Digital Pathways to Positive Health Perceptions: Does Age Moderate the Relationship Between Medical Satisfaction and Positive Health Perceptions Among Middle-Aged and Older Internet Users?

Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments

BACKGROUND

Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how.

OBJECTIVE

This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments.

METHODS

The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed.

RESULTS

A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients.

CONCLUSIONS

Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.

Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study

BACKGROUND

Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age.

OBJECTIVE

This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use.

METHODS

We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year.

RESULTS

We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters.

CONCLUSIONS

Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients.

Online health information seeking and the association with anxiety among older adults

Introduction

The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated.

Methods

To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework.

Results

We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave.

Discussion

This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.

Online Health Information Seeking: An Italian Case Study for Analyzing Citizens' Behavior and Perception

This study aims to understand people's behavior when searching for online health information (and COVID-19 information) and their perception of the trustworthiness and credibility of the searched information, the actors, and sources used to obtain it. A questionnaire addressed to people who permanently live in Italy between ages 19 and 60 has been used to collect data. Data extracted from the analysis are reassuring from the point of view of trust and credibility both in the actors and in the sources used to obtain information on health and COVID-19. A correlation between the analyzed individual features, the online health information-seeking behavior, and perception resulted from the analysis. The study also underlined a positive correlation between the perception of the influence of information on the knowledge of health problems and the ability to identify false online health information, and between the experience in detecting false health online information and the ability to detect it. Finally, a positive correlation also resulted between the experience in finding online health information and the experience in finding false COVID-19 information.

The association among eHealth literacy, depressive symptoms and health-related quality of life among older people: A cross-section study

BACKGROUND

eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health-related quality of life (HRQoL) among older persons.

METHODS

A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short-form health survey (SF-36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors.

RESULTS

The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy.

CONCLUSIONS

The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing.

Patients' health literacy and health behaviour assessment in primary health care: evidence from a cross-sectional survey

BACKGROUND

Health literacy is defined as a person's ability to find, understand, and use health-related information when making health-related decisions. Patients with lower health literacy more frequently face difficulties when they have health issues or need medical help. Such patients are less likely to visit health care facilities and receive less help, which subsequently leads to higher hospitalization and mortality rates. Patients with better health literacy skills pay more attention to their health behaviours.

METHODS

This is a cross-sectional survey conducted in two primary health care centres-one public and one private-in Lithuania. The study enrolled patients who were visiting family physicians (n = 399). The study used the Health Literacy Survey European Questionnaire (HLS-EU-Q47). Calculation of means and two independent samples were used for statistical analysis, and a correlation coefficient was calculated.

RESULTS

The majority (40.6%) of respondents had problematic health literacy, while only 7% had excellent health literacy. Better health literacy was observed among younger patients (aged below 30 years), residing in urban areas, having higher education, and living with a partner. Inadequate or problematic health literacy was noted among 83.6% of respondents aged 59 years and older; similar rates were also observed among patients with basic or primary education (76.1%), secondary education (76.6%), and divorced patients (86%). Respondents with better health literacy also had better health behaviours (p < 0.05).

CONCLUSIONS

Health literacy is influenced by age, residence, education, and family status. Patients with better health literacy also reported better health behaviours.

Research progress on digital health literacy of older adults: A scoping review

With the rapid development of digital health today, the lack of digital health literacy in older adults is an urgent problem. It is crucial that older adults adapt to the digital reform in medical treatment, pension, health management, and other fields. Therefore, we reviewed the current development status of digital health literacy among older adults. A total of 47 articles were included in this scoping review. Our findings revealed that research on digital health literacy in older adults is still in its infancy. Further development is warranted especially in terms of assessment tools and intervention methods.

The mediating and moderating effects of shared decision making and medical autonomy on improving medical service satisfaction in emergency observation units

OBJECTIVE

Distinct from other medical settings, the emergency setting is unique and requires flexible and adaptive decision making to provide quality medical services. This study was designed to investigate the mediating and moderating effects of shared decision making (SDM) and patient attitude toward medical autonomy (AMA) on improving medical service satisfaction (MSS) in emergency observation units.

