Assessing Electronic Health Literacy in the State of Kuwait: Survey of Internet Users From an Arab State

Influence of digital health literacy on online health-related behaviors influenced by internet advertising

BACKGROUND

The frequency of health-related information seeking on the internet and social media platforms has increased remarkably. Thus, the ability to understand and select accurate health-related information online, known as EHealth literacy, is crucial for the population. Therefore, this study aimed to evaluate how eHealth literacy influences the critical analysis of oral health-related information obtained from the Internet and its influence on oral health-related behaviors.  METHODS: A cross-sectional online study was conducted with 418 Brazilian adults who responded to the eHEALS questionnaire, with questions regarding the influence of online information on oral health decisions. Socioeconomic and demographic characteristics were also collected.

RESULTS

The mean eHEALS score was 27.85 (± 8.13), with a range spanning from 8 to 40 points. Participants with higher eHEALS scores reported using social media platforms to seek for dentists and to acque information about symptoms, diagnoses, and treatments. Furthermore, this group tended not to disregard professional health recommendations based on Internet information and abstained from utilizing products promoted by digital influencers. In multivariate models, increased eHEALS scores were associated with reduced consumption of products endorsed by digital influencers.

CONCLUSIONS

The findings from this study suggest that individuals with higher scores on the eHealth literacy questionnaire often conduct research on their health status and seek for health care providers on the Internet. Moreover, these individuals were less likely to be influenced by digital influencers.

Current status of electronic health literacy among pregnant women with gestational diabetes mellitus and their perceptions of online health information: a mixed-methods study

BACKGROUND

Women diagnosed with gestational diabetes mellitus often rely on internet-based health information for managing their condition. This study aims to investigate the present state of electronic health literacy among women with gestational diabetes mellitus, analyze the influencing factors, and explore their experiences regarding accessing, comprehending, evaluating, and applying online health information pertinent to gestational diabetes mellitus.

METHODS

A sequential explanatory mixed methods research design was adopted in this study. Initially, 235 women with gestational diabetes mellitus participated in a cross-sectional survey. The research tools included general information and the Chinese version of the electronic Health Literacy Scale (eHEALS). Descriptive analyses were conducted to describe the characteristics of the sample, and multiple linear regression analyses were used to explore the factors influencing electronic health literacy among women with gestational diabetes mellitus. Secondly, 11 women with gestational diabetes mellitus joined semi-structured in-depth interviews to obtain their perceptions about online health information. The data were analyzed using inductive content analysis to develop themes.

RESULTS

The median score of eHEALS in the Chinese version among 235 women diagnosed with gestational diabetes mellitus was 29 (interquartile range [IQR], 26 to 32). Factors influencing electronic health literacy among these women included accessing health information from medical professionals (β = 0.137, p = 0.029) and utilizing health information from applications (β = 0.159, p = 0.013). From the qualitative phase of the study, four thematic categories emerged: reasons and basis for accessing health information from the Internet; address barriers to accessing and applying online health information; desires for a higher level of online health information services; outcomes of accessing and applying online health information.

CONCLUSION

The electronic health literacy of women diagnosed with gestational diabetes mellitus remains suboptimal and warrants improvement. The sources of access to health information affect electronic health literacy in women with gestational diabetes mellitus. Moreover, women facing gestational diabetes encounter numerous impediments when attempting to access health-related information online, underscoring the necessity for enhanced online health information services to meet their needs.

Associations and gender differences between OHI-seeking behaviors and eHealth literacy among Chinese university students

OBJECTIVE

to explore associations and gender differences between OHI-seeking (online health information seeking) behaviors and eHealth (electronic health) literacy among Chinese university students.

METHODS

Online questionnaires of eHealth literacy scale and OHI-seeking behaviors created in software Wenjunxing were used in this survey. Chi-squared tests, t-test, and Pearson correlation analysis were performed using SPSS for data analysis.

