Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality

Electronic Health Literacy Among Baby Boomers: A Typology

BACKGROUND

Forecasts suggest that older adults will place unprecedented demands on future health care systems. Electronic health (eHealth) resources can potentially mitigate some pressures, but to be effective patients need to be able to use them. The negative relationship between eHealth literacy and age usually results in older adults classified as one homogenous mass, which misses the opportunity to tailor interventions.

OBJECTIVE

This research examines similarities and differences within the baby boom cohort among a sample that uses the internet for health information.

METHODS

We used an electronic survey with random samples of baby boomers (N = 996) from the United States, the United Kingdom, and New Zealand.

KEY RESULTS

Four distinct subgroups, or segments, emerged. While not different from a socioeconomic perspective, these four groups have very different levels of eHealth literacy and corresponding health behaviors. Therefore, we contribute a more complex picture than is usually presented in eHealth studies.

CONCLUSIONS

Resulting insights offer a useful starting point for providers wishing to better tailor health products, services, and communications to this large cohort of future older individuals. [HLRP: Health Literacy Research and Practice. 2024;8(1):e3-e11.].

Structural Validation and Measurement Invariance Testing of the Chinese Version of the eHealth Literacy Scale Among Undergraduates: Cross-Sectional Study

BACKGROUND

The eHealth Literacy Scale (eHEALS) was introduced in China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention, although its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multigroup measurement properties.

OBJECTIVE

This study aimed to evaluate the Chinese version of the eHEALS in terms of its measurement properties.

METHODS

A cross-sectional survey was conducted in a university setting in China. Item statistics were checked for response distributions and floor and ceiling effects. Internal consistency reliability was confirmed with Cronbach α, split-half reliability, Cronbach α if an item was deleted, and item-total correlation. A total of 5 representative eHEALS factor structures were examined and contrasted using confirmatory factor analysis. The study used the item-level content validity index (I-CVI) and the average of the I-CVI scores of all items on the scale to assess the content validity of the dominance model. Furthermore, the validated dominance model was subsequently used to evaluate the relevance and representation of elements in the instrument and to assess measurement invariance across genders.

RESULTS

A total of 972 respondents were identified, with a Cronbach α of .92, split-half reliability of 0.88, and item-total score correlation coefficients ranging from 0.715 to 0.781. Cronbach α if an item was deleted showed that all items should be retained. Acceptable content validity was supported by I-CVIs ≥0.80. The confirmatory factor analysis confirmed that the 3-factor model was acceptable. The measurement model met all relevant fit indices: average variance extracted from 0.663 to 0.680, composite reliability from 0.810 to 0.857, chi-square divided by the df of 4.768, root mean square error of approximation of 0.062, standardized root mean squared residual of 0.020, comparative fit index (CFI) of 0.987, and Tucker-Lewis index of 0.979. In addition, the scale demonstrated error variance invariance (Δnormed fit index=-0.016, Δincremental fit index=-0.012, ΔTucker-Lewis index=0.005, Δcomparative fit index=-0.012, Δrelative fit index=0.005, and Δroot mean square error of approximation=0.005).

CONCLUSIONS

A 3-factor model of the Chinese version of the eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender.

eHealth literacy among hospital health care providers: a systematic review

BACKGROUND

eHealth literacy is a key concept in the implementation of eHealth resources. However, most eHealth literacy definitions and frameworks are designed from the perceptive of the individual receiving eHealth care, which do not include health care providers' eHealth literacy or acceptance of delivering eHealth resources.

AIMS

To identify existing research on eHealth literacy domains and measurements and identify eHealth literacy scores and associated factors among hospital health care providers.

METHODS

This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. A systematic literature search was conducted in MEDLINE, Cinahl, Embase, Scopus, PEDro, AMED and Web of Science. Quantitative studies assessing eHealth literacy with original research, targeting hospital health care providers were included. Three eHealth literacy domains based on the eHealth literacy framework were defined a priori; (1) Individual eHealth literacy, (2) Interaction with the eHealth system, and (3) Access to the system. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data.

RESULTS

Fourteen publications, of which twelve publications were conducted in non-Western countries, were included. In total, 3,666 health care providers within eleven different professions were included, with nurses being the largest group. Nine of the included studies used the eHealth literacy scale (eHEALS) to measure eHealth literacy, representing the domain of individual eHealth literacy. A minority of the studies covered domains such as interaction with the eHealth system and access to the system. The mean eHEALS score in the studies ranged from 27.8 to 31.7 (8-40), indicating a higher eHealth literacy. One study reported desirable eHealth literacy based on the Digital Health Literacy Instrument. Another study reported a relatively high score on the Staff eHealth literacy questionnaire. eHealth literacy was associated with socio-demographic factors, experience of technology, health behaviour and work-related factors.

CONCLUSIONS

Health care providers have good individual eHealth literacy. However, more research is needed on the eHealth literacy domains dependent on interaction with the eHealth system and access to the system. Furthermore, most studies were conducted in Eastern and Central-Africa, and more research is thus needed in a Western context.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews (CRD42022363039).

