Internet-Based Resources for Disease Self-Care Among Middle-Aged and Older Women with Chronic Conditions

The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study

BACKGROUND

During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults.

OBJECTIVE

This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness.

METHODS

This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor-Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses.

RESULTS

We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness.

CONCLUSIONS

Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice.

The preferred IT sources and tools of Iranian people for accessing health information

INTRODUCTION

People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.

METHODS

This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.

RESULTS

The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).

CONCLUSION

The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study

BACKGROUND

Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences.

OBJECTIVE

The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers' experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers' willingness to share their stories with broader audiences as a method for knowledge translation.

METHODS

This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach.

RESULTS

A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants' experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website.

CONCLUSIONS

Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention.

A randomized controlled trial of generic and localized MedlinePlus-based information resources for hard-to-reach urban Hispanic community

OBJECTIVE

To determine if the Conexion digital localized health information resource about diabetes and depression could increase patient activation among Hispanic low-income adults.

MATERIALS AND METHODS

A nonblinded randomized controlled trial was conducted (NCT03984929). Participants at least 18 years old living in Washington Heights/Inwood, New York, were recruited from the community between July 2019 and August 2020 and randomized 1:1 to either the intervention group (localization of MedlinePlus resources customized with community components) or the control group (no localized community components). The primary outcome, patient activation, and secondary outcomes, knowledge, self-efficacy, and behavior change, were collected through surveys at 1-month follow-up.

RESULTS

Of the 134 participants recruited, 50.7% (n = 68) completed the 1-month follow-up. We found no statistically significant differences in the sociodemographic and baseline characteristics between those who missed the 1-month survey and those who completed it. No significant differences were observed in patient activation at 1-month. However, patient activation among all participants (n = 68) significantly increased (P = .048). Statistically significant improvements were also found in self-efficacy (P < .03). In multivariate analysis, birth country outside the United States and higher self-rated attachment to the community emerged as significant predictors of higher patient activation scores.

DISCUSSION

While the trial did not detect significant differences between groups, all participants demonstrated increased patient activation scores and improved secondary outcomes. While other factors may have contributed to this increase, our study suggests that access to carefully selected high-quality health information materials delivered digitally in the context of a community may result in improvements comparable to localized content in a hard-to-reach urban Hispanic population.

CONCLUSIONS

Our study highlights the potential of making carefully selected digital information accessible to hard-to-reach communities.

Factors associated with internet use and health information technology use among older people with multi-morbidity in the United States: findings from the National Health Interview Survey 2018

Background

The number of older adults with physical multi-morbidity is increasing. As Internet-based eHealth and mHealth increasingly require patients to use technology, it is important to examine the use of Internet/health information technology (HIT) among older adults with physical multi-morbidity. Here we examine the distribution of physical multi-morbidity, Internet use, and HIT use, and further explored the factors associated with Internet use and HIT use among older adults with physical multi-morbidity.

Methods

One wave of data from the 2018 US National Health Interview Survey (NHIS) was analysed. We included respondents aged 65 years and older. We used 13 physical non-communicable diseases to measure physical multi-morbidity. Descriptive statistics and logistic regression models, with sociodemographic factors, health status, health insurance, health care service use, and satisfaction with health care as covariates, were used to examine the research questions.

Results

Of 72,746 respondents in NHIS, 7060 were eligible for our analysis. 5380 (76.2%) eligible respondents had physical multi-morbidity in this study. Overall, 60% of older adults reported using the Internet, with 38.9% using eHealth services (defined as looking up health information online, filling a prescription, scheduling an appointment with a health care provider, or communicating with a health care provider via email). Gender, age, marital status, region, race, education, and family income were significant factors associated with the Internet and HIT use among people with multi-morbidity. The study also showed that after adjusting for confounders, good health status, having Medicare, receiving home care from a health professional, and low satisfaction with health care were positive predictors of the Internet and HIT use.

