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

Study on health education methods based on rural residents' infectious disease-specific health literacy in Shandong, China

Adequate infectious disease-specific health literacy (IDSHL) is of benefit to residents in dealing with infectious diseases. This study aimed to investigate the methods by which residents acquire knowledge about infectious disease prevention and control (IDPC knowledge) so as to find effective health education methods used to improve residents' IDSHL level. In 2022, a cross-sectional study was conducted in Shandong Province, China. Participants were recruited from rural areas by multistage sampling. The IDPC knowledge cognitive questionnaire, as a reliable and valid tool, was applied to data collection and to investigate the participants' IDPC knowledge. Chi-square analysis was utilized to analyze the differences in possession level of IDSHL between different subgroups. The relationship between demographic factors and methods to acquire IDPC knowledge was also examined by chi-square analysis. The possession rate of adequate IDSHL among the total 2283 participants was 31.80%. There was a significant association between IDSHL level and socio-demographic factors, including age (P < .001), sex (P = .02), education (P < .001), occupation (P < .001), annual family income (P < .001), whether to use smartphones (P < .001), whether to browse WeChat on smartphones (P < .001), and whether to browse apps on smartphones except WeChat (P < .001). Univariate analysis showed that whether to adopt specific methods, including television (P = .02), WeChat on smartphones (P < .001), propaganda of infectious disease prevention and control (P < .001), and doctor's advice (P < .001) to acquire IDPC knowledge had significant associations with IDSHL level. Age (P < .001), education (P < .05), occupation (P < .05), and annual family income (P < .01) were associated with methods to acquire IDPC knowledge. The rural residents' adequate IDSHL in Shandong Province, China, was not optimistic. The combination of traditional methods and Internet publicity platforms should take greater responsibility for IDSHL health education among rural populations.

Development and content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure

OBJECTIVE

To create and evaluate the content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure (HF).

METHOD

A psychometric study was conducted in three stages: (1) an integrative literature review to identify strategies for self-management of fluid restriction and thirst by individuals with HF; (2) creation of animated videos about strategies for self-management of fluid restriction and thirst; and (3) analysis of the content validity of the educational videos by 11 experts. For each criterion, the content validity ratio (CVR) was calculated; it was considered adequate when <0.636. Suggestions were evaluated by the researchers, and the videos were modified.

RESULTS

Ten scripts and videos were created, averaging 30 s each. The videos' contents were based on 11 studies retrieved from the review and one specialized website. The videos were evaluated by experts, and adjustments were made when CVR < 0.636 and when allowed by the video production platform.

CONCLUSIONS

Educational videos were developed and have satisfactory content validity evidence according to expert opinions.

IMPLICATIONS FOR NURSING PRACTICE

These videos are expected to be used as educational strategies in clinical practice to prevent episodes of decompensation due to excessive fluid volume.

The dynamics of food for special medical purposes (FSMPs) utilization in cancer care: from doctor recommendations to online pharmacy procurement

This cross-sectional study conducted in Romania examines the increasing role of online pharmacies in providing Food for Special Medical Purposes (FSMP) to cancer patients. Key findings indicate patient satisfaction with ease of access, significant challenges related to costs, and the critical role of healthcare professionals in guiding FSMP selection.

INTRODUCTION

As cancer treatments advance, the demand for supportive nutritional care becomes increasingly critical, with FSMPs playing a vital role in patient recovery and quality of life.

METHODS

Employing a cross-sectional study design, we surveyed cancer patients from Romania to assess their experiences purchasing FSMPs through traditional and online pharmacies. We analyzed the factors influencing their choices, the perceived benefits and challenges of online access, and the role of healthcare professional guidance in their decision-making process.

RESULTS

The study reveals that while patients appreciate the ease of access and the broad spectrum of available FSMPs online, they grapple with the financial burden and the need for reliable information to make informed decisions. Through a cross-sectional analysis, we found that the expertise and recommendations of healthcare professionals remain integral to the FSMP selection process, suggesting that digital solutions should enhance, not replace, traditional healthcare interactions. Moreover, our findings highlight a crucial gap in the taste and variety of FSMPs, suggesting that patient adherence could be improved through product innovation. The study found a significant association between the type of medical unit where patients followed their treatment (state-owned clinic) and whether they received recommendations from a specialist oncologist for using FSMPs. Nutritionists' recommendations were also significantly associated with a higher likelihood of purchasing FSMPs online.

DISCUSSIONS

The study reveals that despite the benefits of digital access, a crucial need exists for regulatory measures and professional oversight to ensure the safe and informed use of FSMPs. The trust placed in healthcare professionals' recommendations continues to be instrumental in navigating the digital marketplace.

CONCLUSION

This work paves the way for future strategies to integrate online solutions with established healthcare practices to optimize cancer care in the digital age.

Engagement Among Diverse Patient Backgrounds in a Remote Symptom Monitoring Program

PURPOSE

Previous randomized controlled trials have demonstrated benefit from remote symptom monitoring (RSM) with electronic patient-reported outcomes. However, the racial diversity of enrolled patients was low and did not reflect the real-world racial proportions for individuals with cancer.

METHODS

This secondary, cross-sectional analysis evaluated engagement of patients with cancer in a RSM program. Patient-reported race was grouped as Black, Other, or White. Patient address was used to map patient residence to determine rurality using Rural-Urban Commuting Area Codes and neighborhood disadvantage using Area Deprivation Index. Key outcomes included (1) being approached for RSM enrollment, (2) declining enrollment, (3) adherence with RSM via continuous completion of symptom surveys, and (4) withdrawal from RSM participation. Risk ratios (RR) and 95% CI were estimated from modified Poisson models with robust SEs.

RESULTS

Between May 2021 and May 2023, 883 patients were approached to participate, of which 56 (6%) declined RSM. Of those who enrolled in RSM, a total of 27% of patients were Black or African American and 67% were White. In adjusted models, all patient population subgroups of interest had similar likelihoods of being approached for RSM participation; however, Black or African American patients were more than 3× more likely to decline participation than White participants (RR, 3.09 [95% CI, 1.73 to 5.53]). Patients living in more disadvantaged neighborhoods were less likely to decline (RR, 0.49 [95% CI, 0.24 to 1.02]), but less likely to adhere to surveys (RR, 0.81 [95% CI, 0.68 to 0.97]). All patient populations had a similar likelihood of withdrawing.

CONCLUSION

Black patients and individuals living in more disadvantaged neighborhoods are at risk for lower engagement in RSM. Further work is needed to identify and overcome barriers to equitable participation.

