Pediatric injury information seeking for mothers with young children: The role of health literacy and ehealth literacy

Depiction of Homemade Infant Formula and Formula Hacks on Pinterest: An Unsafe and Unhealthy Pin for Infants?

PURPOSE

To examine Pinterest pins to discern the content, messaging and claims, and engagement with pins regarding formula hacking and homemade formula.

BACKGROUND

The American Academy of Pediatrics and the Centers for Disease Control and Prevention discourage formula hacking (ie, preparing formula not according to directions to extend its use) and making homemade infant formula due to its associated health risks. Yet, caregivers are using social media platforms to find information on these topics.

METHODS

This study conducted a content analysis of Pinterest pins related to formula hacking and homemade infant formula identified from the platform in January 2023 by using 14 search terms.

RESULTS

A total of 63 pins were included in the sample. The topic of all (100.0%) pins was homemade formula. More than one-half (56.0%) of the 25 pins that provided a recipe included an unsafe ingredient, such as raw milk. The most frequently provided reasons to use homemade infant formula were in an emergency (38.2%) and when breastfeeding was not possible (38.2%). The most common claim was that homemade infant formula was healthy (59.6%). The total number of followers for the 63 pins was 861 636.

CONCLUSIONS

Pinterest is widely used by caregivers to find feeding information for their infants. Credible organizations should utilize Pinterest to disseminate safe infant feeding practices supported by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

IMPLICATIONS

The results will help nurses advocate for safe infant feeding and help them guide caregivers away from unsafe formula practices found on social media.

Exploring the interplay: Maternal electronic health literacy and its impact on early childhood development and parenting practices

BACKGROUND

Mothers need a competent electronic health literacy (eHL) skill for beneficial gains for the health of their children in the virtual environment, which is a new health platform. We predict that a competent eHL of mothers who play a central role in early childhood will positively affect the health of their children. This study aimed to determine the level of eHL of mothers of young children and investigate the relationship between mothers' eHL and early childhood development (ECD) and early parenting practices (EPP).

METHODS

This cross-sectional study was conducted on mothers with children aged 36-59 months using eHealth. Sociodemographic and personal characteristics form, Early Childhood Development Module and eHealth Literacy Scale were administered to the participating mothers.

RESULTS

The data from 440 mother-child pairs were analysed. Children of mothers with sufficient eHL levels were more likely to be Early Childhood Development Index (ECDI)-on-track, adjusted odds ratio (AOR), 95% confidence interval (CI): 2.16 (1.29-3.61); have adequate support in learning, AOR (%95 CI): 3.23 (1.69-6.18); and have adequate daily meals and snacks, AOR (%95 CI): 2.43 (1.56-3.78).

CONCLUSION

These results revealed that there is a need for interventions that will contribute to child health by improving mothers' eHL levels.

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

Bridging evidence-to-care gaps with mHealth: Designing a symptom checker for parents accessing knowledge translation resources on acute children's illnesses in a smartphone application

Background

Smartphone applications offer a novel platform for delivering health information to parents. This study created and evaluated an app-based symptom checker that recommends educational tools to parents based on their child's symptoms.

Methods

Symptoms extracted from 23 knowledge translation (KT) tools for 10 children's illnesses comprised a set of plain-language symptoms. The symptom checker works by producing confusion matrices evaluating a child's reported symptoms against possible illnesses, comparing precision scores to examine how well each illness matched reported symptoms, and ordering possible illnesses by performance score. Performance was evaluated by extracting symptoms from 8 clinical vignettes, and examining correct first-try matches.

Results

We created a final list of 54 plain-language symptoms. Visualizations of the symptom set creation process and logic mapping are presented, as well as images of the working symptom checker. The symptom checker matched 100% (8/8) of tested clinical vignettes to the appropriate illness resource.

Discussion

Symptom checkers are a potentially useful tool to integrate into apps that parents use for their children's health. The design of these systems has the potential to change parents' relationship with technology, affecting both their adoption and acceptance of symptom checkers. Our design choices contribute to addressing current barriers to the adoption of symptom checkers, reducing functional, critical, and interactive literacy requirements for parents.