The relationship between eHealth literacy and palliative care knowledge, attitudes, and practice among nurses: a cross-sectional study

BACKGROUND

The crucial role that nurses play in offering palliative care to patients with life-threatening diseases is widely acknowledged, but the correlation between their eHealth literacy and their knowledge, attitudes, and practice in this domain has yet to be investigated. This study is conducted to investigate the status of eHealth literacy and knowledge, attitudes, and practice regarding palliative care among nurses, and to examine their relationship.

METHODS

A cross-sectional study design was conducted among 546 nurses selected from the first-class tertiary hospitals located both inside and outside of Zhejiang Province between May 12 and May 20, 2022. The online survey of eHealth literacy scale (eHEALS) and scale of knowledge, attitudes, and practice (KAP) regarding palliative care was performed using snowball sampling through the WeChat mini program "Questionnaire Star". The Spearman rank correlation and binary logistic regression model were used to analyze the independent association between eHealth literacy and KAP toward palliative care.

RESULTS

The median scores of eHEALS and KAP regarding palliative care were 32 (interquartile range[IQR] 29 to 38) and 82 (IQR 54 to 106) points. The results of correlation analysis showed that the KAP regarding palliative care was significantly correlated with eHEALS (rho = 0.189, P < 0.001). In addition, the results of binary logistic regression analysis demonstrated that the eHEALS score was independently associated with the KAP score regarding palliative care when controlling for sociodemographic factors (OR = 2.109; P < 0.001).

CONCLUSION

Nurses who worked in first-class tertiary hospitals have good levels of eHealth literacy, while the overall level of KAP regarding palliative care is moderate. Our findings highlight that the eHEALS score is independently associated with the KAP score regarding palliative care. Therefore, nursing managers should adopt multiple measures to comprehensively improve eHealth literacy among nurses, further enrich their knowledge of palliative care, promote a positive transformation of attitudes towards palliative care, and efficiently implement palliative care practice, in order to promote high-quality development of palliative care.

Sentiment Analysis on Twitter: Role of Healthcare Professionals in the Global Conversation during the AstraZeneca Vaccine Suspension

The vaccines against COVID-19 arrived in Spain at the end of 2020 along with vaccination campaigns which were not free of controversy. The debate was fueled by the adverse effects following the administration of the AstraZeneca-Oxford (AZ) vaccine in some European countries, eventually leading to its temporary suspension as a precautionary measure. In the present study, we analyze the healthcare professionals' conversations, sentiment, polarity, and intensity on social media during two periods in 2021: the one closest to the suspension of the AZ vaccine and the same time frame 30 days later. We also analyzed whether there were differences between Spain and the rest of the world. Results: The negative sentiment ratio was higher (U = 87; p = 0.048) in Spain in March (Med = 0.396), as well as the daily intensity (U = 86; p = 0.044; Med = 0.440). The opposite happened with polarity (U = 86; p = 0.044), which was higher in the rest of the world (Med = -0.264). Conclusions: There was a general increase in messages and interactions between March and April. In Spain, there was a higher incidence of negative messages and intensity compared to the rest of the world during the March period that disappeared in April. Finally, it was found that the dissemination of messages linked to negative emotions towards vaccines against COVID-19 from healthcare professionals contributed to a negative approach to primary prevention campaigns in the middle of the pandemic.

Professional Competence and Its Effect on the Implementation of Healthcare 4.0 Technologies: Scoping Review and Future Research Directions

BACKGROUND

The implementation of Healthcare 4.0 technologies faces a number of barriers that have been increasingly discussed in the literature. One of the barriers presented is the lack of professionals trained in the required competencies. Such competencies can be technical, methodological, social, and personal, contributing to healthcare professionals managing and adapting to technological changes. This study aims to analyse the previous research related to the competence requirements when adopting Healthcare 4.0 technologies.

METHODS

To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the most important databases and retrieved 4976 (2011-present) publications from all the databases. After removing duplicates and performing further screening processes, we ended up with 121 articles, from which 51 were selected following an in-depth analysis to compose the final publication portfolio.

RESULTS

Our results show that the competence requirements for adopting Healthcare 4.0 are widely discussed in non-clinical implementations of Industry 4.0 (I4.0) applications. Based on the citation frequency and overall relevance score, the competence requirement for adopting applications of the Internet of Things (IoT) along with technical competence is a prominent contributor to the literature.

CONCLUSIONS

Healthcare organisations are in a technological transition stage and widely incorporate various technologies. Organisations seem to prioritise technologies for 'sensing' and 'communication' applications. The requirements for competence to handle the technologies used for 'processing' and 'actuation' are not prevalent in the literature portfolio.