The impact of digital literacy on personal health: Evidence from the China family panel study

BACKGROUND

In the digital era, digital literacy is a fundamental indicator of a nation's quality and plays a crucial role in public health. Exploring the theoretical mechanisms and effects of digital literacy on individuals' health is of great practical importance, advancing the initiatives of 'Digital China' and 'Healthy China'.

METHODS

The study utilised three-period survey panel data from the China Family Panel Study spanning 2016, 2018, and 2020 to measure and evaluate levels of digital literacy, physical health, mental health, healthy lifestyle, and integrated health among the participants. Subsequently, a series of empirical analyses were conducted to examine the general impact, heterogeneous effects and transmission pathways of digital literacy on various types of health levels.

RESULTS

Digital literacy significantly enhances all aspects of respondents' health, and this conclusion remains valid even after conducting robustness tests and addressing endogeneity through variable substitution and selecting instrumental variables using the 2SLS method. Furthermore, examining heterogeneity by considering individual traits and the makeup of digital literacy reveals that the impact of digital literacy on individuals' health varies according to age, cultural background, personal income, and the components of digital literacy. Pathway analyses also demonstrate that medical accessibility, information access, social network, and planned behaviour are key routes through which digital literacy enhances the health of the population.

CONCLUSIONS

It is imperative for the government to actively promote the advancement of the digital healthcare industry, while individuals should strive to enhance their digital literacy. By collectively focussing on these efforts, national health can be significantly improved.

Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study

BACKGROUND

Digital technology is a social determinant of health that affects older people's ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults.

OBJECTIVE

In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach.

METHODS

The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys.

RESULTS

Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students' fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program.

CONCLUSIONS

A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults' digital literacy as well as other potential benefits to both older and younger adults.

Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study

Background

Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads.

Objective

This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice.

Methods

A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients.

Results

Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver's technology use were associated with more technology use (P<.05).

Conclusions

Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers.

The paradigm shift in allergy consultations through a digital ecosystem

In Spain, specialist outpatient care traditionally relied on in-person consultations at public hospitals, leading to long wait times and limited clinical analysis in appointment assignments. However, the emergence of Information and Communication Technologies (ICTs) has transformed patient care, creating a seamless healthcare ecosystem. At the Allergy Department, we aimed to share our experience in transitioning form a traditional linear model of patient flow across different healthcare levels to the implementation of a digital ecosystem. By telemedicine, we can prioritize individuals based on clinical relevance, promptly and efficiently addressing potentially life-threatening conditions such as severe uncontrolled asthma or hymenoptera venom anaphylaxis. Furthermore, our adoption of telephone consultations has markedly reduced the need for in-person hospital visits, while issues with unstable patients are swiftly addressed via WhatsApp. This innovative approach not only enhances efficiency but also facilitates the dissemination of personalized medical information through various channels, contributing to public awareness and education, particularly regarding allergies. Concerns related to confidentiality, data privacy, and the necessity for informed consent must thoroughly be addressed. Also, to ensure the success of ICT integration, it is imperative to focus on the quality of educational information, its efficient dissemination, and anticipate potential unforeseen consequences. Sharing experiences across diverse health frameworks and medical specialties becomes crucial in refining these processes, drawing insights from the collective experiences of others. This collaborative effort aims to contribute to the ongoing development of a more effective and sustainable healthcare system.

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

BACKGROUND

The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI).

OBJECTIVE

This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions.

METHODS

A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions.

RESULTS

The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03).

CONCLUSIONS

To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life.

The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping

Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.

Exploring Patient Needs and Preferences in CKD Education: A Cross-Sectional Survey Study

Key Points

This largest to date patient survey study explores what patients with kidney disease want to know about treatments, such as dialysis or conservative management. A surprising number of patients want extensive doctor-like education, but are willing to spend only several hours on education. Patients are notably open to online and digital educational modalities—technology may allow for individualized and ongoing patient education.

Background

Despite efforts to educate individuals with CKD and thereby improve outcomes, studies have shown that a significant number of patients still report poor CKD knowledge. Thus, understanding patient needs and preferences is crucial for the development and implementation of an effective CKD educational program.

Methods

A paper survey was distributed to patients with CKD 21 years and older at a tertiary care hospital's outpatient nephrology clinic in Rochester, NY. Data on patient demographics; print and technological literacies; and preferences regarding topics, instructors, class formats, session frequency, duration, and peer support were gathered.

Results

The mean age of 337 patients was 65 years (±12.33 years), and the self-identified races were American Indian or Alaska Native (<1%), Asian (3%), Black (12.17%), Native Hawaiian or other Pacific Islander (<1%), White (83%), and Other (2%). Most of the patients (69%) never needed help with health instructions, and 68% of patients used a smartphone or computer every day. Key topics identified by patients included the definitions of CKD, creatinine, and GFR and information on kidney diet. Seventy-three percent of patients desired more than basic CKD information, with one in five even wanting to know everything a doctor knows. Forty-six percent were willing to attend classes, and 33% preferred using digital (video, computer, or smartphone) modalities. Patients were willing to attend an average of 3.6 classes, and most preferred hour-long classes. Most of the patients (46%) preferred a doctor as the educator, and 53% expressed interest in connecting with fellow patients for peer support.

Conclusions

Most patients with CKD are interested in comprehensive education about their disease. This research may offer insights into the optimal content and delivery of CKD educational programs by elaborating on patients' needs and the integration of online modalities to deliver content. Future person-centered educational programs for people with CKD are needed.

Customization options in consumer health information materials on type-2 diabetes mellitus-an analysis of modifiable features in different types of media

Introduction

The understanding of health-related information is essential for making informed decisions. However, providing health information in an understandable format for everyone is challenging due to differences in consumers' health status, disease knowledge, skills, and preferences. Tailoring health information to individual needs can improve comprehension and increase health literacy.

Objective

The aim of our research was to analyze the extent to which consumers can customize consumer health information materials (CHIMs) for type-2 diabetes mellitus through various media types.

Methods

We conducted a comprehensive search for various CHIMs across various media types, such as websites, apps, videos, and printed or printable forms. A representative sample of CHIMs was obtained for analysis through blocked randomization across the various media types. We conducted a quantitative content analysis to determine the frequency of user-centered customization options. Cross-comparisons were made to identify trends and variations in modifiable features among the media.

Results

In our representative sample of 114 CHIMs, we identified a total of 24 modifiable features, which we grouped into five main categories: (i) language, (ii) text, (iii) audiovisual, (iv) presentation, and (v) medical content. Videos offered the most customization opportunities (95%), while 47% of websites and 26% of apps did not allow users to tailor health information. None of the printed or printable materials provided the option to customize the information. Overall, 65% of analyzed CHIMs did not allow users to tailor health information according to their needs.

