health decision making (P = 0.009) and using the internet to access health resources (P = 0.001).

CONCLUSION

Half of the nursing students have inadequate eHealth literacy skills, particularly skills in identifying trusted health resources and using this information in health decision making indicating the need for improving eHealth literacy skills among nursing students. A positive attitude towards the internet has a significant role in developing eHealth literacy skills. Improving competencies in eHealth literacy skills of nursing students is essential. Introducing these concepts into curricula, planning target interventions, and enhancing IT facilities within the educational environment are essential.

The Effect of Age on Electronic Health Literacy: Mixed-Method Study

Background

The world’s internet penetration rate is increasing yearly; approximately 25% of the world’s population are internet users. In Asia, Taiwan has the fifth highest internet usage, and has an internet penetration rate higher than the world average. Electronic health (eHealth) literacy is the ability to read, understand, and utilize Web health information. eHealth literacy is gaining attention worldwide.

Objective

This study aimed compare the differences in eHealth literacy between traditional college students (aged between 18 and 22 years) and older adult students (aged between 55 and 72 years). It also summarizes the experiences and performances of these 2 groups in terms of searching online health-related information.

Methods

A mixed-method approach was used, including questionnaire surveys and interviews. A total of 208 respondents were interviewed: 65 traditional college students (31.3%) and 143 older adult students (68.7%). The results of the interviews were used to compare the eHealth literacy scores of the 2 groups.

Results

There were significant differences in the overall eHealth literacy scores (t₂₀₇=2.98; P=.001) and the functional eHealth literacy dimension (t₂₀₇=12.17; P<.001). The findings showed a significant gap in eHealth literacy between the 2 groups. Most participants believed that online health information could be largely read and understood. However, they were skeptical about the quality of the information and noted that it consisted of either subjective judgments or objective standards.

Conclusions

Traditional college students preferred esthetically pleasing health information, whereas older adult students focused on its promotion. Furthermore, the first group often used websites for solving health problems, whereas the second group forwarded health information through communication software.

eHealth Literacy and General Interest in Using Online Health Information: A Survey Among Patients with Dental Diseases

Objectives

The aim of the study is to explore the eHealth literacy and general interest in using eHealth information among patients with dental diseases.

Methods

A total of 171 patients with dental diseases completed the survey including the eHEALS. The effect of participants' age, gender and education on eHealth literacy was assessed. Spearman’s correlation coefficient was also used to assess the correlation between the importance of access to health information and the usefulness of the internet for decision-making.

Results

The mean score of eHealth literacy in the participants was 30.55 (SD=4.069). The participants' age has significant effect on eHealth literacy level (t=3.573, P-value=0.002). Moreover, there was a significant correlation between the total score of eHealth literacy and the importance of access to eHealth information (r=0.33, n=171, P<0.s001). The difference in eHealth literacy in terms of educational background showed no statistically significant differences (F=1.179, P-value=0.322).

Discussion

The participants had a high level of eHealth literacy. Determining eHealth literacy among dental patients leads to a better understanding of their problems in health decision-making.

Conclusion

Dental institutions efforts should aim to raise awareness on online health information quality and to encourage patients to use evaluation tools, especially among low electronic health literate patients.

eHealth and adolescents in Serbia: psychometric properties of eHeals questionnaire and contributing factors to better online health literacy

Internet is important resource of health-related information and health services. Factors associated with higher level of online health (eHealth) literacy among adolescence have been understudied. The aim of this study was to assess psychometric properties of the eHealth Literacy Scale (eHEALS) in Serbian language and to evaluate eHealth literacy among adolescents in Serbia. The study was carried out in four high schools in Belgrade, Serbia in the period December 2016 to January 2017. A total of 702 students comprised the study sample. The eHEALS was translated according to internationally accepted methodology and its psychometric properties were analyzed. The Cronbach’s alpha coefficient for the entire eHEALS was 0.849. On exploratory factor analysis we obtained two-factorial structure. Our adolescents reported low confidence in knowing what health resources are available online. High confidence was observed for knowing how to use and how to find health information online. There was no difference in eHEALS score between genders or between school years. After adjustment for gender, type of school program, parental marital status, fathers’ education level and household income, being female was associated with higher eHealth literacy (B = 1.12, 95% confidence interval 0.07–2.18; p = 0.036). Serbian version of the eHEALS is a valid instrument in assessment of online health literacy and can be further used in evaluation of eHealth literacy in other population groups in Serbian language. It is advised that some classes in school are dedicated to appraisal and use of online health websites. This could be achieved through peer-education.

Associations of eHealth literacy with health-promoting behaviours among hospital nurses: A descriptive cross-sectional study

AIMS

To investigate the associations of eHealth Literacy with health-promoting behaviours among hospital nurses in South Korea.

BACKGROUND

Health-promoting behaviours of nurses are crucial for their own improved health and health-related behaviours of patients. eHealth literacy refers to the ability to search, understand and evaluate health information available online. With the growing use of the Internet, eHealth literacy is emerging as an important factor enhancing health-promoting behaviours.

DESIGN

Descriptive cross-sectional design with self-reported questionnaires.

METHODS

Data were collected between March-May 2016 from five hospitals in South Korea. Health-promoting behaviours and eHealth literacy were assessed using Health Promoting Lifestyle Profile-II and K-eHEALS, respectively. Multiple linear regression models were used to examine the associations of eHealth literacy and health-promoting behaviours.

RESULTS

Nurses with high level of eHealth literacy had significantly positive overall health-promoting behaviours, stress management, interpersonal relations, self-actualization and health responsibility, but not for nutrition and physical activity.

CONCLUSION

Improving eHealth literacy through various strategies could be an effective way to boost health-promoting behaviours among nurses. However, improvement of actual health-promoting behaviours such as nutrition and physical activity will require systematic and organizational changes.

The Korean eHealth Literacy Scale (K-eHEALS): Reliability and Validity Testing in Younger Adults Recruited Online

Background

In this digital era, eHealth literacy is an essential skill set to leverage health information available online to promote health outcomes. South Korea has an advanced health information technology infrastructure, including widespread use of the internet and mobile phones. A few studies have explored eHealth literacy in South Korea using translated versions of the eHEALS; however, they were not fully validated. A unified reliable and valid assessment tool is critical to assess and enhance the eHealth literacy level across the population.

Objective

The aim was to develop a Korean version of eHealth Literacy Scale (K-eHEALS) and evaluate its reliability and validity employing healthy young adults in Korea.

Methods

The K-eHEALS was developed based on eHEALS, a widely used tool that measures eHealth literacy, and was validated using a sample of 500 young adults recruited from a pool of a Korean internet survey panel. Content validity was assessed using the content validity index (CVI) for individual items and for scale. Construct validity was examined using exploratory factor analysis and hypothesis testing. The Cronbach alpha coefficient was used to determine the internal consistency and the Pearson correlation coefficient was used to evaluable the stability of the measure (n=55).

Results

Both individual and scale CVIs were acceptable (individual CVIs>0.67; scale CVI=0.83). Single factors accounting for 50.3% of the variance in the scales were extracted revealing the unidimensional latent structure of K-eHEALS. Hypothesis testing showed significant association between eHealth literacy and hours of internet use per day, supporting the construct validity. Items of the K-eHEALS were internally consistent (Cronbach alpha=.88) and stable over a 1-month period (r=.754, P<.001).

Conclusions

The findings of this study suggest that K-eHEALS is a valid and reliable measure of eHealth literacy in Korean young adults. Additional studies are needed with more diverse groups of adults in Korea.