A Mobile Health Information Behavior Model: Theoretical Development and Mixed-Method Testing in the Context of Mobile Apps on Child Poisoning Prevention

While several studies have explored the use of mobile health applications, few have observed determinants of mobile health information behavior. To develop a model explaining parents' mobile information behavior on child poisoning prevention, we first explored relevant theories to suggest a theoretical model. In that, we combine existing models on risk and health information seeking, such as the Planned Risk Information Seeking Model, with models on the acceptance of mobile technologies, such as the Unified Theory of Acceptance and Use of Technologies. Thereafter, we employed a sequential mixed-method design with an initial qualitative study (four online focus groups with n = 25 parents in total) and a standardized online survey of n = 1,013 parents to evaluate our research model. Results confirm that both, determinants of information seeking and determinants of technology acceptance, contribute to the explanation of mobile information behavior. App use intention was mainly related to the performance expectancy of app use, the subjective information norm, and social influence on app use. To increase the usage of prevention apps and contribute to the reduction of child injuries, communication on poisoning apps should address subdimensions of the performance expectancy, such as their utility and peoples' trust in app providers. Moreover, physicians are important multipliers for these messages.

Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review

BACKGROUND

Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development.

OBJECTIVE

This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles.

METHODS

In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app's architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps.

CONCLUSIONS

The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies.

Childhood environmental harshness and unpredictability negatively predict eHealth literacy through fast life-history strategy

Background

eHealth literacy-the ability to obtain, understand, evaluate, and use health information from the Internet-is important to maintaining and improving personal health. Prior research found that people differ notably in the levels of eHealth literacy, and this study tests a theoretical account of some of those individual differences. Drawing on life history theory, we propose that low eHealth literacy is partly the outcome of people adopting a resource-allocation strategy emphasizing early and fast reproduction, namely, a fast life-history strategy.

Methods

We conducted a cross-sectional survey study (N = 1,036) that measured Chinese adult respondents' eHealth literacy, childhood environmental harshness and unpredictability, and fast life-history strategy. Covariates included health-information seeking online, self-rated health, sex, age, education level, and monthly income.

Results

Supporting a life-history explanation of eHealth literacy, childhood environmental harshness and unpredictability negatively predicted eHealth literacy through fast life-history strategy and mainly the insight-planning-control dimension of it. Harshness, not unpredictability, also directly and negatively predicted eHealth literacy after fast life-history strategy was controlled for.

Conclusion

Our findings suggest that the psychological mechanisms associated with human life-history strategies produce at least some of the individual differences in levels of eHealth literacy, including those related to neuroticism, socioeconomic status, self-rated health and social capital. Thus, a possible way to increase future generation's eHealth literacy and thereby their health is to reduce the harshness and unpredictability of the environment in which they grow up, thereby making them more likely to adopt a relatively slow life-history in their adulthood.

Social Media and Black Maternal Health: The Role of Health Literacy and eHealth Literacy

BACKGROUND

Black women experience greater maternal mortality and morbidity than White women. Although there are many causes of this disparity, providing more and better maternal health information to this population may be beneficial. Social media offers a way to easily and quickly disseminate information to empower and educate Black women about health during pregnancy.

OBJECTIVE

This study sought to identify social media use patterns to determine what sources Black women used to obtain information about pregnancy and to explore whether health literacy/eHealth literacy influence those patterns.

METHODS

This cross-sectional, nationally representative survey panel included 404 Black women. Health literacy was measured by the Single Item Literacy Screener, and eHEALS was used to measure eHealth literacy. We examined participants' social media activity, social media use, social media use for support, and sharing of pregnancy-related health information. Relationships between health literacy, eHealth literacy, and social media use were assessed.

KEY RESULTS

Overall, 67.5% of participants had high health literacy, and the average eHealth literacy score was high (34.5). Most women (71.6%) reported using more than three social media accounts as a source for pregnancy information. Women with low health literacy searched social media for general and specific pregnancy health information, reported more social media use during pregnancy in general (p < .001), and more use of social media for giving and getting support (p = .003). Women with higher eHealth literacy were more likely to report more social media use (r = 0.107, p = .039) and often used social media to give and get support (r = 0.197, p = .0001). Women with high health literacy more often reported sharing the pregnancy information they found on social media with their nurse (χ² = 7.068, p = .029), doula (χ² = 6.878, p = .032), and childbirth educator (χ² = 10.289, p = .006). Women who reported higher eHealth literacy also reported more often sharing the pregnancy information they found on social media with their doctor (r = 0.115, p = .030), nurse (r = 0.139, p = .001), coworkers (r = 0.160, p = .004), and family or friends (r = 0.201, p = .0001).