Conclusion

Our results show that CHIMs for type-2 diabetes mellitus could be significantly improved by providing more customization options for users. Further research is needed to investigate the effectiveness and usability of these options to enhance the development and appropriate provision of modifiable features in health information.

Health Technology Readiness amongst Patients with Suspected Breast Cancer Using the READHY-tool - a Cross-sectional Study

Information technologies are increasingly used when informing patients about their disease, treatment and prognosis. These digital platforms have many advantages compared to traditional education interventions. However, there are concerns that some patients may have difficulty with this mode of information delivery. Newly diagnosed breast cancer patients are dependent on understanding their treatment options to make informed treatment decisions. Yet, there is a lack of published material on breast cancer patients and their relationship with technology. We aimed to assess health technology readiness profiles amongst women with a suspected breast cancer diagnosis. Secondly, we wanted to investigate the potential differences between these profiles according to sociodemographic factors and the patients´ current use of technology. This cross-sectional study used the Readiness and Enablement Index for Health Technology (READHY) questionnaire. We included all patients (n = 92) referred to our department with suspected breast cancer. Cluster analysis revealed three distinct profiles: medium (n = 54), high (n = 18), and low (n = 20) health technology readiness. The third profile showed difficulties in health literacy, eHealth literacy, and health insights, along with higher emotional stress. Our study found that most patients had medium to high health technology readiness, but we also identified a group with lower health technology readiness. Based on our results, healthcare personnel dealing with women with suspected breast cancer should be aware of patients struggling with health technology. Age and technology familiarity may indicate vulnerable patients. Future studies should explore optimal methods for information delivery to these distinct profiles and evaluate the long-term impacts.

Effect of digital messages from health professionals on COVID-19-related outcomes: A systematic review of randomized controlled trials

Effectiveness of health professionals' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic

BACKGROUND

Understanding perceptions of telehealth  implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits.

METHODS

Using anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September-October 2020. We examined whether telehealth perceptions differed according to patients' age, educational attainment, insurance status, and distance to clinical site and providers' age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test.

RESULTS

Over 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39).

CONCLUSIONS

Telehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.

Exploring the experiences and priorities of women with a diagnosis of ovarian cancer

PURPOSE

Ovarian cancer is the third most common gynaecological cancer among women, yet remains under-researched. Past studies suggest that women who present with ovarian cancer have more supportive care needs compared to women experiencing other gynaecological cancers. This study explores the experiences and priorities of women with a diagnosis of ovarian cancer and whether age may influence these needs and experiences.

METHODS

Participants were recruited by a community organization, Ovarian Cancer Australia (OCA), via a social media campaign promoted on Facebook. Participants were asked to rank priorities around living with ovarian cancer, and to endorse which supports and resources they had used to address those priorities. Distributions of priority rankings and resource use were compared by age (19-49 vs. 50+ years).

RESULTS

Two hundred and eighty-eight people completed the consumer survey and most respondents were 60-69 years (33.7%). Priorities did not vary by age. Fear of cancer recurrence was identified by 51% respondents as the most challenging aspect of having ovarian cancer. Compared with older respondents, a higher proportion of young participants were more inclined to use a mobile app version of the OCA resilience kit (25.8% vs 45.1%, p=0.002) and expressed interest in using a fertility preservation decision aid (2.4% vs 25%, p<0.001).

CONCLUSION

Fear of recurrence was participants' primary concern, presenting an opportunity to develop interventions. Information delivery needs to consider age-specific preferences to better reach the target audience. Fertility is more important to younger women and a fertility preservation decision aid may address this need.

Smart senior care cognition and health among Chinese elderly: A moderated mediation model featuring parent-child relationship and internet use

In the context of digital transformation, smart senior care (SSC) cognition among elderly individuals has become an important contributor to their health. Using a sample of 345 older adults derived from the cross-sectional data of a questionnaire survey on the application of home-based SSC services and products among elderly individuals, this study explored how the parent‒child relationship mediated the linkage between SSC cognition and elderly health. To examine the moderating role of internet use, we applied the multigroup structural equation modeling (SEM) approach to test whether significant disparities exist between older adults who use the internet and those who do not on the pathways in the mediation model. After controlling for gender, age, hukou (household registration permit), ethnicity, income, marital status, and education level, we found that SSC cognition exerted significant positive effects on elderly health, in which the parent‒child relationship exerted a mediating effect. As for differences between the elderly with internet use and those without, on the three pathways connecting SSC cognition and health, SSC cognition and parent‒child relationship, and parent‒child relationship and health among elderly individuals, older adults who used the internet were more susceptible than those who did not. The findings are helpful for improving the policy-making on elderly health and may serve as a practical guide and theoretical reference for the promotion of active aging.

Scoping review of the preferences of older adults for patient education materials

OBJECTIVE

To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults.

METHODS

A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems.

RESULTS

A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults.

CONCLUSIONS

Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded.

PRACTICE IMPLICATIONS

Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.

Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study

BACKGROUND

Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person's COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved.

OBJECTIVE

This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals' perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status.

METHODS

The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling.

RESULTS

After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (β=0.688; P<.001), self-efficacy (β=0.292; P<.001), and an individual's prior infection with COVID-19 (β=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β=-0.360; P<.001), risk aversion (β=-0.150; P=.09), and a family member's prior infection with COVID-19 (β=-0.139; P=.02) had statistically significant negative influences on a person's intention to use mobile tracing apps.

CONCLUSIONS

This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement.

Perspectives of Patients With Orthopedic Trauma on Fully Automated Digital Physical Activity Measurement at Home: Cross-sectional Survey Study

BACKGROUND

The automated digital surveillance of physical activity at home after surgical procedures could facilitate the monitoring of postoperative follow-up, reduce costs, and enhance patients' satisfaction. Data on the willingness of patients with orthopedic trauma to undergo automated home surveillance postoperatively are lacking.

OBJECTIVE

The aims of this study were to assess whether patients with orthopedic trauma would be generally willing to use the proposed automated digital home surveillance system and determine what advantages and disadvantages the system could bring with it.

METHODS

Between June 2021 and October 2021, a survey among outpatients with orthopedic trauma who were treated at a European level 1 trauma center was conducted. The only inclusion criterion was an age of at least 16 years. The paper questionnaire first described the possibility of fully automated movement and motion detection (via cameras or sensors) at home without any action required from the patient. The questionnaire then asked for the participants' demographics and presented 6 specific questions on the study topic.