RESULTS

Among 5,383 participants, 72.4% were girls, 77.5% lived in rural areas, 51.2% majored in liberal arts, 76.6% with low education parents. The average C-eHEALS scores of boys and girls were 26.53 ± 5.861 and 26.84 ± 5.816, respectively, with no significant difference (P = 0.084). The top three OHI-seeking behaviors for boys and girls, as well as for the C-eHEALS low and high groups, were "finding information about physical exercises" "reading or sharing health information via social media" "finding information about nutrition and diet", all of which had significant gender and eHealth literacy differences.

CONCLUSIONS

Gender and eHealth literacy differences should be focused for intervention when developing and implementing eHealth intervention training for parents and adolescents in schools and communities.

Arabic Web-Based Information on Oral Lichen Planus: Content Analysis

BACKGROUND

The use of web-based health information (WBHI) is on the rise, serving as a valuable tool for educating the public about health concerns and enhancing treatment adherence. Consequently, evaluating the availability and quality of context-specific WBHI is crucial to tackle disparities in health literacy and advance population health outcomes.

OBJECTIVE

This study aims to explore and assess the quality of the WBHI available and accessible to the public on oral lichen planus (OLP) in Arabic.

METHODS

The Arabic translation of the term OLP and its derivatives were searched in three general search platforms, and each platform's first few hundred results were reviewed for inclusion. We excluded content related to cutaneous LP, content not readily accessible to the public (eg, requiring subscription fees or directed to health care providers), and content not created by health care providers or organizations (ie, community forums, blogs, and social media). We assessed the quality of the Arabic WBHI with three standardized and validated tools: DISCERN, Journal of the American Medical Association (JAMA) benchmarks, and Health On the Net (HON).

RESULTS

Of the 911 resources of WBHI reviewed for eligibility, 49 were included in this study. Most WBHI resources were provided by commercial affiliations (n=28, 57.1%), with the remainder from academic or not-for-profit affiliations. WBHI were often presented with visual aids (ie, images; n=33, 67.4%). DISCERN scores were highest for WBHI resources that explicitly stated their aim, while the lowest scores were for providing the effect of OLP (or OLP treatment) on the quality of life. One-quarter of the resources (n=11, 22.4%) met all 4 JAMA benchmarks, indicating the high quality of the WBHI, while the remainder of the WBHI failed to meet one or more of the JAMA benchmarks. HON scores showed that one-third of WBHI sources had scores above 75%, indicating higher reliability and credibility of the WBHI source, while one-fifth of the sources scored below 50%. Only 1 in 7 WBHI resources scored simultaneously high on all three quality instruments. Generally, WBHI from academic affiliations had higher quality scores than content provided by commercial affiliations.

CONCLUSIONS

There are considerable variations in the quality of WBHI on OLP in Arabic. Most WBHI resources were deemed to be of moderate quality at best. Providers of WBHI could benefit from increasing collaboration between commercial and academic institutions in creating WBHI and integrating guidance from international quality assessment tools to improve the quality and, hopefully, the utility of these valuable WBHI resources.

Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis

INTRODUCTION

Differences in digital health literacy levels are associated with a lack of access to digital tools, usage patterns, and the ability to effectively use digital technologies. Although some studies have investigated the impact of sociodemographic factors on digital health literacy, a comprehensive evaluation of these factors has not been conducted. Therefore, this study sought to examine the sociodemographic determinants of digital health literacy by conducting a systematic review of the existing literature.

METHODS

A search of four databases was conducted. Data extraction included information on study characteristics, sociodemographic factors, and the digital health literacy scales used. Meta-analyses for age and sex were conducted using RStudio software with the metaphor package.

RESULTS

A total of 3922 articles were retrieved, of which 36 were included in this systematic review. Age had a negative effect on digital health literacy (B = -0.05, 95%CI [-0.06; -0.04]), particularly among older adults, whereas sex appeared to have no statistically significant influence among the included studies (B = - 0.17, 95%CI [-0.64; 0.30]). Educational level, higher income, and social support also appeared to have a positive influence on digital health literacy.