CONCLUSION

Substantial numbers of Black women use social media to find pregnancy health information. Future studies should elicit more detailed information on why and how Black women use social media to obtain pregnancy information and support as well as what role health literacy and eHealth literacy may have on birth outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(3):e119-e129.].

How paediatricians communicate with parents who access online health information

AIMS

Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor-parent relationship.

METHODS

This qualitative study was conducted utilising semi-structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line-by-line coding.

RESULTS

Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information; paediatricians' communication approaches; and the perceived impact on the doctor-parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet-informed parents, a few changed their management plans and a few reported discouraging parents from further searching online.

CONCLUSIONS

Our results indicate that paediatricians predominantly used patient-centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision-making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet-informed parents and stimulate research about more effective doctor-parent communication approaches. In a digital age, paediatricians may benefit from employing more time-efficient approaches to manage increasing workloads with their new role of digital stewardship of parents.

Effective communication with caregivers to prevent unintentional injuries in children under seven years. A systematic review

OBJECTIVE

This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries.

METHODS

Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs.

RESULTS

Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective.

CONCLUSION

The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies.

PRACTICE IMPLICATIONS

Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.

Profile of the Users and the Most Visited Topics of a Pediatric eHealth Website

Parents need information about their children's health, and the Internet has become an essential repository for this information. However, there is almost no information about which topics are the most searched, consulted, or shared, or about the main characteristics of pediatric website users. The main aim of this research was to describe the profile of the users of a pediatric website, which topics they searched for, which topics were the most consulted, and which were the most shared. Users' demographic data were analyzed regarding their use of the Internet to search for information about health. A pediatric website for parents was analyzed. A 26-item questionnaire collected demographical features of the users of the website. Descriptive and analytical analyses were performed. Most participants used general search engines for their health searches, and the most searched keywords were prurigo, barking cough, and laryngitis. The most visited topics were unexplained fever, snots, and laryngitis. The most shared were snots, lipotomy, and dizziness. The users were mainly women (67.8%), with an average age of 38.8 years, and one or two children (89%) with a mean age of 4.6 years. The users who mainly used the Internet for health purposes were women of younger age, and with a higher educational level.

Influence of education and residence on the parental search for pediatric surgical information on the internet

BACKGROUND

The internet is a valuable tool for access to health-related information. There is limited literature regarding its use by parents of children with surgical conditions.

AIM

To investigate internet usage by parents seeking information about the surgical conditions of their offspring in relation to epidemiological factors such as family residential area and parental educational level and to subsequently review the literature regarding this topic.

METHODS

An anonymous questionnaire about internet usage was completed by eligible parents of children who were admitted to our clinic for minor surgical procedures during a six-month period.

RESULTS

Our results demonstrated that the internet has been mostly used by mothers for children’s health information. Google was the most commonly used search engine, while pediatricians were the first parental choice for ‘live’ information. Only one-quarter of the parents informed their doctor about the information found online. Nine of ten parents had a positive opinion of an official website managed by the doctors of our clinic. Our results mostly agreed with the international literature.

CONCLUSION

In conclusion, the establishment of official websites (designed and managed by specialists) that parents can access to receive appropriate health information is mandatory in the internet era.

A Year of Child Injury Prevention on Instagram

Injury is the leading cause of death for children but little is known about what types of injury prevention messages are communicated on Instagram. Conducted in the United States, the aim of this study was to better understand child injury prevention messages on Instagram to develop recommendations for the future. Informed by Social Cognitive Theory, a quantitative content analysis was conducted on all Instagram posts from selected organizations from May 2018 through April 2019. Of the 818 injury prevention posts, almost all included an image (575, 70%) or video (211, 26%). Of the 575 images, 245 (42.46%) had in image that did not match the topic of the post. Regarding injury prevention recommendations, 579 posts (71%) provided a clear action that parents should take. For these posts, 115 (20%) had an image that communicated the desired safety recommendation, but many more (285, 50%) did not; in 23 cases it was not clear if there was a match or not. There are missed opportunities for child health and injury organizations to reach parents and caregivers through Instagram. Posts made during the study period often lacked specificity about action-oriented measures and failed to utilize images that demonstrated the recommended practices. Organizations posting on Instagram and other social media platforms should provide clear action tips and utilize images that depict child injury prevention recommendations.