Conclusions

In summary, our study found that Internet and HIT use among older patients with chronic diseases is far from the Healthy People 2030 target. Internet and HIT use vary depending on a number of sociodemographic factors. Relevant influencing factors should be fully considered in health education interventions promoted.

Web-Based Health Information Seeking Among African American and Hispanic Men Living With Chronic Conditions: Cross-sectional Survey Study

Background

Previous research has identified disparities in seeking and using web-based health information to inform health-related behaviors. Relatively few studies however have examined the correlations between web-based health information seeking and use based on race, gender, age, and the presence of chronic health conditions.

Objective

In this study, we identify factors associated with seeking and using web-based health information among a uniquely vulnerable and intersectional population—middle-aged and older (40 years and older) African American and Hispanic men living with one or more chronic conditions.

Methods

Survey responses were collected from a purposive sample of African American and Hispanic men using Qualtrics web-based survey management software. To qualify for inclusion in the study, respondents had to identify as African American or Hispanic men, report having at least one chronic condition, and be aged 40 years and older. A series of binary logistic regression models was created using backward elimination. Statistical significance was determined at P<.05 for all analyses.

Results

Web-based health information seeking among African American and Hispanic men is a function of education, the presence of multiple chronic conditions, frustration with health care providers, internet use, and the perceived reliability of web-based health information. The use of web-based health information to inform interactions with health care providers was more common among African American and Hispanic men, who rated their health as relatively good, perceived barriers to care, used technology regularly, and took more daily medications.

Conclusions

Understanding the factors that influence African American and Hispanic men seeking web-based health information may help improve the care and treatment of chronic conditions. African American and Hispanic men seek web-based health information as a substitute for routine care and to inform their discussions with health care providers.

Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort

BACKGROUND

Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support.

OBJECTIVE

The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet.

METHODS

We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (≥65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support.

RESULTS

Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8% (390/816) were female, and 91.1% (743/816) were non-Hispanic white. Roughly half (52.5%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95% CI 1.08-2.10) and less common among patients aged ≥85 years (aOR 0.27, 95% CI 0.15-0.48). Forty percent (40.4%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95% CI 1.10-2.61 and aOR 1.82, 95% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95% CI 1.32-2.56 and aOR 2.78, 95% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95% CI 1.26-2.46). Among mobile users, 51.8% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95% CI 1.27-2.74 and aOR 2.24, 95% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95% CI 2.62-5.86).

CONCLUSIONS

Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication.

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background

Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective

The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions.

Methods

The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years.

Results

The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users.

Conclusions

Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources.

"You can explore it more online": a qualitative study on Australian women's use of online health and medical information

BACKGROUND

Previous research has demonstrated the importance of search engines, websites, online discussion groups and social media groups for women in developed countries looking for health and medical information, but few studies have focused on Australian women. The Australian Women and Digital Health Project was designed to investigate how Australian women from a range of age groups and locations used digital health technologies across the full spectrum available to them. The findings on their use of online information and decision-making in relation to seeking face-to-face medical advice are discussed in this article.

METHODS

Qualitative research, including focus group discussions (24 participants) and face-to-face (12 participants) and telephone (30 participants) semi-structured interviews was conducted with a total of 66 Australian women aged between 21 and 74. The focus groups and interviews were transcribed and analysed using inductive thematic analysis sensitised by a feminist new materialism theoretical standpoint. This involved identifying the dimensions of affordances, relational connections, affective forces and agential capacities in the women's accounts.

RESULTS

All participants regularly used online sources to find health information, advice and support. We identified six key agential capacities relating to these ways in which the women enacted online health information seeking: 1) self-screening; 2) preparing for and following up a consultation; 3) selective engagement; 4) caring for others; 5) creating and sharing new information; and 6) challenging medical authority. The affordances of accessibility and convenience of online sources, relational connections between women and trusted sources (both online and offline) and between women and family members on whose behalf they sought information and affective forces such as trust, the need for reassurance and frustration and anger with deficient healthcare services contributed to these capacities.