METHODS

In this cross-sectional study, we collected data via a verified structured questionnaire. A total of 165 participants met the inclusion criteria, and 100% of the questionnaires recovered were valid.

RESULTS

The results show that SDM had a partial mediating effect (p < 0.01) and that it significantly improved MSS. AMA had a moderating effect on some domains (p < 0.01). Meeting patient needs and increasing their participation in decision making can effectively improve MSS. However, excessive patient participation might not be productive, which is an important finding of this study.

CONCLUSION

In emergency observation units, SDM-based doctor-patient interactions and cooperation, effective patient-centered communication, and respect for patients' medical autonomy improve the doctor-patient relationship and patients' health literacy. Patients can thus participate in selecting the best treatment plan to achieve expected health outcomes, and ultimately improve MSS.

Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey

BACKGROUND

The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.

OBJECTIVE

We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.

METHODS

Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.

RESULTS

Age (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).

CONCLUSIONS

This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.

Robust older adults in primary care: factors associated with successful aging

OBJECTIVE

To estimate the prevalence of robustness among older adults assisted in primary health care and identify factors in successful aging.

METHODS

This is a cross-sectional study conducted with older adults in Northern Minas Gerais, Brazil. Two questionnaires were used for data collection: the Brazilian Older Americans Resources and Services Multidimensional Function Assessment Questionnaire (BOMFAQ) and the Clinical-Functional Vulnerability Index IVCF-20). The adjusted prevalence ratios were obtained by robust Poisson regression. Statistical analysis was performed for older adults in general (60 to 107 years) and stratified by age: from 60 to 79 years and 80 years or more.

RESULTS

A total of 1,750 older adults aged 60 to 107 years participated; between them, 48.7% were robust. Older adults aged 60 to 79 years (n = 1,421) and 80 years or more (n = 329) had a prevalence of robustness of 55.4% and 19.3%, respectively. Some factors associated with successful aging were: positive self-perception of health, dancing habits, walking habits, absence of cognitive impairment, absence of depressive symptoms and polypathology, as well as daily life independence. After adjustment by age, the absence of polypathology and independence for activities of daily living stand out for robustness between 60 and 79 years; in those aged 80 years and over, independence for activities of daily living and dance practice presented greater strength of association.

CONCLUSION

The prevalence of robust older adults in primary care is considered satisfactory for the older population in general but decreases with age and is associated with the absence of diseases and disabilities. These results denote the need to redesign the health care system, focusing on promoting and preventing clinical-functional vulnerability.

Expansion of Parson's sick role into cyberspace: Patient information consumerism and subjective health in a representative sample of U.S. internet users

The self-help culture, in the context of the U.S. medical system, demands proactive patient behavior as more responsibility for good health falls on the patient. The presence of health/medical information online alters the dynamics of medical encounters and transforms patients into reflexive consumers or consumer-patients who are engaged in personal health management. This paper examined whether using health information obtained from the Internet to manage personal health care (referred as e-health information consumerism) is associated with subjectively reported negative health outcomes in a representative sample of Internet users in the U.S. These outcomes are conceptualized as experiencing (a) adverse affect (feeling worried and anxious) and (b) health problem due to using Internet information. An online survey (n = 710) was conducted with study participants who were recruited from the largest online probability U.S. research panel developed by a non-profit academic research firm, Knowledge Networks. Analyses included multivariate regressions that included the statistical interactions between e-health information consumerism and the communicational and interactional aspects of medical encounters. Parallel models were tested in the gender-stratified subsamples. Results indicate that robust associations exist between e-health information consumerism and patient-reported health outcomes. Respondents who indicated greater satisfaction with medical communication reported lower averages on experiencing worry and a health problem due to e-health information consumerism. While e-health information consumerism is significantly associated with experiencing a self-reported health problem in both men and women, the association with adverse affect is significant only among women. The moderating role of patient satisfaction with medical communication is stronger among women. Interestingly, the moderating role of patient satisfaction with a medical interaction is stronger among respondents who reported higher averages on experiencing a health problem due to e-health information consumerism. e-Health information consumerism can translate into health benefits if the Internet information is deployed to promote a satisfactory medical partnership.