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

Social support and audience engagement of lupus-related posts on social networking sites in China

Background

Lupus, known as a chronic multisystem autoimmune disease, has become more common in China currently. Above all, most Chinese Lupus patients haven't ample knowledge and adequate understanding of this complicated chronic disease. In recent years, social networking sites have created an interactive environment in which patients can obtain health information and also can exchange personal experiences with others having similar health concerns.

Objective

The overall aim of this study is to develop a better understanding of the social support requested and received during the routine social media use of lupus activists and their referents. In other words. This paper seeks to explore whether the lupus-related posts disseminated on the Sina microblog platform can serve and satisfy the needs of this group.

Methods

Content analysis and descriptive analysis were conducted to ascertain the core topics of lupus-related posts on the Sina microblog. Chi-square tests were performed to determine the differences in types of social support between provision and request groups, as well as engaged and non-engaged groups. Finally, negative binomial regression was undertaken to investigate which types of social support generated more audience engagement.

Results

By analyzing 9822 lupus-related posts derived from the Sina microblog, disease description was the most prominent theme. Evidence is presented which shows that information support was requested and supplied more frequently than emotional and instrumental support. Specifically, information support was provided more than requested, while the instrumental and emotional support provisions were less numerous than the requests. Analysis revealed that posts containing information support provisions attracted more engagement than those with the other five types of social support.

Conclusions

Social networking sites play a critical role on disseminating lupus-related information and provide an interactive space in which users can freely communicate their health conditions and seek peer support. However, health practitioners not only have to present more communication strategies to provide emotional and instrumental support through social media, but also have to boost audience engagement.

The relationship between health literacy and adherence to personal protective anti-COVID-19 measures in health workers and their relatives: A mixed methods design

In the fight against the COVID-19 pandemic, the importance of health literacy in individuals' attitudes has increased. This study aimed to show whether there is a relationship between health literacy and adherence to personal protective anti-COVID-19 health behaviors in health workers and their relatives and to evaluate the barriers to adherence to personal protective anti-COVID-19 health behaviors. Designed as a cross-sectional mixed-methods study. Participants were asked to fill in an online survey form containing questions designed to determine their sociodemographic data, health literacy, adherence to protective anti-COVID-19 health behaviors, and barriers to adherence. The research results were evaluated with a confidence interval of 95% and margin of error of 0.05. Thematic content analysis was used to evaluate participants' answers to the open-ended questions. In this study, data collected from 393 participants were analyzed. In the Disease Prevention and Health Promotion Subscale, the group of participants who adhered to wearing masks "at all times" obtained a higher average score from the Turkey Health Literacy Scale than other participant groups, while the participant group that "always" complied with hand washing and social distancing obtained higher average scores from the Turkey Health Literacy Scale and its two subscales compared to other participant groups. As a result of the thematic content analysis carried out in order to determine the situations that prevent the participants from complying with personal protective anti-COVID-19 health behaviors, the main themes were determined as "forgetting/not wearing the habit of wearing a mask," "mask ergonomics" and "noncompliance with social distance." This study shows that there is a positive relationship between health literacy and adherence to protective anti-COVID-19 health behaviors among health workers and their relatives and revealed major barriers to adherence to protective anti-COVID-19 health behaviors among health workers and their relatives.

"I Saw it Incidentally but Frequently": Exploring the Effects of Online Health Information Scanning on Lung Cancer Screening Behaviors Among Chinese Smokers

In China, lung cancer is the most common cancer with high mortality. While prior research suggests that health information scanning influences cancer screening within the general population, a deeper exploration of the underlying mechanisms is imperative. This study specifically targets smokers, aiming to investigate whether online health information scanning can effectively encourage lung cancer screening and elucidate the mechanisms driving this association. Data were extracted from a Chinese national survey conducted between January and September 2023, exclusively involving current smokers (N = 992). A moderated mediation model was employed to examine a cognitive-affective sequential chain of mediation through risk perceptions and cancer worry. Results showed that 99.1% of Chinese smokers reported online health information scanning, which possessed significant influence. Online health information scanning was positively associated with effective lung cancer screening among smokers directly (OR = 1.927, p < .01) and indirectly (OR = .065, p < .001). The perceived threat of smoking and cancer worry served as the cognitive and affective mediating mechanisms. Furthermore, a moderating effect of eHealth literacy was observed (OR = 6.292, p < .05). Smokers with higher eHealth literacy are more inclined to undergo effective lung cancer screening. Based on these findings, public health sectors should leverage online platforms to disseminate tailored cancer screening education and implement initiatives to enhance public eHealth literacy.