RESULTS

In total, we included 201 patients whose mean age was 46.9 (SD 18.6) years. Most of the assessed patients (124/201, 61.7%) were male. Almost half of the patients (83/201, 41.3%) were aged between 30 and 55 years. The most stated occupation was a nine-to-five job (62/199, 30.8%). The majority of the participants (120/201, 59.7%) could imagine using the proposed measurement system, with no significant differences among the genders. An insignificant higher number of younger patients stated that they would use the automated surveillance system. No significant difference was seen among different occupations (P=.41). Significantly more young patients were using smartphones (P=.004) or electronic devices with a camera (P=.008). Less than half of the surveyed patients (95/201, 47.3%) stated that they were using tracking apps. The most stated advantages were fewer physician visits (110/201, 54.7%) and less effort (102/201, 50.7%), whereas the most prevalent disadvantage was the missing physician-patient contact (144/201, 71.6%). Significantly more patients with a part-time job or a nine-to-five job stated that data analysis contributes to medical progress (P=.047).

CONCLUSIONS

Most of the assessed participants (120/201, 59.7%) stated that they would use the automated digital measurement system to observe their postoperative follow-up and recovery. The proposed system could be used to reduce costs and ease hospital capacity issues. In order to successfully implement such systems, patients' concerns must be addressed, and further studies on the feasibility of these systems are needed.

Designing for patient decision-making: Design challenges generated by patients with atrial fibrillation during evaluation of a decision aid prototype

Shared decision-making (SDM) empowers patients and care teams to determine the best treatment plan in alignment with the patient's preferences and goals. Decision aids are proven tools to support high quality SDM. Patients with atrial fibrillation (AF), the most common cardiac arrhythmia, struggle to identify optimal rhythm and symptom management strategies and could benefit from a decision aid. In this Brief Research Report, we describe the development and preliminary evaluation of an interactive decision-making aid for patients with AF. We employed an iterative, user-centered design method to develop prototypes of the decision aid. Here, we describe multiple iterations of the decision aid, informed by the literature, expert feedback, and mixed-methods design sessions with AF patients. Results highlight unique design requirements for this population, but overall indicate that an interactive decision aid with visualizations has the potential to assist patients in making AF treatment decisions. Future work can build upon these design requirements to create and evaluate a decision aid for AF rhythm and symptom management.

The Effect of a Patient Education Multimodal Digital Platform on Knowledge Acquisition, Self-efficacy, and Patient Satisfaction

This study examined the impact of digital training instrument based on multimodal learning approach on surgical ward hospitalized patient education-related variables. The study was conducted as a multisite study in a large medical center as a two-arm, controlled trial with randomized cluster sampling. All patients meeting the inclusion criteria were offered the opportunity to participate. The control group (n = 40) received nurse explanation on home self-injection of enoxaparin sodium, whereas the intervention group (n = 40) received a tablet for multimodal learning specifically developed for this study. All participants completed before-and-after questionnaires evaluating knowledge acquisition, change in self-efficacy, and patient satisfaction. Results showed that the intervention group gained significantly more knowledge than the control group (P < .01). There was no significant difference in the level of self-efficacy change between the groups, and it was found that the control group patients were more satisfied with the training process (P = .01). This study shows that the use of a digital application for the benefit of patients' self-injection learning is effective in achieving educational goals such as knowledge acquisition and therefore can be a helpful resource for caregivers. Yet, these applications are not a substitute for attention provided by professionals, which is highly valued by patients.

Parental knowledge of children's developmental milestones in Aseer, Saudi Arabia

Background

Better parental knowledge about developmental milestones of children is linked to better parent-child interaction. Only a handful of surveys have been conducted to evaluate parental knowledge of developme ntal milestones in Arabic-speaking countries.

Materials and Methods

The study is a cross-sectional, questionnaire-based observational investigation using a simple random sampling scheme. The sampling frame consisted of all parents attending the family medicine services during the period of conduct of the study. Poisson regression modelling techniques were used to analyse the adjusted effect of sociodemographic factors on knowledge score.

Results

Three hundred and seventy-five parents agreed to be included in the study. Only 29 (7.7%) had an excellent knowledge level. Poor knowledge was found among 141 (37.6%) participants. Also, 180 (48%) participants were found to have an acceptable level of knowledge. Mothers achieved acceptable knowledge of developmental milestones better than fathers, and better knowledge was found in less-crowded houses. Physical developmental milestones were known by 304 (81.1%) participants, followed by cognitive development milestones (n = 78, 20.8%), social development milestones (n = 47, 12.5%) and emotional development milestones (n = 85, 22.7%). The internet was the most used source (n = 83, 22.1%). The most avoided sources were educational workshops (n = 230, 61.3%), followed by doctors (n = 159, 42.4%) and social media (n = 130, 34.7%).

Conclusions

We confirmed in this work that parental knowledge of children's developmental milestones is suboptimum among Saudi parents. Use of the internet and avoidance of healthcare professionals is a source of concern. Care is required for children coming from overcrowded homes in terms of their developmental progress. Focus should be on educating parents about the social and emotional developmental milestones.

Mobile learning: research context, methodologies and future works towards middle-aged adults - a systematic literature review

Over the past several years, mobile learning concepts have changed the way people perceived on mobile devices and technology in the learning environment. In earlier days, mobile devices were used mainly for communication purposes. Later, with many new advanced features of mobile devices, they have opened the opportunity for individuals to use them as mediated technology in learning. The traditional way of teaching and learning has shifted into a new learning dimension, where an individual can execute learning and teaching everywhere and anytime. Mobile learning has encouraged lifelong learning, in which everyone can have the opportunity to use mobile learning applications to gain knowledge. However, many of the previous studies on mobile learning have focused on the young and older adults, and less intention on middle-aged adults. In this research, it is targeted for the middle-aged adults which are described as those who are between the ages of 40 to 60. Middle-aged adults typically lead very active lives while at the same time are also very engaged in self-development programs aimed at enhancing their spiritual, emotional, and physical well-being. In this paper, we investigate the methodology used by researchers based on the research context namely, acceptance, adoption, effectiveness, impact, intention of use, readiness, and usability of mobile learning. The research context was coded to the identified methodologies found in the literature. This will help one to understand how mobile learning can be effectively implemented for middle-aged adults in future work. A systematic review was performed using EBSCO Discovery Service, Science Direct, Google Scholar, Scopus, IEEE and ACM databases to identify articles related to mobile learning adoption. A total of 65 journal articles were selected from the years 2016 to 2021 based on Kitchenham systematic review methodology. The result shows there is a need to strengthen research in the field of mobile learning with middle-aged adults.