DISCUSSION

This review highlighted the importance of addressing the digital health literacy needs of underprivileged populations, including immigrants and individuals with low socioeconomic status. It also emphasizes the need for more research to better understand the influence of sociodemographic, economic, and cultural differences on digital health literacy.

CONCLUSIONS

Overall, this review suggests digital health literacy is dependent on sociodemographic, economic, and cultural factors, which may require tailored interventions that consider these nuances.

A systematic review of the effectiveness of patient education through patient portals

Objective

The objective of this study was to systematically review all literature studying the effect of patient education on patient engagement through patient portals.

Introduction

Patient portals provide patients access to health records, lab results, medication refills, educational materials, secure messaging, appointment scheduling, and telehealth visits, allowing patients to take a more active role in their health care decisions and management. A debate remains around whether these additional aids actually improve patient engagement and increase their ability to manage their own health conditions. This systematic review looks specifically at the effect of educational materials included in patient portals.

Materials and Methods

In accordance with PRISMA guidelines, the literature search was mapped across 5 databases (PubMed, CINAHL, Scopus, PsychINFO, Embase), and implemented on June 2, 2020.

Results

Fifty-two studies were included in the review. Forty-six (88.5%) reported rates of patient utilization of educational resources in the patient portal. Thirty (57.9%) shared patients' perceptions of the usefulness of the education materials. Twenty-one (40.4%) reported changes in health outcomes following educational interventions through the patient portal. This review found that efforts are indeed being made to raise awareness of educational resources in patient portals, that patients are increasingly utilizing these resources, that patients are finding them useful, and that they are improving health outcomes.

Conclusion

It seems that patient portals are becoming a powerful tool for patient education and engagement, and show promise as a means of achieving the quadruple aim of healthcare. Moving forward, research should establish more uniform methods of measurement in order to strengthen the literature surrounding the effectiveness of patient education through patient portals.

Associations Among Online Health Information Seeking Behaviors, Electronic Health Literacy and Food Neophobia: A Cross-Sectional Study

Few studies have investigated whether improve electronic health (eHealth) literacy can alleviate food neophobia in university students. We explored the associations among online health information (OHI)-seeking behaviors, eHealth literacy and food neophobia. A questionnaire-based, cross-sectional study of 5151 university students in China was conducted from October to December 2022. The study used Chinese versions of the eHealth literacy scale (C-eHEALS), and the food neophobia scale (FNS-C), as well as the OHI-seeking behaviors scale. Data were collected through Wenjuanxing software. Analysis of variance, t-tests, the Pearson correlation coefficient and chi-square tests were performed for data analysis. The average (SD) scores of C-eHEALS and FNS-C were 26.81 (5.83) and 38.86 (6.93), respectively. University students in China had a low C-eHEALS and a high FNS-C level, and there were significant differences between the high and low groups of C-eHEALS (P < .001) and FNS-C (P < .001). There was also a significant correlation between eHealth literacy and food neophobia (P < .001), and a lower eHealth literacy level indicated a higher probability of food neophobia occurrence. University students with high FNS-C and low C-eHEALS show more OHI-seeking behaviors. When schools, communities, and parents want to alleviate students' food neophobia, OHI-seeking training to improve eHealth literacy may be a good intervention.

The association and intervention effect between eHealth literacy and lifestyle behaviors among Chinese university students

OBJECTIVE

Our aim was to evaluate the association between eHealth literacy and lifestyle behaviors to intervene among Chinese university students.

METHOD

The Chinese eHealth Literacy Scale (C-eHEALS) questionnaire was used to investigate the eHealth literacy level and association with lifestyle behaviors among Chinese university students. Independent sample t-test and Pearson's correlation coefficient were used by statistical software SPSS v20.