Shopping online for children: Is safety a consideration?

INTRODUCTION

There has been a significant increase in online purchasing and product safety problems have been identified in e-commerce. This study examines consumer behavior and safety perceptions among parents purchasing child products online.

METHOD

A mixed methods approach, including focus groups and a survey with parents, identified key characteristics and behaviors. Cluster analysis was used to determine different population segments (including "Informed," "Uninformed," and "Infrequent" consumer groups) based on their frequency of online shopping and search for product information. "Safe" and "Unsafe" behavior groups were identified related to their search for safety information on child products. Logistic regression analysis was used to study the effects of consumer type groups and demographic variables on the chances of being a safer consumer.

RESULTS

Findings indicate that child product safety considerations are not a priority for parents when shopping online. Only 62% of the survey respondents indicated that they search for information prior to buying a child product online, of which only 13% of the respondents noted that they search for information on product safety. Risky consumer behaviors were identified including the purchase of imitation products (counterfeit or knockoff products) and autonomous checks for product safety in lieu of safety standards. The logistic regression analysis found that being an "Uninformed Consumer" increases the odds of an individual being an "Unsafe Consumer" by 8.4 times (χ²(11) = 97.33, p < .001). Practical Applications: Design of a social marketing campaign that targets these different population segments to change perceptions and promote safe online purchasing is recommended.

When Social Media Images and Messages Don't Match: Attention to Text versus Imagery to Effectively Convey Safety Information on Social Media

Health organizations can use visuals that support observational learning in social media. The social cognitive theory construct of observational learning illustrates how social media messages can inform health-related behavior change. In a within-subjects design, parents (n = 150) were exposed to real-world social media posts where safety recommendation text and imagery was matched (n = 3) or unmatched (n = 3). Safety topics were relevant to children age seven and younger: infant sleep, poisoning prevention, and bicycling safety. Eye tracking software captured visual attention (in milliseconds) on visual imagery and a post-experiment survey recorded correct answers to safety recommendations. Analyses examined the relationship between the match between text and imagery and visual attention. Participants spent more time on the matched image posts compared to mismatched image posts (5.3 versus 3.3 seconds; p < .001). After accounting for frequency of social media use and health literacy, each second of viewing time on the matched posts was associated with a 2.8% increase in the correct response safety information knowledge score (p < .001). Matched text and visuals on social media posts attracted significantly higher visual attention and improved safety knowledge.

Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Periodic Information-seeking Behaviors of First-time Mothers in China

First-time mothers have a unique and varied set of information needs, but at present, these needs are seldom adequately addressed by libraries in China. As a first step in making libraries more helpful to this group, this study reports the results of a series of interviews aimed at understanding new mothers’ current information seeking behaviors. Thirty-seven first-time mothers (children from first year of birth to six years of age) took part in semi-structured in-depth interviews, answering questions about their information demand, information source selection (and factors influencing this selection), and obstacles encountered in the process of information search. It was found that first-time mothers’ information-seeking behavior varies from stage to stage, e. g. between pregnancy and the immediate postpartum period. Internet search plays an important role because of its perceived convenience and accessibility, but trust is the key factor during the process of information selection, regardless of source. Overall, the mothers we interviewed seldom use the library. This paper puts forward some suggestions to remedy that situation: libraries might consider opening a first-time-mothers reading room, increasing cooperative promotions with other institutions, providing diversified service projects, and organizing reading-promotion activities for first-time mothers at different stages. If implemented, these suggestions promise to help mothers navigate the transitions of pregnancy, childbirth, and childcare.