Assessment of freely available online videos of cardiac electrophysiological procedures from a shared decision-making perspective

Background

Physicians recommend electrophysiological (EP) procedures to patients with arrhythmic risk. This involves shared decision-making (SDM). Patients increasingly search for additional information online. Freely available online videos are an attractive source.

Objective

We assessed freely available online videos for EP procedures from the perspective of SDM to determine if such videos can be shared with patients for SDM.

Methods

We searched for freely available online videos related to 6 common EP procedures limited to English language and duration between 1 and 10 minutes using Google and Bing. Data collected included date and source of upload, number of hits, and duration. Videos were assessed systematically for understandability, actionability (PEMAT tool), relatability, teamwork, and mention of risk.

Results

A total of 78 videos met our inclusion criteria, out of 960 video links. Overall inter-rater agreement was moderate to good. Video upload dates spanned 12 years and number of hits ranged from 87 to 594,000. The majority of videos (63%) were produced by health care systems or academic institutions. For all 78 videos the mean total PEMAT tool score was 48.6%. Thirty-five percent of videos showed a patient engaged in a conversation with the physician or a team member; 41% of videos showed other team members. The potential for complications was mentioned in 10%.

Conclusion

The majority of online, freely available videos for common EP procedures lack features useful for SDM and may not be helpful for sharing with patients from that perspective. It is possible to create high-quality videos that can facilitate SDM.

Age and neurocognition are associated with credibility evaluations of health websites

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Impact of a digital manual for guidance on malignant hyperthermia: patient education

Background

Malignant hyperthermia (MH) is a rare, hereditary disease with a hypermetabolic response to volatile anesthetics/succinylcholine. Susceptible patients face difficulties due to a lack of knowledge about MH. As informational materials could increase knowledge and adherence to prevention/therapy, digital information about rare diseases validated for patients is needed. Our objective was to evaluate the following: (1) the impact of digital manuals on the knowledge/quality of life of MH patients and (2) access to MH services.

Materials and methods

Fifty MH-susceptible patients filled out a virtual questionnaire twice (demographic/economic/clinical data, MH knowledge and impact on daily life, and SF-36 quality of life). Test groups 1 (n = 17) and 2 (n = 16) were evaluated 30 and 180 days after receiving a digital manual, and the control group (n = 17; without manual) was evaluated after 180 days. We collected the MH service data about the number of contacts.

Results

Twenty-four (48%) patients reported problems in personal/professional life, sports, clinical/surgical/dental treatments, and military service, in addition to concerns about emergency care and complaints of sequelae. The percentage of correct answers in the second MH knowledge questionnaire increased for test group 2 (62% vs. 74.1%; unpaired t test, p < 0.01), was significantly greater in test groups 1 (68.1%) and 2 (74.1%) than in the control group (56.5%; Kruskal–Wallis, p < 0.05), and correlated with more time studying the manual and reports of MH-related problems (multiple regression, p < 0.05).

Conclusions

The digital manual improved patients’ MH knowledge. Online contacts with the MH service increased, allowing greater information dissemination. As informational materials could increase knowledge/adherence to prevention/therapy, digital information about MH validated for patients should be implemented.

A survey on the psychological impact and access to health care of thyroid patients during the first SARS-COV-2 lockdown

OBJECTIVE

Information on the impact of SARS-COV-2 on the daily life of thyroid patients during lockdown is sparse. The main objective was explorative, focusing on how SARS-COV-2 affected thyroid patients.

DESIGN

Cross-sectional, questionnaire-based, using an online platform.

PATIENTS

Patients >18 years with a history of thyroid disease.

MEASUREMENTS

Demographic data, psychological impact of SARS-COV-2, medical care during the pandemic.

RESULTS

Valid responses were received from 609 responders. The median age was 50 years, 94% were female and 98.5% were UK residents. The commonest diagnosis was primary hypothyroidism (52.2%). Negative psychological effects following the lockdown were reported by 45.6%-58.7%. Cancellations of appointments with thyroid specialists were reported by 43.8%, although cancellations of thyroid investigations and treatments were relatively infrequent (12.9%-14.1%). Overall satisfaction rates for thyroid services were low (satisfaction score 40.1-42.8 out of 100), but nearly 80% were satisfied with remote consultations. Responder ratings of online information sources about SARS-COV-2 and thyroid diseases were lowest for government sites. Unmet needs during lockdown were: more remote access to thyroid specialists, more online information in 'plain English', and psychological support. In multivariate analyses, younger age, female gender, history of depression, hyperthyroidism, not having contracted SARS-COV-2 and multiple comorbidities were risk factors for a negative psychological impact of lockdown.

CONCLUSIONS

This survey identified a significant negative impact of SARS-COV-2 and lockdown on psychological wellbeing, particularly in some groups of patients defined by demographic factors, history of hyperthyroidism and comorbidities. Low satisfaction with healthcare services among thyroid patients was noted, but remote consultations were rated favourably.

Contextualizing the Chronic Care Model among Non-Hispanic Black and Hispanic Men with Chronic Conditions

Middle-aged and older men of color with chronic conditions have low utilization of preventive health services. In the context of the Chronic Care Model (CCM), the objective of this study was to identify perceptions about being informed, activated patients and having productive interactions in healthcare settings among non-Hispanic Black and Hispanic middle-aged and older men with chronic health conditions in the United States. Using an internet-based survey deployed nationally using a Qualtrics panel, data were collected from a sample of non-Hispanic Black and Hispanic men aged 40 years and older with one or more self-reported chronic conditions (n = 2028). Chi-square tests and one-way ANOVAs were used to describe this national sample by race/ethnicity and age group (40-64 years and ≥65 years). Results suggest that most health-related factors differed more on age than by race/ethnicity. Younger age groups reported less preventive care, greater barriers to self-care, mental health issues, and risky behavior. Findings from this study provide insight into the health status and healthcare utilization of racial/ethnic men with one or more chronic conditions. Results may help inform prevention and treatment interventions for middle-aged and older men of color.