eHealth literacy of migrant domestic workers in Hong Kong in the COVID-19 pandemic: A mixed methods study

BACKGROUND

Health communication in the COVID-19 pandemic can be effectively implemented if all members of the populations, including marginalized population such as migrant domestic workers (MDWs), have good eHealth literacy. Lessons learned during this critical period may help improve planning and mitigation of the impacts of future health crises.

METHODS

This study aimed to examine and explore the eHealth literacy levels of the MDWs in Hong Kong during the COVID-19 pandemic by using a convergent mixed methods research design. A total of 1156 Hong Kong MDWs participated in a paper-based survey using a multistage cluster random sampling design for the quantitative component. eHealth literacy was measured using an eHealth literacy Scale (eHEALS). For the qualitative component, a purposive sampling of 19 MDWs participated in face-to-face, semi-structured, in-depth interviews. Descriptive statistics and multiple regression analyses were used to carry out the quantitative analysis, while thematic analysis was used for the qualitative analysis. Both quantitative and qualitative data were merged and integrated for mixed-methods analysis.

RESULTS

The meta-inferences of the quantitative and qualitative results mainly confirmed that MDWs in Hong Kong had good levels of eHealth literacy. The use of Instagram, YouTube and WhatsApp as the COVID-19 information sources, in addition to having an interest in the topic of the current spread of COVID-19 together with the Hong Kong government's policies related to COVID-19, were found to be associated with eHealth literacy.

CONCLUSIONS

The eHealth literacy level of MDWs in Hong Kong was shown to be good and it was influenced by the use of popular social media platforms including Instagram, YouTube, and WhatsApp. It is realistic to suggest that such platforms should be harnessed for health communication during the pandemic. Yet, regulations to combat false information on these media are also urgently needed.

Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study

BACKGROUND

The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022.

OBJECTIVE

This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM.

METHODS

An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention.

RESULTS

A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001).

CONCLUSIONS

Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.

The association between health literacy, COVID-19 knowledge and adherence to preventive measures in Turkey

Despite vaccination and various prevention policies, the coronavirus (COVID-19) pandemic maintains its negative effects globally. Therefore, people must be adequately informed and put this knowledge into practice in order to take the necessary precautions. This can be achieved with adequate health literacy. In this context, this study was conducted to determine the relationship between health literacy, COVID-19 knowledge and adherence to preventive measures. The sample of this descriptive cross-sectional online survey consisted of 1086 people. Data were collected using a demographics questionnaire, the European Health Literacy Scale, the COVID-19 Knowledge Assessment Questionnaire and the COVID-19 Adherence Assessment Questionnaire. Participants' health literacy index had a median score of 30.9, with 67.5% having inadequate or problematic health literacy. Gender, age, education, marital status, region of residence, employment status and economic status were associated with health literacy (p < 0.05). Participants' median knowledge and adherence scores were 40 and 54, respectively. There were significant positive correlations between health literacy index, knowledge and adherence scores (p < 0.001). This study demonstrated that health literacy, COVID-19 knowledge and adherence were associated with each other. As a result, strategies aimed at improving health literacy may be beneficial in terms of having better knowledge and demonstrating high adherence to measures, thus, eradicating the COVID-19 pandemic, reducing COVID-19-related conditions and promoting public health.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Psychometric evaluation of the Chinese version of the Scale of Effects of Social Media on Eating Behaviour and research of its influencing factors

BACKGROUND

Social media has become an indispensable part of contemporary young people's lives, and the influence of social media on college students' eating and other health-related behaviors has become increasingly prominent. However, there is no assessment tool to determine the effects of social media on Chinese college students' eating behavior. This study aims to translate the Scale of Effects of Social Media on Eating Behaviour (SESMEB) into Chinese. Its applicability to Chinese college students was examined through reliability and validity indexes, and the influencing factors of SESMEB were explored.