CONCLUSIONS

Women engaged in complex interactions with online information, actively and creatively using it in diverse ways in their negotiations with seeking face-to-face medical expertise. Their online practices generated a set of agential capacities that help them to assess whether they or their family members need medical attention, supplement or challenge the medical advice they have already received or generate and share their own information.

Factors Associated With Interest in Worksite Health-Related Discussions/Events Among Employed Adults With Chronic Conditions

OBJECTIVE

Worksite health promotion interventions have the potential to reach half of Americans nationally, but low participation rates hinder optimal intervention effectiveness. This study examines factors associated with employee interest in worksite health-related discussions/events.

METHOD

We analyzed cross-sectional survey data from a representative sample of employed adults in California with one or more chronic conditions. An ordinal regression model was developed.

RESULTS

Employees who reported more interest in worksite health-related discussions/events had higher coworkers support, perceived greater value from learning health-related knowledge and getting practical tips from others, and reported higher interest in health discussions/events held in community settings.

CONCLUSION

Efforts are needed to enhance the culture of worksite health and encourage communication and support among workers. Practitioners should consider connecting different settings to enhance reach and accessibility, and applying multiple delivery strategies to increase employee interest and engagement.

Restricted Social Engagement among Adults Living with Chronic Conditions

Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44-64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population.

Factors Associated With Pain Frequency Among Adults With Chronic Conditions

CONTEXT

Chronic pain affects approximately 100 million Americans, but little is known about the factors associated with pain frequency.

OBJECTIVES

This article examines participants' sociodemographics, medical history, health care access and utilization, self-management barriers, and social support associated with pain frequency among a sample of middle-aged and older adults with one or more chronic condition.

METHODS

Data were from the National Council on Aging Chronic Care Survey. An ordinal regression model was fitted to examine factors associated with self-reported pain frequency.

RESULTS

Having more chronic conditions (P < 0.001), taking more medication daily (P < 0.001), and visiting the physician five or more times a year (P = 0.011) were associated with more frequent pain. Always getting the help and support needed to manage their health problems was associated with less frequent pain (P < 0.001).

CONCLUSION

More attention should be given to pain management during interactions with health care providers. Providing resources and support for disease self-management may help reduce pain frequency and self-management in middle-aged and older adults with chronic conditions.

Self-care difficulties and reliance on support among vulnerable middle-aged and older adults with chronic conditions: A cross-sectional study

OBJECTIVES

Chronic conditions are pervasive among middle-aged and older adults. This study identified: (1) factors associated with participants reporting difficulties self-managing their chronic condition(s); and (2) factors associated with participants' reliance on external sources for ongoing help and support to improve their health and manage their health conditions.

STUDY DESIGN

Cross-sectional data were collected using the National Council on Aging Chronic Care Survey, a nationally representative telephone survey of adults aged 45 years and older with at least one chronic condition.

MAIN OUTCOME MEASURES

Self-care difficulties among middle-aged and older adults with one or more chronic conditions and factors associated with reliance on ongoing help and support were examined.

RESULTS

Among 731 middle-aged and older adults with one or more chronic conditions, 31% of participants reported their health condition(s) made it difficult for them to care for themselves. Participants who were Hispanic (OR=3.08, P=0.009), had three or more chronic conditions (OR=3.05, P <0.001), took more medications daily (OR=1.07, P=0.046), and experienced certain healthcare-related frustrations (P≤0.023) were more likely to report difficulties self-managing their chronic condition(s). Participants relied on healthcare providers (40%), friends/relatives (20%), internet (9%), people with similar problems (6%), and community groups (3%) for help and support. Reliance on sources of support varied with participants' sociodemographic factors as well as healthcare and medication use.

CONCLUSIONS

Simultaneously considering patients' disease profiles, patient characteristics, difficulties managing their chronic conditions at home, and interactions with the healthcare system can inform tailored approaches and strategies to enhance patient education and resource identification, and can support service linkages.