Digital Health Literacy in Patients With Heart Failure in Times of Pandemic

This study sought to determine the effect of a digital health literacy program regarding knowledge and skills in the use of digital resources related to self-care and health empowerment for patients with heart failure. A cross-sectional pilot study was conducted before and after the program in patients (n = 28) with heart failure at a tertiary care center. Both a knowledge test and the Health Empowerment Scale were used with a Cronbach's α of 0.89. The information was processed using the statistical software Restudio, which allowed us to make a descriptive and inferential analysis. Seventy-five percent of the participants were men with an average age of 68 years, 60.7% had elementary schooling, 71.4% had preserved ejection fraction, and 57.6% had a family member as a caregiver. A statistically significant change ( P < .005) was found in the level of empowerment and the knowledge and skills in the use of digital resources applied in health. The results showed that the digital health literacy program is a cost-effective intervention that nursing professionals must integrate into continuity of care, not only in pandemic times but also in a permanent and standardized manner. An empowered patient with knowledge and skills in the use of digital resources is a patient with the ability to decide, satisfy needs, and solve problems, with critical thinking and control over their health.

Generational Perspectives on Technology's Role in Mental Health Care: A Survey of Adults With Lived Mental Health Experience

Introduction

Personal technology (e.g., smartphones, wearable health devices) has been leveraged extensively for mental health purposes, with upwards of 20,000 mobile applications on the market today and has been considered an important implementation strategy to overcome barriers many people face in accessing mental health care. The main question yet to be addressed is the role consumers feel technology should play in their care. One underserved demographic often ignored in this discussion are people over the age of 60. The population of adults 60 and older is predicted to double by 2,050 signaling a need to address how older adults view technology for their mental health care.

Objective

The objective of this study is to better understand why digital mental health tools are not as broadly adopted as predicted, what role people with lived mental health experience feel technology should play in their care and how those results compare across age groups.

Method

In a mixed-methods approach, we analyzed results from a one-time cross-sectional survey that included 998 adults aged 18–83 with lived experience of mental health concerns recruited from Prolific, an online research platform. We surveyed participant's use of technology including their perspectives on using technology in conjunction with their mental health care. We asked participants about their previous use of digital mental health tools, their treatment preferences for mental health care, and the role technology should play in their mental health care.

Results

Across all age groups, respondents had favorable views of using digital mental health for managing mental health care. However, older adults rated their acceptability of digital mental health tools lower than middle-aged and younger adults. When asked what role technology should play in mental health care in an open-ended response, most participants responded that technology should play a complementary role in mental health care (723/954, 75.8%).

Conclusion

Digital mental health is seen as a valuable care management tool across all age groups, but preferences for its role in care remain largely administrative and supportive. Future development of digital mental health should reflect these preferences.

Replacing vaccine paper package inserts: a multi-country questionnaire study on the acceptability of an electronic replacement in different target groups

Background

In the European Union it is mandatory to include paper package leaflets (PPL) with all medicines, including vaccines, to inform the recipient. However, it is difficult to meet the necessity for localized PPLs in each of the 24 official European languages. Replacing PPLs with electronic versions offers many advantages including redistribution across nations, reduced storage space, accessibility by the visually impaired, easily updated information or the addition of video content. We wanted to assess the attitudes of patients (vaccine recipients or their parents) to the potential of replacing PPL with electronic versions.

Methods

We surveyed vaccinees or their parents in four European countries—Belgium, Italy, Bulgaria and France—for their actual use of vaccine PPLs and their opinions about switching to an electronic package leaflet. Our survey was conducted online because of the COVID-19 pandemic and resulted in 2518 responses to a questionnaire targeted at three specific groups with particular information needs: parents of young children, pregnant women and the elderly (≥ 60 years).

Results

Our main findings are that currently vaccine PPLs are rarely used and frequently unavailable for the vaccinee. Across the four countries surveyed 55–82% of vaccinees would accept an electronic version, as did 64% when there was an option to request a printout of the leaflet.

Conclusions

We found that switching to electronic versions of vaccine PPLs is an acceptable alternative for the public, potentially increasing the quality and amount of information reaching vaccinees while eliminating some barriers to redistribution of vaccines between countries.

Understanding The Use Of Medicare Procedure Codes For Advance Care Planning: A National Qualitative Study

In 2016 Medicare introduced advance care planning Current Procedural Terminology (CPT) codes to reimburse clinicians for time spent providing the service. Despite recent increases, use of these codes remains low for reasons incompletely captured by quantitative research. To further identify barriers and facilitators to code use for Medicare fee-for-service enrollees, we conducted case studies at eleven health systems, including 272 interviews with clinicians, administrators, and key leadership. Five themes related to use of the new codes emerged: code-based constraints to billing, burdening patients with unexpected charges, ethical concerns with billing for discussion of advance care plans, incentives to signal the importance of their use in billing, and increasing both workflow burden and the need for institutional supports and training. Respondents also observed that use was facilitated by health systems' investment in clinician training and in processes to audit the codes' use. Our findings suggest that increased reimbursement, strong institutional commitment and support, and streamlined workflow could improve the use of the new CPT codes to document receipt of and ensure access to Medicare advance care planning.

Factors associated with eHealth literacy focusing on digital literacy components: A cross-sectional study of middle-aged adults in South Korea

Background

Digital technology has dramatically changed the world in which we live, and the ability to access and understand information through these new technologies is becoming increasingly important. eHealth literacy is closely related to digital literacy, and some concepts may overlap to a certain extent. Identifying personal and digital-related factors related to eHealth literacy levels in middle-aged adults would be useful for planning tailored interventions and health promotion strategies.

Objective

We aimed to identify the differences in digital literacy and eHealth literacy levels according to demographic features, and to elucidate the factors associated with eHealth literacy in the middle-aged population.

Methods

We conducted a cross-sectional, observational study from 4th to 8th February 2021. A total of 320 South Korean participants aged 40–64 years were recruited and completed an online questionnaire, where demographic features, chronic disease status, frequency of Internet use, digital skills, digital competence, and eHealth literacy were measured. eHealth literacy was measured with the eHEALS. We used multiple regression analysis to elucidate the factors associated with eHealth literacy.

Results

Multiple regression analysis revealed that digital competence was the highest contributor to an individual's eHealth literacy (β = 0.330, P < 0.001), while digital skills was not significantly associated with eHealth literacy (β = 0.086, P = 0.267). In addition, eHealth literacy was positively associated with increasing age (β = 0.258, P < 0.001), female gender (β = −0.118, P = 0.022), and higher education levels (β = 0.114, P = 0.041), while marital state, chronic disease, and frequency of internet use were not significantly associated with eHealth literacy.

Conclusions

Our study provides valuable information on digital literacy and eHealth literacy in middle-aged adults and may be used to guide tailored interventions for improving eHealth literacy. Future studies should consider the differences in digital literacy levels across generations when assessing eHealth literacy or planning digital health interventions.