METHODS

The questionnaire survey included 2374 Chinese college students. The Brislin translation model was used to translate the original scale into Chinese. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the construct validity of the scale, and the content validity of the scale was assessed through the content validity index. The internal consistency of the scale was assessed by calculating Cronbach's alpha coefficient, McDonald's Omega coefficient, split-half reliability, and test-retest reliability. Multiple stepwise linear regression analysis was performed to identify potential influences on the effects of social media on eating behavior.

RESULTS

EFA supported the one-factor structure, and the factor loadings of each item on this dimension were higher than 0.40. CFA showed good model fitness indexes. The content validity index of the scale was 0.94. The Cronbach's alpha coefficient and McDonald's Omega coefficient for the scale were 0.964, the split-half reliability coefficient was 0.953, and the test-retest reliability was 0.849. Gender, education, major, frequency of social media use, online sexual objectification experiences, fear of negative evaluations, and physical appearance perfectionism explained 73.8% of the variance in the effects of social media on eating behavior.

CONCLUSIONS

The Chinese version of the SESMEB has good psychometric properties and is a valid measurement tool for assessing the effects of social media on college students' eating behavior. Subjects who were female, highly educated, non-medical, had frequent social media use, online sexual objectification experiences, fear of negative evaluations, and physical appearance perfectionism used social media to have a higher impact on eating behavior.

The role of social media literacy in infodemic management: a systematic review

Background

The term infodemic refers to the proliferation of both accurate and inaccurate information that creates a challenge in identifying trustworthy and credible sources. Among the strategies employed to mitigate the impact of the infodemic, social media literacy has emerged as a significant and effective approach. This systematic review examines the role of social media literacy in the management of the infodemic.

Methods

Six databases, including SID, Magiran, Scopus, PubMed, Google Scholar and Web of Science were systematically searched using relevant keywords. We included the relevant publications between 2012 and 2023 in our analysis. To ensure a qualitative assessment of the studies, we used the STROBE and AMSTAR checklists as evaluation tools. The Preferred Reporting Items for Systematic Reviews (PRISMA) guideline was used for the design of this review study. Finally, we organized the studies into groups based on similarities and retrieved and analyzed evidence pertaining to the challenges and opportunities identified.

Results

Eleven papers were included in this study after reviewing the retrieved studies. Five of them examined the effect of social media literacy and health literacy on acceptance of health behaviors. Four studies investigated the role of media literacy in managing misinformation and fake news related to health. Two studies focused on infodemic management and promoting citizen engagement during health crises. Results showed that health-related infodemics are derived from the users' lack of media knowledge, distrust of government service systems, local influencers and peers, rapid circulation of information through mass media messages, weakness of solutions proposed by health care providers, failure to pay attention to the needs of the audience, vertical management, and inconsistency of published messages.

Conclusion

The findings of this study highlight the importance of increasing social media literacy among the general public as a recognized strategy for managing the infodemic. Consequently, it is recommended that relevant organizations and institutions, such as the Ministry of Health, develop targeted training programs to effectively address this need.

College Students' E-health Literacy, Social Media Use, and Perceptions of E-cigarettes in Taiwan

