A Typology of Patients Based on Decision-Making Styles: Cross-Sectional Survey Study

Associations of eHealth Literacy with Social Activity among Community-Dwelling Older Adults: A Cross-Sectional Study

Older adults who use digital technology are desired to adapt to digitalization and literacy. One required aspect is eHealth literacy, measured with the eHealth Literacy Scale (eHEALS). Many studies on eHealth literacy have used the eHEALS to examine the health behaviors of college students, relatively younger adults, and Internet users. However, the relevance of eHealth literacy to social activity has not yet been studied in older adults. The purposes of this study were to examine the relationship between eHealth literacy and health behaviors and social activities (community, cultural, and sports activities) and to investigate the factors associated with eHEALS scores among community-dwelling older adults. The mean eHEALS score was 12.4 points (SD 8.2), with the majority (73.3%) having the lowest score (the lowest score is 8 points). Males (17.6, SD 10.5) scored significantly higher than females (11.8, SD 7.7). The eHEALS score had a significant relationship with both cultural and community activity. Five factors significantly associated with having the lowest eHEALS score were cultural activity at least once a week, no cultural activity, no community activity, total IADL score, and intellectual activity. These results suggest that eHealth literacy is associated with community activity and cultural activity among older adults.

Decision-making styles of patients and general population in health care: A scoping review

OBJECTIVE

Decision-making styles form the backbone of effective decision-making and show promise as an important construct that warrants further attention. We investigated what is known about decision-making styles among patients and the general population in a health care setting.

METHODS

We used Arksey and O'Malley's framework and searched PubMed and CINAHL databases using relevant combinations of keywords and subject headings. Articles were limited to those published in English up to February 2020.

RESULTS

Sixteen articles met the inclusion criteria. We found that decision-making styles were described as role preferences or personality, psychological, and cognitive factors that influence decision-making. In the identified studies, the evidence was scarce regarding decision-making styles as the foundation for effective decision-making. Moreover, most studies were vague in the description of decision-making styles, offered little explanation of the concept, and varied substantially in the terminology, numbers, and types of decision-making styles and measurement methods.

CONCLUSIONS

Decision-making styles, as a dynamic process, have received little attention in health care and are rarely addressed in health communication research or investigations of decision-making support. Other frameworks that are not directly related to decision-making styles were used in most analyzed studies.

PRACTICE IMPLICATIONS

Decision-making styles in health care should be reinterpreted as a dynamic process that can be developed or changed.

Patient participation in electronic nursing documentation: An interview study among home-care patients

Background

Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self‐evident.

Objective

To explore how home‐care patients perceive their participation in electronic nursing documentation.

Methods

Semi‐structured interviews were conducted with 21 home‐care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis.

Results

We identified a typology with four patient types: ‘high need, high ability’, ‘high need, low ability’, ‘low need, high ability’ and ‘low need, low ability’. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals.

Conclusion

Patient participation in electronic nursing documentation varies between patients since home‐care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation.

Patient or Public Contribution

Home‐care patients were involved in the interviews.

Exploring the relationship between the usability of a goal-oriented mobile health application and non-usage attrition in patients with multimorbidity: A blended data analysis approach

Background

Mobile health applications are increasingly used to support the delivery of health care services to a variety of patients. Based on data obtained from a pragmatic trial of the electronic Patient Reported Outcome (ePRO) app designed to support goal-oriented care primary care, this study aims to (1) examine how patient-reported usability changed over the one-year intervention period, and (2) explore participant attrition rate of the electronic Patient Reported Outcome app over one year study period.

Methods

We performed a secondary analysis of 44 older adults with complex chronic needs enrolled in the electronic Patient Reported Outcome-digital health intervention. App usage and attrition were measured using device-generated usage logs; usability was measured using the patient-reported post-study system usability questionnaire collected at 3, 6, 9, and 12 months. Research memos were used to interpret potential contextual contributing factors to patients' overall usage and usability score pattern. A data triangulation method of both quantitative and qualitative data was used to analyze and interpret study findings.

Results

While there was gradual attrition in the use of the ePRO app, patients' usability scores remained consistent throughout the study period. Qualitative memos suggested patients' encounters with technical difficulties and relationship dynamics with primary providers influenced patients' adherence to the ePRO app.

Conclusion

This study highlights that the patient-provider relationship is a key determining factor that influences complex patients' continued engagement with a Mobile health app. The finding calls attention to the measurement of usability of a Mobile health app, its impact on attrition, and contributing factors that influence patients' attrition. Trial registration: Clinicaltrials.gov Identified NCT02917954.

Exploring eHealth Literacy and Patient-Reported Experiences With Outpatient Care in the Hungarian General Adult Population: Cross-Sectional Study

Background

Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine toward people-centeredness. Thus, eHealth literacy, assisted by innovative digital health solutions, may support better experiences of care.

Objective

The purpose of this study is to explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary.

Methods

In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS). PREMs with outpatient care were measured with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD) for respondents who attended outpatient visit within 12 months preceding the survey. Bivariate relationships were explored via polychoric correlation, the Kruskal–Wallis test, and chi-square test. To capture nonlinear associations, after controlling covariates, we analyzed the relationship between eHEALS quartiles and PREMs using multivariate probit, ordinary least squares, ordered logit, and logistic regression models.

Results

From 1000 survey respondents, 666 individuals (364 females, 54.7%) were included in the study with mean age of 48.9 (SD 17.6) years and mean eHEALS score of 29.3 (SD 4.9). Respondents with higher eHEALS scores were more likely to understand the health care professionals’ (HCPs’) explanations (χ²₉=24.2, P=.002) and to be involved in decision making about care and treatment (χ²₉=18.2, P=.03). In multivariate regression, respondents with lowest (first quartile) and moderately high (third quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.02) and experience fewer problems (P=.02). In addition, those respondents had better experiences in terms of how easy it was to understand the HCPs’ explanations (P<.001) and being able to ask questions during their last consultation (P=.04). Patient-reported experiences of individuals with highest (fourth quartile) and lowest (first quartile) eHEALS levels did not differ significantly in any items of the PREM instrument, and neither did composite PREM scores generated from the PREM items (P>.05 in all models).

Conclusions

We demonstrated the association between eHealth literacy and PREMs. The potential patient-, physician-, and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation, which may contribute to the development of efficient eHealth literacy interventions. Further research is needed to establish causal relationship between eHealth literacy and patient-reported experiences.