OUP accepted manuscript

While families have a central role in shaping individual choices and behaviors, healthcare largely focuses on treating individuals or supporting self-care. However, a family is also a health unit. We argue that family informatics is a necessary evolution in scope of health informatics. To deal with the needs of individuals, we must ensure technologies account for the role of their families and may require new classes of digital service. Social networks can help conceptualize the structure, composition, and behavior of families. A family network can be seen as a multiagent system with distributed cognition. Digital tools can address family needs in (1) sensing and monitoring; (2) communicating and sharing; (3) deciding and acting; and (4) treating and preventing illness. Family informatics is inherently multidisciplinary and has the potential to address unresolved chronic health challenges such as obesity, mental health, and substance abuse, support acute health challenges, and to improve the capacity of individuals to manage their own health needs.

Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians

Importance

Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease. Perceptions of telehealth among older patients with chronic illness, their care partners, and clinicians are largely unknown but are critical to successful telehealth use and expansion efforts.

Objective

To identify patient, care partner, and nephrologists' perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits.

Design, Setting, and Participants

This qualitative study used semistructured interviews conducted from August to December 2020 with purposively sampled patients (aged 70 years or older, chronic kidney disease stages 4 to 5), care partners, and clinicians in Boston, Massachusetts; Chicago, Illinois; Portland, Maine; and San Diego, California.

Main Outcomes and Measures

Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Thematic analysis was used to analyze data.

Results

Of 60 interviews, 19 (32%) were with clinicians, 30 (50%) with patients, and 11 (18%) with care partners; 16 clinicians (84%) were nephrologists; 17 patient participants (43%) were non-Hispanic Black, and 38 (67%) were women. Four overarching themes characterized telehealth's benefits and drawbacks for patient-centered care among older, chronically ill adults: inconsistent quality of care, patient experience and engagement, loss of connection and mistrust (eg, challenges discussing bad news), and disparities with accessing telehealth. Although telehealth improved convenience and care partner engagement, participants expressed concerns about clinical effectiveness and limitations of virtual physical examinations and potentially widening disparities in access. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust.

Conclusions and Relevance

Older patients, care partners, and kidney clinicians (ie, nephrologists and physician assistants) shared divergent views of patient-centered telehealth care, especially its clinical effectiveness, patient experience, access to care, and clinician-patient relationship. Understanding older patients' and kidney clinicians' perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use.

Sources of Health Information, Technology Access, and Use Among Non-English-Speaking Immigrant Women: Descriptive Correlational Study

BACKGROUND

As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information.

OBJECTIVE

This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet.

METHODS

We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy-focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women's internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use.

RESULTS

Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24).

CONCLUSIONS

The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans.

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach

Background

Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic).

Objective

The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop.

Methods

We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues.

Results

The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout.

Conclusions

This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Stakeholders' Perspectives on eHealth Support in Colorectal Cancer Survivorship: Qualitative Interview Study

Background

eHealth interventions may represent the way forward in following up patients with colorectal cancer (CRC) after hospital discharge to support them in coping with the illness, strengthen their self-management, and increase their quality of life. By involving end users of eHealth in cocreation processes when designing eHealth solutions, an acceptable and relevant product can be secured. Stakeholders’ perspectives could aid in closing the gap between research-developed products and the implementation of eHealth services in real-life scenarios.

Objective

This study aims to explore the views of patients with CRC, their informal caregivers, and health care professionals (HCPs) on information technology and the design of eHealth support in CRC care.

Methods

A qualitative, explorative design was used to conduct 31 semistructured individual interviews with 41% (13/31) patients with CRC, 29% (9/31) informal caregivers, and 29% (9/31) HCPs recruited from the gastrosurgical ward of a university hospital in southwestern Norway. A semistructured interview guide was used for data collection, and the data were analyzed by systematic text condensation.

Results

Participants described the diverse experiences of patients with CRC seeking web-based information. Age and digital competence were highlighted as influencers of the use of information technology. Patients rarely received advice from HCPs about relevant and secure websites containing information on CRC diagnosis and treatment. Features of desired eHealth interventions in following up patients with CRC were patient education, health monitoring, and communication with HCPs.

Conclusions

Several elements affect the activities of patients with CRC seeking health information. Age, inexperience with computer technology, and lack of access to web-based health information may reduce the ability of patients with CRC to engage in decision-making processes regarding illness and treatment. An eHealth service for patients with CRC should comprise features for information, education, and support for self-management and should aim to be individually adapted to the patient’s age and digital competence. Involving end users of eHealth services is necessary to ensure high-quality tailored services that are perceived as user friendly and relevant to the end users.

The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.

Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses

Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = -4.10, 95% CI: [-6.38, -1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.

Implementing information and communication technology education on food allergy and anaphylaxis in the school setting

Introduction

Every year, 1/10,000 children experiences a food‐anaphylactic reaction. Most of these events, including attack‐related deaths, may happen during the school hours. In the current study, we assessed the influence of information and communication technologies (ICT) in the school‐staff's education on food allergy and anaphylaxis (FAA).

Methods

The target population of this intervention was non‐university teaching centers from the local Regional Education Council, including both state and private institutions. The digital intervention was supported by the free‐of‐charge and open‐source learning‐management Aulatic Educational Platform. Structured questionnaires were developed to evaluate the educators' knowledge, feelings, and self‐efficacy on FAA, in addition to a satisfaction and quality survey of the training program.

Results

A total of 1748 school‐educators were virtually enrolled from May 2016 to June 2020 in one of the 8‐week course editions, with 80.6% of attendees successfully completing the full training. All scores concerning school‐staff's basic knowledge and self‐efficacy on FAA significantly improved after the educational intervention, reaching a high level of satisfaction among participants (98.5%) over the 4‐year educational program.

Conclusion

Our results highlighted the effectiveness of a focused e‐learning activity to improve teachers and school caretakers in the management of food allergic scholars and anaphylactic reactions during the school hours. The use of ICTs tools should become an integrated part of curricular frameworks in non‐university education, leading to a better care of FAA school children.

Changes in Internet Use Over Time Among Individuals with Traumatic Spinal Cord Injury

OBJECTIVE

To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI).

DESIGN

Cross-sectional analysis of multicenter cohort study.

SETTING

National SCI Database.

PARTICIPANTS

Persons with traumatic SCI with follow-up data collected between 2012 and 2018 (n=13,622).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018.