This study aimed to examine the relationship between social media use, e-health literacy, and the risk and benefit perceptions of e-cigarettes among college students in Taiwan. A cross-sectional online survey was conducted with 1,571 Taiwanese college students, which included four questionnaires to assess participants' perceptions, social media use behavior, e-health literacy, and sociodemographic factors. The data were presented in terms of means, standard deviations, and percentages. Stepwise regression was used to identify factors associated with the participants' perceptions. The study found that 75.01% of the participants were exposed to e-cigarette information on social media, with 31.26% actively searching for it and 15.95% sharing it. Participants had a high e-cigarette risk perception, indicating low benefit perception, but acceptable e-health literacy. Factors such as current e-cigarette and tobacco use, e-health literacy, academic achievement, and sex significantly predicted e-cigarette risk perception, while sharing e-cigarette related information, sex, age, academic achievement, and current e-cigarette use significantly predicted its benefit perception. Thus, implementing effective e-health literacy programs to enhance college students' e-cigarette risk perception is recommended along with a proactive approach to tackle e-cigarette advertising messages on social media, minimizing their sharing behavior to decrease their perception of associated benefits.

Validation of the digital health literacy assessment among the university students in China

Purpose

With the development of the internet, digital health literacy (DHL) has become increasingly important for managing health. Consequently, various digital health literacy scales have been created for different groups. The purpose of this study was to verify the reliability and validity of the simplified Chinese version of the Digital Health Literacy Assessment (DHLA) scale among university students in China.

Method

Snowball sampling was used to recruit the participants via an online platform (Wenjuan.com), and finally 304 university students were included in the survey. Demographic information and the status of DHL were collected through the online questionnaire. Cronbach's alpha and split-half reliability were used to test the internal consistency of the scale, while the structural validity was verified by exploratory factor analysis and confirmatory factor analysis. Additionally, the convergence of the scale was tested by composite reliability (CR) and average variance extracted (AVE).

Result

Two dimensions were generated from 10 entries in the scale, named Self-rated Digital Health Literacy and Trust Degree of Online Health Information, respectively. The Cronbach's alpha and split-half reliability of the total scale were 0.912 and 0.828, while the Cronbach's alpha of the two dimensions were 0.913 and 0.830, respectively. The structural validity-related indexes of the scale met the standards (RMSEA = 0.079, GFI = 0.943, AGFI = 0.902, CFI = 0.971). In each dimension, the CR and AVE also reached critical values (CR > 0.7 and AVE > 0.5).

Conclusion

The scale had high reliability and validity, indicating the simplified Chinese DHLA scale could be used to evaluate the DHL of university students in China.

Bilibili, TikTok, and YouTube as sources of information on gastric cancer: assessment and analysis of the content and quality

BACKGROUND

Gastric cancer has attracted widespread attention on social media due to its high incidence and severity. The Bilibili, TikTok, and YouTube video-sharing platforms have received considerable interest among general health consumers. Nevertheless, it remains unclear whether the information in videos on these platforms is of satisfactory content and quality.

METHODS

A total of 300 eligible videos related to gastric cancer were screened from three video-sharing platforms, Bilibili, TikTok, and YouTube, for assessment and analysis. First, the basic information presented in the videos was recorded. Next, we identified the source and content type of each video. Then, the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA), and Modified DISCERN were used to assess the educational content and quality of each video. A comparative analysis was undertaken of the videos procured from these three sources.

RESULTS

We identified six categories of uploaders of the 300 videos: 159 videos (53%) were uploaded by health professionals, 21 videos (7%) by users in science communications, 29 videos (9.67%) by general users, 27 videos (9%) from news agencies, 63 videos (12%) by nonprofit organizations, and one video (0.33%) by a for-profit organization. In terms of the content types of the 300 videos, we identified five distinct categories. There were 48 videos (16%) on early signals, 12 videos (4%) on late symptoms, 40 videos (13.33%) on etiologies and causations, 160 videos (53.33%) on scientific introductions, and 40 videos (13.33%) on treatment methods. The overall quality of the videos was evaluated by the GQS, JAMA, and Modified DISCERN and was found to be medium, with scores of 2.6/5, 2.41/4, and 2.71/5 points, respectively.