Health Literacy and Critical Lecture as Key Elements to Detect and Reply to Nutrition Misinformation on Social Media: Analysis between Spanish Healthcare Professionals

Health misinformation about nutrition and other health aspects on social media is a current public health concern. Healthcare professionals play an essential role in efforts to detect and correct it. The present study focuses on analyzing the use of competencies associated with training in methodology, health literacy, and critical lecture in order to detect sources of health misinformation that use scientific articles to support their false information. A qualitative study was conducted between 15 and 30 January 2022, wherein the participants were recruited from active users from a nutrition conversation on Twitter, diets, and cancer and defined themselves as healthcare professionals. This study demonstrates that health literacy and critical lecture competencies allow for the detection of more misinformation messages and are associated with a high rate of responses to users that spread the misinformation messages. Finally, this study proposes the necessity of developing actions to improve health literacy and critical lecture competencies between healthcare professionals. However, in order to achieve this, health authorities must develop strategies to psychologically support those healthcare professionals faced with bullying as a result of their activity on social media debunking health hoaxes.

Factor Structure of the eHEALS

Abstract. The dimensionality of the eHEALS has been the subject of some controversy. Sample populations and language versions vary widely, as do the employed statistical methods to assess dimensionality. In previous research, we assessed the factor structure in two different samples testing 1 vs. 2 and 1 vs. 2 vs. 3 correlated factors. The objective of this reanalysis was to assess whether the 3-factor model fitted better than the 2- and 1-factor models. We analyzed data from a 2009 cross-sectional survey on health literacy in grade 12 ( n = 327) using CFA. All factor models of the eHEALS showed unsatisfactory model fit. A subsequent exploratory bifactor analysis confirmed multidimensionality and indicated that Item 2 was problematic. When this item was excluded from the correlated factor models, model fit improved, and the 3-factor model showed the best fit. The results in our sample of 12th-grade students offer some support to the German eHEALS having a 3-factor structure similar to the results from our previous research in women aged 50. The replicability of the fit pattern in a different sample and setting was limited by diverging results on Item 2.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

The relationship between e-health literacy and health-promoting behaviors of Turkish hospital nurses

The increase in information technologies has made it easy to access much health information online. In this context, e-health literacy emerges as a skill for acquiring health information. Obtaining health information through information technology for health promotion requires e-health literacy. The aim of this study was to examine the e-health literacy and the health-promoting behaviors of Turkish hospital nurses directly involved in patient care. This descriptive and cross-sectional study was carried out with 451 nurses working in two large training and research hospitals in Izmir between June and August 2019. Data were collected using the Turkish version of the Healthy Lifestyle Behavior Scale II and the Turkish version of the e-Health Literacy Scale. Descriptive statistics and multiple linear regression analysis were used for data analysis. Nurses were found to have moderate levels of healthy lifestyle behaviors (130.56 ± 21.90) and e-health literacy (29.87 ± 5.39). There was significant relationship between the e-health literacy levels of the nurses and their overall health-promoting behaviors (R = .349; F = 12,381; p = 0.013), health responsibility (R = .326; F = 10,567; p = 0.014), spiritual development (R = .242; F = 5.276; p = 0.001) and interpersonal relations (R = .343; F = 9.896; p = 0.001) scores. The results of this study showed that the development of strategies to improve the e-health literacy of nurses may contribute to the maintenance of health-promoting behaviors of both nurses and their patients.

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.

Assessing eHealth literacy among internet users in Lebanon: A cross-sectional study

Objective

Assessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics.

Methods

A cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS’ psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS.

Results

A total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information.

Conclusions

Future internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.

eHealth Literacy Instruments: Systematic Review of Measurement Properties

Background

The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies.

Objective

This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument.

Methods

We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology.

Results

This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated.

Conclusions

The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence.

The Role of Health Literacy among Outpatient Caregivers during the COVID-19 Pandemic

Health literacy became an important competence during the COVID-19 pandemic. Despite outpatient caregivers being a particularly vulnerable occupational group, their health literacy has hardly been examined yet, especially during the pandemic. Hence, this study aimed to explore this field and provide first empirical insights. Data were collected based on a cross-sectional online survey among 155 outpatient caregivers. In particular, health literacy (HLS-EU-Q16), diet and physical activity, pandemic-related worries, perceived information sufficiency and stress perception were examined. Descriptive and ordinal logistic regression analyses were run to test explorative assumptions. The majority of outpatient caregivers reported high values of health literacy (69% on a sufficient level). Although no significant associations between health literacy and health behaviours or perceived information sufficiency were found, perceived information sufficiency and perceived stress (OR = 3.194; 95% CI: 1.542-6.614), and pandemic-related worries (OR = 3.073; 95% CI: 1.471-6.421; OR = 4.243; 95% CI: 2.027-8.884) seem to be related. Therefore, dissemination of reliable information and resource-building measures to reduce worries may be important parameters for improving outpatient caregivers' health. Our results provide first explorative insights, representing a starting point for further research. Considering outpatient caregivers' mobile work setting, they need to be provided with adequate equipment and comprehensible information to ensure physically and mentally healthy working conditions.

US Physicians' and Nurses' Motivations, Barriers, and Recommendations for Correcting Health Misinformation on Social Media: Qualitative Interview Study

BACKGROUND

Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media.

OBJECTIVE

This study aims to identify US physicians' and nurses' motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers.

METHODS

In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis.

RESULTS

Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence.

CONCLUSIONS

US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation.