Relationships of Contextual and Relational Factors to Health Empowerment in Women

Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study

BACKGROUND

Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research.

OBJECTIVE

First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health.

METHODS

The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results.

RESULTS

When compared with previous generations, Generation Z respondents (995/1862, 53.44%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: β=.192, P<.001; older population: β=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: β=.070, P=.002; older population: β=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall.

CONCLUSIONS

This study examined and compared the health information-seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors.

Designing a library of lived experience for mental health (LoLEM): protocol for integrating a realist synthesis and experience based codesign approach

INTRODUCTION

People with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be 'living books', sharing their experiences in dialogue with 'readers' who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts.

METHODS AND ANALYSIS

We will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries' impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream 1.

ETHICS AND DISSEMINATION

Ethical approval was granted by Coventry and Warwick National Health Service Research Ethics Committee on 29 December 2021 (reference number 305975). The programme theory and implementation guide will be published as open access and shared widely through a knowledge exchange event, a study website, mental health provider and peer support networks, peer reviewed journals and a funders report.

PROSPERO REGISTRATION DETAILS

CRD42022312789.

Causal Model of Psychological Empowerment Among People With Spinal Cord Injury in Thailand

The purpose of this study was to develop and evaluate a causal model illustrating the relationships of age, education, physical impairment duration, social support, functional ability, and self-esteem with psychological empowerment in persons with spinal cord injury. Participants were 260 individuals admitted to a hospital in Thailand. Data were analyzed using path analysis (with the maximum likelihood estimation technique) in Linear Structural Relationship (LISREL). The study results revealed that age and education did not significantly influence psychological empowerment. However, self-esteem had a direct effect on psychological empowerment, whereas physical impairment duration, functional ability, and social support had indirect effects through self-esteem. These four predictors explained 64% of the total variance in this model of psychological empowerment for people with spinal cord injury. These findings can be used as a guideline for developing appropriate interventions to promote psychological empowerment among Thais with spinal cord injury.

A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study

Background

Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW.

Objective

This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability.

Methods

The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES).

Results

YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text.

Conclusions

We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW.

Psychometric Properties of the Health Empowerment Scale Arabic Version for Working Women in Saudi Arabia

In a country such as Saudi Arabia where gender equality-related challenges continue to be social issues, measuring the health empowerment of Saudi working women is critical in understanding the real picture of women empowerment in the country during this era of great transformation. Therefore, we conducted this research to evaluate psychometric properties of the Health Empowerment Scale Arabic version (HES-A) in measuring the health empowerment of Saudi working women. We surveyed a sample of 322 Saudi working women from June to August 2020 using an online survey constituting questions on demographic and work-related information and the HES-A. The computed values for the item-level content validity index of the 8 scale items were from .80 and 1.00, whereas the computed value of the scale-level content validity index by average method was .91. The principal component and confirmatory factor analyses revealed a unidimentional scale. The computation revealed an alpha of .92. Education, type of employment, years of working experience, and salary were identified as significant factors influencing the health empowerment. The HES-A exhibited adequate validity and internal consistency for use in measuring the health empowerment of Saudi women. The HES-A can expand the research agenda on health empowerment Arab women. Researchers and policymakers could use the HES-A in assessing the status of health empowerment of Arabic-speaking women, which could inform policies and interventions aimed at ensuring health empowered women in this part of the globe.

Fostering older adult care experiences to maximize well-being outcomes

Purpose

Caring for older adults is an increasingly complex and multi-dimensional global concern. This article provides a comprehensive definition of the older adult care experience and discusses its key components to help practitioners deliver older adult-centered care to maximize well-being outcomes for older adults.

Design/methodology/approach

Based on prior research on service operations, service experience, person-centered care and the unique, evolving needs of older adults regarding their care, this paper develops a conceptual framework in which the older adult care experience is the central construct, and key dimensions of well-being are the outcomes.

Findings

The older adult care experience is shaped by older adults' perceptions and evaluations of the care that they receive. Older adult-centered care has autonomy, dignity, unique needs and social environment as its core dimensions and results in those older adults feel empowered, respected, engaged and connected as part of their experience. The article also discusses how such experience can be evaluated by using quality dimensions from service operations, hospitality and healthcare contexts, and challenges that service firms may face in creating older adult care experience.

Research limitations/implications

Given the changing demographics and unique needs of older adults, it is an imperative for academics and practitioners to have an understanding of what determines older adult care experience to better serve them. Such understanding is important as by creating and fostering older adult care experience, service organizations can contribute to individual and societal well-being.

Originality/value

To the authors' best knowledge, this is the first paper to provide a comprehensive conceptualization of the older adult care experience.

Longitudinal Study of Effectiveness of a Patient-Centered Self-Management Empowerment Intervention During Predischarge Planning on Stroke Survivors

PURPOSE

To examine the effectiveness of a patient-centered self-management empowerment intervention (PCSMEI) on self-efficacy, activities of daily living (ADL), and rehospitalization of first-time stroke survivors.