RESULTS

In the first round, 5,151 university students participated in the study, including 71.46% female and 28.54% male, aged 18-22 (93.13%).The average eHealth literacy score was 26.81 ± 5.83. Four lifestyle behaviors (e.g., exercise, smoking, drinking and sleeping) were all significantly correlated with eHealth literacy scores and demonstrated significant differences. In the second investigation (N = 2,939), the average eHealth literacy score was 31.64 ± 6.44, a notable improvement compared with the first investigation.

CONCLUSION

Those in the group with high eHealth literacy scores have a healthier lifestyle than those in the low-score group. Training in eHealth-related resources is a positive measure to improve university students' eHealth literacy.

The technological intervention in e-health management: evidence from Thailand

Purpose

The e-health services came up as an effective tool to mitigate effects of COVID-19 and following social distance norms. This study highlighted an issue of contentious usage intentions of e-health services among Thai older citizens. This study aims to examine the relationship of social influence (SI), information quality (IQ) and the digital literacy (DL) to contentious usage intentions.

Design/methodology/approach

This study follows quantitative techniques, and the sample size is 140 to analyze, that is collected from the older Thai citizens. The convenient sampling technique was used to collect the data and the items were measured by using a five-point Likert scale.

Findings

The findings of this study are having mixed results. The effect of DL and satisfaction (SAT) on continuous usage intention (CUI) is significant. The effect of IQ and SI on CUI is non-significant. The effect of IQ and SI on SAT is significant. Further, the mediating effect of SAT between IQ and CUI is non-significant. However, the mediating effect of SAT between SI and CUI is significant.

Originality/value

This study contributes to knowledge by empirical testing of DL and usage of the medicine. Furthermore, to the best of the authors’ knowledge, this study is one of the rare studies that incorporate technological intervention for drug usage intentions.

Laypeople's Online Health Information Search Strategies and Use for Health-Related Problems: Cross-sectional Survey

Background

With the increase in the use of the internet to search for health information about health-related problems, there is a need for health care professionals to better understand how their patients search for and use the online health information that may influence their medical decision making.

Objective

The aims of this study are to explore laypeople’s online health information search strategies and examine the relationships between their search strategies and utilization behavior of online health information.

Methods

Two scales, namely match and elaboration, were used to measure patients’ basic search strategies (ie, simple approach) and advanced search strategies (ie, integrative approach), respectively. In addition, the consultation scale was used to evaluate the participants’ use of online health information to consult doctors and others. A total of 253 outpatients without university education were purposely selected and surveyed. The participants were outpatients at a university-affiliated teaching hospital. Partial least squares-structural equation modeling (PLS-SEM) was performed to analyze the measurement model to specify the measurement validation. In addition, the structure model of PLS-SEM was evaluated to examine the path correlations between variables and to execute interaction effect and curvilinear relationship analyses.

Results

The results of the path correlation analysis by PLS-SEM showed that both elaboration strategy (path coefficient=0.55, P<.001) and match strategy (path coefficient=0.36, P<.001) were positively correlated with consultation on online health information with doctors and others. In addition, interaction effect and curvilinear relationship analyses indicated that there was a significant interaction effect between elaboration and match on consultation (path coefficient=–0.34, P<.001) and a significant curvilinear relationship between match and consultation (path coefficient=–0.09, P=.046).

Conclusions

Increasing patients’ exposure to online health information through both a simple search approach (ie, match strategy) and a complex search approach (ie, elaboration strategy) may lead them to appropriately use the information to consult doctors and others. However, the results of interaction effect and curvilinear relationship analyses highlighted the essential role of the elaboration strategy to properly locate, evaluate, and apply online health information. The findings of this study may help health care professionals better understand how to communicate with their patients through the health information on the internet.