RESULTS

The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (p<0.001), those with lower annual income (p<0.001), less education (p<0.001), non-White race or Hispanic ethnicity (p<0.001), motor incomplete tetraplegia (p=0.004), or males (p=0.035) were less likely to use internet from 2012 to 2018. By 2018, there were no longer differences in internet use based upon race/ethnicity (p=0.290) or sex (p=0.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012 to 2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (p<0.001), income less than $50,000 (p<0.001), high school diploma or less (p=0.011), or non-Hispanic White race/ethnicity (p=0.001) were associated with less mobile internet use over time. By 2018 there were no differences in mobile internet use by education (p=0.430) and only participants with incomes greater than $75,000/year had greater odds of mobile internet use (p=0.016).

CONCLUSIONS

Disparities associated with internet access are decreasing likely due to mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI.

Factors Influencing Healthcare Experience of Patients with Self-Declared Diabetes: A Cross-Sectional Population-Based Study in the Basque Country

Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their sociodemographic, economic, and health-related characteristics from a comprehensive viewpoint in an integrated delivery system. Methods: We used data from the 2018 Basque Health Survey, which includes a questionnaire for the measurement of the experiences of patients with chronic problems. We present descriptive and regression analyses to explore differences by sociodemographic, economic, and health-related characteristics of patients’ experiences with different healthcare services. Results: Having diabetes plus other comorbidities significantly decreases the quality of the experience with all healthcare services and decreases the global healthcare experience score. When comorbidities are present, the elderly seem to report better experiences than younger patients. Some differences in experience can be explained by sociodemographic and economic factors. No differences exist between conditions co-occurring with diabetes. Conclusion: Patients with diabetes who also suffer from other conditions report worse experiences than individuals who suffer from diabetes only. No specific conditions explain the differences in care experience.

eHealth for Addressing Balance Disorders in the Elderly: Systematic Review

Background

The population is aging on a global scale, triggering vulnerability for chronic multimorbidity, balance disorders, and falls. Falls with injuries are the main cause of accidental death in the elderly population, representing a relevant public health problem. Balance disorder is a major risk factor for falling and represents one of the most frequent reasons for health care demand. The use of information and communication technologies to support distance healthcare (eHealth) represents an opportunity to improve the access and quality of health care services for the elderly. In recent years, several studies have addressed the potential of eHealth devices to assess the balance and risk of falling of elderly people. Remote rehabilitation has also been explored. However, the clinical applicability of these digital solutions for elderly people with balance disorders remains to be studied.

Objective

The aim of this review was to guide the clinical applicability of eHealth devices in providing the screening, assessment, and treatment of elderly people with balance disorders, but without neurological disease.

Methods

A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Data were obtained through searching the PubMed, Google Scholar, Embase, and SciELO databases. Only randomized controlled trials (RCTs) or quasiexperimental studies (QESs) published between January 2015 and December 2019 were included. The quality of the evidence to respond to the research question was assessed using Joanna Briggs Institute (JBI) Critical Appraisal for RCTs and the JBI Critical Appraisal Checklist for QESs. RCTs were assessed using the Cochrane risk of bias tool. We provide a narrative synthesis of the main outcomes from the included studies.

Results

Among 1030 unduplicated articles retrieved, 21 articles were included in this review. Twelve studies explored different technology devices to obtain data about balance and risk of falling. Nine studies focused on different types of balance exercise training. A wide range of clinical tests, functional scales, classifications of faller participants, sensor-based tasks, intervention protocols, and follow-up times were used. Only one study described the clinical conditions of the participants. Instrumental tests of the inner ear were neither used as the gold-standard test nor performed in pre and postrehabilitation assessments.

Conclusions

eHealth has potential for providing additional health care to elderly people with balance disorder and risk of falling. In the included literature, the heterogeneity of populations under study, methodologies, eHealth devices, and time of follow-up did not allow for clear comparison to guide proper clinical applicability. This suggests that more rigorous studies are needed.

Mobile device use among inpatients on a psychiatric unit: A preliminary study

Few studies have investigated barriers to mobile phone use for health purposes among patients with serious mental illness. In an inpatient psychiatric adult sample, we examined: (a) patterns and perceptions of mobile phone use and (b) the role of psychiatric diagnoses on mobile phone use for mental health purposes. Participants completed questionnaires after using a psychometrically validated scale to determine capacity for consent. Descriptive analyses revealed that most participants owned a smartphone (94%), data plan (94%), and frequently accessed the internet (75%). Only 27% used their mobile phones daily for health purposes and 47% had used their mobile phone to access their electronic medical record (EMR). Participants with psychotic disorders were significantly less likely to have mobile access to their EMR and expressed difficulty in using a mobile app for mental health purposes; whereas participants with depressive disorders expressed low interest in using their mobile devices to monitor their mental health. Adult psychiatric inpatients may have access to and be willing to use mobile phones for purposes related to mental health. However, key barriers may include frequency of mobile phone use for health purposes and lack of mobile access to the EMR, particularly among those with psychotic disorders.

Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study

Background

The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior.

Objective

The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior.

Methods

We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics.

Results

Better health literacy (β=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; β=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (β=.28, SE 0.07), female gender (β=.15, SE 0.05), poor health (β=.22, SE 0.06), participation in social groups (β=.13, SE 0.05), and having an annual health exam (β=.35, SE 0.12) were all associated with online health-related information-seeking.

Conclusions

Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy.

Queensland Consumers' Awareness and Understanding of Clinical Genetics Services

As genetic testing becomes increasingly utilized in health care, consumer awareness and understanding is critical. Both are reported to be low in Australia, though there are limited studies to date. A consumer survey assessed perceived knowledge, awareness and attitudes toward genetic medicine, prior to consumers’ genomics forums in Queensland in 2018 and 2019. Data was analyzed using t-test and Mann-Whitney U tests analysis to detect any associations between sociodemographic factors and familiarity or attitudes. This highly educated and experienced health consumer cohort reported they were significantly more familiar with the healthcare system generally than genetic medicine specifically (p < 0.0001). Consumers perceived that genetic testing would be significantly more important in the future than it is currently (p < 0.00001). Consumers agreed that genetic testing should be promoted (91.4%), made available (100%), better funded (94.2%), and offered to all pregnant women (81.6%). The preferred learning modality about genetics was internet sites (62.7%) followed by talks/presentations (30.8%). Benefits of genetic testing, reported in qualitative responses, included the potential for additional information to promote personal control and improve healthcare. Perceived concerns included ethical implications (including privacy and discrimination), and current limitations of science, knowledge and/or practice. This study demonstrates that even knowledgeable consumers have little familiarity with genetic medicine but are optimistic about its potential benefits. Ethical concerns, particularly concerns regarding genetic discrimination should inform legislation and policy. Consumers are supportive of online resources in increasing genomic literacy.