METHODS

One hundred forty-four first-time stroke survivors were recruited from a comprehensive hospital in China. The intervention group (IG; n = 72) received a PCSMEI, whereas the control group (CG; n = 72) received routine care. The data on self-efficacy and ADL were collected at baseline (T0), on discharge (T1), 1-month postdischarge (T2), and 3 months postdischarge (T3) while the rehospitalization was collected at T2 and T3. The general estimation equations model was used to examine the effects of the PCSMEI program on the outcome variables.

RESULTS

One hundred twenty-six participants finished the study (IG: n = 64; CG: n = 62). Compared with the CG, patients in the IG showed significant higher level in self-efficacy on discharge (p = .014), 1-month postdischarge (p = .008), and 3 months postdischarge (p = .023), and higher level in ADL at 3 months postdischarge (p = .044). The rehospitalization rate of the IG was lower than that in the CG at 1-month postdischarge and 3 months postdischarge, which had clinical significance.

LINKING EVIDENCE TO ACTION

PCSMEI is of great value to stroke patients. This paper forms the basis for more widespread implementation of PCSMEI.

Project LifeSkills - a randomized controlled efficacy trial of a culturally tailored, empowerment-based, and group-delivered HIV prevention intervention for young transgender women: study protocol

Background

Transgender women in the U.S. have an alarmingly high incidence rate of HIV infection; condomless anal and vaginal sex is the primary risk behavior driving transmission. Young transgender women are the subpopulation at the highest risk for HIV. Despite this, there are no published randomized controlled efficacy trials testing interventions to reduce sexual risk for HIV among this group. This paper describes the design of a group-based intervention trial to reduce sexual risk for HIV acquisition and transmission in young transgender women.

Methods

This study, funded by the National Institutes of Health, is a randomized controlled trial of a culturally-specific, empowerment-based, and group-delivered six-session HIV prevention intervention, Project LifeSkills, among sexually active young transgender women, ages 16-29 years in Boston and Chicago. Participants are randomized (2:2:1) to either the LifeSkills intervention, standard of care only, or a diet and nutrition time- and attention-matched control. At enrollment, all participants receive standardized HIV pre- and post-test counseling and screening for HIV and urogenital gonorrhea and chlamydia infections. The primary outcome is difference in the rate of change in the number of self-reported condomless anal or vaginal sex acts during the prior 4-months, assessed at baseline, 4-, 8-, and 12-month follow-up visits.

Discussion

Behavioral interventions to reduce sexual risk for HIV acquisition and transmission are sorely needed for young transgender women. This study will provide evidence to determine feasibility and efficacy in one of the first rigorously designed trials for this population.

Trial registration

ClinicalTrials.gov number, NCT01575938, registered March 29, 2012.

Empowerment Interventions for Older Adults

There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult’s participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.

Randomized control trial of the Health Empowerment Intervention: feasibility and impact

BACKGROUND

Older adults prefer to stay in their homes for as long as possible but are often unaware of the resources in their community to help them to remain in their home. Access to resources may be important among older adults, representing a critical area for intervention.

OBJECTIVES

The study aim was to evaluate the feasibility of the Health Empowerment Intervention (HEI) and to explore the impact of the HEI on the theoretical mediating variables of health empowerment and purposeful participation in goal attainment and the outcome variable of well-being with homebound older adults.

METHOD

Fifty-nine eligible homebound older adults were randomly assigned to the intervention group or the comparison group. The HEI consisted of 6 weekly visits, whereas the comparison group received a weekly newsletter for 6 weeks. Participants were measured at baseline, after the 6-week protocol, and at 12 weeks. Data were analyzed using descriptive statistics, t test, chi, and analysis of covariance.

RESULTS

There was a significant difference between groups in education. The participants in the intervention found the sessions to be helpful in recognizing resources. In addition, participants in the intervention group had significantly higher scores in the mediator purposeful participation in goal attainment, F(2, 83) = 3.71, p = .03. There was no significant main effect for the mediator health empowerment; however, the intervention group increased in the subscale personal growth from baseline to 12 weeks, F(1, 83) = 3.88, p = .05.

DISCUSSION

This randomized control trial provided initial support for the hypothesis that homebound older adults receiving the HEI would find the intervention acceptable and have significantly improved health empowerment, purposeful participation in goal attainment, and well-being than an attentional comparison group receiving a weekly newsletter.

Social Support and Physical Activity in Type 2 Diabetes A Social-Ecologic Approach

Purpose This study utilized social-ecology to describe sources of social-environmental support for physical activity perceived by people with type 2 diabetes, and examined the relationship between support and physical activity.

Methods Multidimensional support and physical activity were measured in 58 people with diabetes. Descriptive and correlational statistics were used.

Results Support from the media scored highest, followed by the health care team, personal support, workplace, family and friends, and lowest for the community. Physical activity was related to personal, media, and community support.

Conclusions Using a social-ecological approach, health care professionals must focus on enhancing support from media sources, strengthening community context, and bolstering personal self-management. Professionals must also critically examine patient-provider interactions to motivate lifestyle change.