Using a social media based intervention to enhance eye health awareness of members of a deprived community in India

Deprived communities in India experience a range of health challenges as the result of a mixture of lack of access to information technologies, and difficulties in accessing health information and provision. This article reports on an intervention centred on the use of the social media platform, WhatsApp, in order to promote eye health communication. The case study based research was conducted in the village of Chowbaga, close to Kolkata, in West Bengal, with women participants who had low levels of education and high levels of unemployment. The women were invited to participate in a WhatsApp intervention that comprised five educational sessions. Participants were recruited through the local school that their children attended. Shortly after the conclusion of the intervention, focus groups were conducted with the participants in order to develop an understanding of participants views of the beneficial characteristics of such a social media based intervention, and, more specifically, the benefits of WhatsApp in increasing awareness of eye problems within their community. This research demonstrates and summarises the benefits of WhatsApp as a communications medium for deprived communities, as well as its potential for increasing awareness of eye problems. In particular, participants were of the view that future access to WhatsApp and other mobile-based platforms empowered them to take better care of their own and their family’s health.

Exposure Detection Applications Acceptance: The Case of COVID-19

The pandemic's context is rife with numerous dangerous threats and high fear levels, influencing human decision-making. Such characteristics are identified by investigating the acceptance of exposure detection apps from the technology acceptance model (TAM) perspective. This study purposed a model to investigate protection technology acceptance, specifically exposure detection apps in the context of COVID-19. Quantitative study approach and a cross-section design targeted 586 participants from Saudi Arabia. As the study model is complex, the study hypotheses were analysed using the structural equation modelling-partial least squares (SEM-PLS3) approach. The findings support the entire model hypothesis except the link between social media awareness and exposure detection apps' intention. Mediation of COVID-19 anxiety and influence was confirmed as well. The current paper contributes to the technologies acceptance domain by developing a context-driven model comprising the major pandemic characteristics that lead to various patterns of technology acceptance. This study also fills the literature gap regarding mediating effects of social influence and COVID-19 anxiety in the relationship between trust in government and exposure detection apps implementation, and between COVID-19 anxiety and exposure detection apps implementation, respectively. The results may assist government agencies, health policymakers, and health organisations in the wide world and specifically Saudi Arabia, in their attempts to contain the COVID-19 pandemic spread.

Purposive and non-purposive information behaviour on Instagram

User information behaviour on Instagram was explored via 274 responses to an online survey. Instagram is recognised as a powerful visual platform and consistently reports high engagement statistics across its variety of users. Research on Instagram to date has focussed on marketing communications theory, in particular its production of influencers as a new type of celebrity and source. The authors undertook an exploratory study to examine user interaction with the platform from the perspective of information behaviour research. The survey sought data relating to the rich body of information behaviour theory, particularly in relation to the needs or motivations underpinning information seeking, preferred sources of information and criteria for their evaluation, trust of Instagram creators and purposive and non-purposive engagement with information. An evolutionary model of information behaviour on Instagram is proposed, which draws on previous studies of information behaviour. The credibility of information on Instagram was a key theme in the survey findings, with respondents varying in the degree to which they trusted information on the platform and adopting complex, time-consuming and sometimes conflicting strategies to fact check where they felt reliability was important; future research exploring this further is recommended, to help understand the role and motivations of the information seeker in this process. The research also reveals a heightened blurring in comprehension surrounding the concepts of information and opinion amongst users and academics.

Evaluating the Presence of Hospitals on Social Media

Today, adults are use social media to seek health information. Evidence suggests that hospitals using Instagram reported better patient engagement and in turn increased profit and reputation. Yet, little is known about how public and private hospitals are leveraging Instagram. This study aims to analyze the presence of hospitals on Instagram using Kuwait as a case study. Hospitals were identified using the Ministry of Health’s website and Instagram. Posts collected from 7 odd months were analyzed using the Constant Comparison method. A total of 3,439 posts were distributed across six categories: Health advice & education, operations & services, current events, hospital community, seasonal occasions, and trivia. Public and private hospitals differed in their activity on Instagram in terms of health topics covered, post categories, and interactions. Hospitals should improve their presence on Instagram to promote healthy lifestyles, augment public health campaigns, and be a source of reliable and accessible health information online.

Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (β=-0.13, p < 0.05) and SOC (β=-0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (β = 0.34, p < 0.01) and DHL (β = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (β= -0.11, p = 0.004) and financial satisfaction (β= -0.12, p = 0.004) on anxiety of older adults.Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

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.

Role of factors in eHealth literacy in period of COVID-19: a study of Turkey

Purpose

This study aims to understand the eHealth literacy skills of chronic patients and to explore the relations, patterns between eHealth literacy skills and different factors such as demographics, search strategies and health information sources and to explain their effects on eHealth literacy in Turkey in Izmir in COVID-19 outbreak.

Design/methodology/approach

A quantitative method was used in the study including a questionnaire. A total of 604 chronic patients responded to the questionnaire who applied the five popularly identified hospitals in Izmir in Turkey. CHAID analysis method was implemented to explore the strongest correlation between eHealth literacy and independent variables.

Findings

Using different social media types were correlated with patients’ eHealth literacy scores. Using Facebook, Twitter were the supportive predictors for the eHealth literacy scores. However, digital literacy was highly important for eHealth literacy.

Originality/value

This study shows that the social media channels which provides much more information such as Facebook and Twitter for the chronic patient. This could be beneficial for the eHealth tools and social media content developers in terms of the supply of health information. Moreover, the study gives ideas about the effect of digital literacy and the importance of health information provided.

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.

Perceived Efficiency Outcomes, Sources and Awareness of Online Health Information among the Elderly during COVID-19

The Internet and social media are crucial platforms for health information. Factors such as the efficiency of online health information, the outcomes of seeking online health information and the awareness of reliable sources have become increasingly important for the elderly during the COVID-19 pandemic. This study aimed to examine differences between elderly individuals' income above and below the average monthly wage in relation to their online health information efficiency and the outcomes of seeking online health information; to evaluate types of online information sources with online health information efficiency and the outcomes of seeking online health information; and to explore online health information efficiency as a mediator between health status and awareness of online sources. A cross-sectional study design was conducted with 336 elderly participants age 65 or older. The participants volunteered to complete a questionnaire. No differences were found between the two groups regarding efficiency in retrieving health information from official online health sites and Google. Perceived efficiency mediated health status and awareness of online sources. In these challenging times, it is important to provide a tailor-made education strategy plan for reliable sources of online health information for the elderly, in order to enhance their technology safety skills. It is also important to explore other mediating variables between health status and awareness of online sources.

Network analysis and psychometric properties of the Brazilian version of the eHealth Literacy Scale in a dental clinic setting

BACKGROUND

The eHealth Literacy Scale (eHEALS) has become a standard tool for the evaluation of digital health literacy.

OBJECTIVES

This study aims to examine the validity and reliability of the Brazilian version of the eHEALS in a sample of patients from a dental clinic setting.

MATERIAL AND METHODS

A cross-sectional survey was conducted in a dental setting. The sample included patients from the Dental Clinic of the Dentistry School of the University of São Paulo between September 2019 and March 2020. The underlying structure of the data was exploratorily investigated using Exploratory Graph Analysis, a network analysis method. The internal reliability was assessed using the McDonald's Omega coefficient. Confirmatory Factor Analysis (CFA) was used to assess the fit of the structure identified by the network analysis. Convergent validity was assessed using the Average Variance Extracted, and measurement invariance was examined using nested models in multigroup CFA. Criterion-related validity was examined calculating the latent mean differences between subgroups (genders, age groups, and educational levels).