Factors Influencing eHealth Literacy of Middle School Students in Korea: A Descriptive Cross-Sectional Study

Objectives

The aim of this study is to identify eHealth literacy level and to analyze the factors influencing eHealth literacy among middle school students in Korea.

Methods

This descriptive cross-sectional study involved the administration of a self-report questionnaire. The participants were 799 middle school students. Descriptive statistics were analyzed via an independent t-test, Mann-Whitney U-test, and one-way ANOVA. Pearson correlation coefficients were used to test the correlations among variables. Multiple linear regression analysis was conducted to identify the factors influencing eHealth literacy.

Results

eHealth literacy was substantially lower in students in their first year than in students in their third year of middle school. Participants with asthma, herniated disc, and atopic dermatitis had significantly lower eHealth literacy than those without the diseases. The major finding was that eHealth literacy of middle school students was influenced by their grade and number of diseases diagnosed. eHealth literacy was higher among students in their second and third years of middle school and among those who had fewer diagnosed diseases.

Conclusions

eHealth literacy among adolescents is important for better health outcomes; however, middle school students with diseases had lower eHealth literacy than healthy students. Therefore, efforts to enhance eHealth literacy should focus on adolescents with diseases; moreover, health education in schools and healthcare settings for adolescents should include critical analytical skill development for better eHealth literacy.

eHealth literacy research-Quo vadis?

The concept of electronic health (eHealth) literacy evolved from the social and information sciences and describes competencies necessary to use electronic health services. As it is a rather new topic, and as there is no current overview of the state of the art in research, it is not possible to identify research gaps. Therefore, the objective of this viewpoint article is to increase knowledge on the current state of the art of research in eHealth literacy and to identify gaps in scientific research which should be focused on by the research community in the future. The article provides a current viewpoint of the concept of eHealth literacy and related research. Gaps can be found in terms of a missing "gold standard" regarding both the definition and the measurement of eHealth literacy. Furthermore, there is a need for identifying the implications on eHealth developers, which evolve from the measurement of eHealth literacy in eHealth users. Finally, a stronger inclusion of health professionals, both in the evolving concept and in the measurement of eHealth literacy, is needed in the future.

Internet use, eHealth literacy and attitudes toward computer/internet among people with schizophrenia spectrum disorders: a cross-sectional study in two distant European regions

BACKGROUND

Individuals with schizophrenia spectrum disorders use the Internet for general and health-related purposes. Their ability to find, understand, and apply the health information they acquire online in order to make appropriate health decisions - known as eHealth literacy - has never been investigated. The European agenda strives to limit health inequalities and enhance mental health literacy. Nevertheless, each European member state varies in levels of Internet use and online health information-seeking. This study aimed to examine computer/Internet use for general and health-related purposes, eHealth literacy, and attitudes toward computer/Internet among adults with schizophrenia spectrum disorders from two distant European regions.

METHODS

Data were collected from mental health services of psychiatric clinics in Finland (FI) and Greece (GR). A total of 229 patients (FI = 128, GR = 101) participated in the questionnaire survey. The data analysis included evaluation of frequencies and group comparisons with multiple linear and logistic regression models.

RESULTS

The majority of Finnish participants were current Internet users (FI = 111, 87%, vs. GR = 33, 33%, P < .0001), while the majority of Greek participants had never used computers/Internet, mostly due to their perception that they do not need it. In both countries, more than half of Internet users used the Internet for health-related purposes (FI = 61, 55%, vs. GR = 20, 61%). The eHealth literacy of Internet users (previous and current Internet users) was found significantly higher in the Finnish group (FI: Mean = 27.05, SD 5.36; GR: Mean = 23.15, SD = 7.23, P < .0001) upon comparison with their Greek counterparts. For current Internet users, Internet use patterns were significantly different between country groups. When adjusting for gender, age, education and disease duration, country was a significant predictor of frequency of Internet use, eHealth literacy and Interest. The Finnish group of Internet users scored higher in eHealth literacy, while the Greek group of never Internet users had a higher Interest in computer/Internet.

CONCLUSIONS

eHealth literacy is either moderate (Finnish group) or low (Greek group). Thus, exposure to ICT and eHealth skills training are needed for this population. Recommendations to improve the eHealth literacy and access to health information among these individuals are provided.