RESULTS

The sample included 132 adults aged 18 to 82 years (mean 44.7 years). The eHEALS network indicated that items form a single-factor structure. The 1-factor model presented adequate fit (χ2 (18) = 29.873, p < 0.039; R-CFI = 0.997; R-TLI = 0.996; R-RMSEA = 0.032, 90% CI [0.000, 0.052]), good internal reliability, and convergent validity. Configural invariance was found for genders, educational levels, and age groups. Scalar invariance was observed for genders and age, whereas partial scalar invariance was confirmed for education. Participants aged 18 to 45 and those with higher education presented greater latent means for eHEALS subscales. There were no differences between genders.

CONCLUSION

The BR-eHEALS presented good internal reliability, convergent validity, measurement invariance, and was able to discriminate the levels of eHealth literacy among groups with different ages and educational levels. These findings demonstrate that the tool is valid and reliable for use in a dental setting with the Brazilian population.

Knowledge, attitude, and perception of oral and maxillofacial surgery specialty amongst healthcare professionals, and the General Public from a Gulf Cooperation Council (GCC) Country

Background

Oral and maxillofacial surgery specialty has grown rapidly in Kuwait in recent years. However, the general public and healthcare professionals remain unaware of its expanding scope of practice. The aim of the study is to assess public and professional (dental and medical) perception of the oral and maxillofacial surgical specialty in Kuwait.

Methods

This is a cross-sectional study evaluating responses of dental professionals, medical professionals, and general public in Kuwait toward the oral and maxillofacial surgical specialty using a previously validated survey instrument with 100 participants in each group. Participants were asked to choose the most appropriate specialist to treat certain procedures across 4 disciplines: reconstruction, trauma, pathology, and cosmetic. Statistical comparison was conducted between dentists and medical doctors using Fisher’s exact test with a p-value of < 0.05.

Results

Disparities were noted each group’s responses. Oral and maxillofacial surgery was preferred overall for most clinical scenarios in trauma (p < 0.001), pathology (p < 0.001), and reconstructive surgery (p < 0.001). Plastic surgery was preferred for cosmetic surgeries (p < 0.001).

Conclusions

This study indicates the need to increase awareness especially towards cosmetic surgery procedures, and conduct health campaigns regarding oral and maxillofacial surgery among healthcare professionals, especially medical doctors, and the general public.

Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens

Background

Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19.

Objective

In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors.

Methods

A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (“netizens”) in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables.

Results

Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income >¥5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (β=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (β=.11, P=.001) and eHealth literacy (β=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (β=.07) affected this relationship positively and disease knowledge (β=–.07) affected it negatively. Different social media types differed in predicting an individual’s preventive behaviors for COVID-19. Aggregated social media (β=.22, P<.001) was the best predictor, followed by public social media (β=.14, P<.001) and professional social media (β=.11, P=.002). However, official social media (β=.02, P=.597) was an insignificant predictor.

Conclusions

Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries.

Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study

Background

Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy—the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision—is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries.

Objective

The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non–health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake.

Methods

Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant.

Results

In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants.

Conclusions

University students in non–health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.

A Bibliometric Analysis of the Health Field Regarding Social Networks and Young People

Social networks have historically been used to share information and support regarding health-related topics, and this usage has increased with the rise of online social media. Young people are high users of social media, both as passive listeners and as active contributors. This study aimed to map the trends in publications focused on social networks, health, and young people over the last 40 years. Scopus and the program VOSviewer were used to map the frequency of the publications, keywords, and clusters of researchers active in the field internationally. A structured keyword search using the Scopus database yielded 11,966 publications. The results reveal a long history of research on social networks, health, and young people. Research articles were the most common type of publication (68%), most of which described quantitative studies (82%). The main discipline represented in this literature was medicine, with 6062 documents. North American researchers dominate the field, both as authors and partners in international research collaborations. The present article adds to the literature by elucidating the growing importance of social networks in health research as a topic of study. This may help to inform future investments in public health research and surveillance using these novel data sources.