CONCLUSIONS

This innovative study demonstrates that videos on social media platforms can help the public learn about early signals, late symptoms, treatment methods, etiologies and causations, and scientific introductions of gastric cancer. However, both the content and quality of uploaded recordings are inadequate currently. More efforts should be made to enhance the content and quality of videos on gastric cancer and to increase public awareness.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners

Digital communication tools have demonstrated significant potential to improve health literacy which ultimately leads to better health outcomes. In this article, we examine the power of digital communication tools such as mobile health apps, telemedicine and online health information resources to promote health and digital literacy. We outline evidence that digital tools facilitate patient education, self-management and empowerment possibilities. In addition, digital technology is optimising the potential for improved clinical decision-making, treatment options and communication among providers. We also explore the challenges and limitations associated with digital health literacy, including issues related to access, reliability and privacy. We propose leveraging digital communication tools is key to optimising engagement to enhance health literacy across demographics leading to transformation of healthcare delivery and driving better outcomes for all.

Determinants and outcomes of eHealth literacy in healthy adults: A systematic review

BACKGROUND

eHealth has shown many benefits in health promotion and disease prevention. For engaging in and taking advantage of eHealth, eHealth literacy is essential. This systematic review aims to summarise and examine the existing evidence on determinants and outcomes of eHealth literacy in healthy adults.

METHODS

We searched the relevant peer-reviewed articles published in English in six databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and ProQuest. The inclusion criteria of the review were: 1) studies examining 'eHealth literacy', which refers to the ability to search, select, judge and apply online health information to address or solve health problems and to improve wellbeing; 2) the type of study included observational and experimental studies, mixed method studies or qualitative studies; 3) the participants were healthy adults; 4) the main outcomes were the determinants (i.e. influencing or associated factors) and outcomes (i.e. benefits and disadvantages) of eHealth literacy. Articles were assessed by two reviewers using the Joanna Briggs Institute critical appraisal tool. A conceptual model to map the determinants and outcomes of eHealth literacy in healthy adults into the non-modifiable, individual, social and community networks and structural layers was developed to classify the identified determinants and outcomes.

RESULTS

Forty-four studies were included in this review, of which 43 studies were cross-sectional and one was qualitative. eHealth literacy determinants included age, sex, literacy factors, socioeconomic factors and language. eHealth literacy outcomes included better general health promotion behavior, COVID-19 preventive behaviors, psychological wellbeing, social support, self-rated health and health service utilisation.

CONCLUSIONS

Our results showed that eHealth literacy has multi-layered determinants and positive outcomes. Different strategies at different policy levels are needed to improve the eHealth literacy levels of healthy adults.

Online information acquisition affects food risk prevention behaviours: the roles of topic concern, information credibility and risk perception

BACKGROUND

The COVID-19 pandemic has not only brought great challenges to the global health system but also bred numerous rumours about food safety. Food safety issues have once again attracted public attention.

METHODS

The data were drawn from the fifth wave of the first Taiwan Communication Survey database. The respondents were selected via multistage stratified random sampling. The sampling units were townships/districts, villages/neighbourhoods and households. The sample consisted of 2098 respondents. This study first used propensity value matching to analyse the direct impact of online food safety information acquisition on preventive behaviours and examined the heterogeneous impact caused by the difference in the degree of topic attention through value matching. Hayes' PROCESS macro model 6 was applied to confirm the mediating effect and the serial mediating effect.

RESULTS

The research results show that an increase in the frequency of the acquisition of online food safety information significantly increases individuals' food risk prevention behaviour. However, only users with high concern about the issue are affected. The food risk prevention behaviour of users with low concern about this issue is not affected by the acquisition of online food safety information. Further analysis shows that risk perception and information credibility both play mediating roles in the impact of online food safety information acquisition on food risk prevention behaviour. Moreover, the transmission and united effects of information credibility and risk perception play a distal mediating role.

CONCLUSIONS

Food risk prevention behaviours are an important topic for personal health as well as government management. Our study's findings can provide empirical evidence for risk managers and decision-makers to reevaluate the role of the internet in food risk management.

Digital literacy as a new determinant of health: A scoping review

INTRODUCTION

Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation.

METHODS

A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley.

RESULTS

A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support.

CONCLUSIONS

Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.

Parents' Knowledge of and Attitude toward Acute Otitis Media and Its Treatment in Children: A Survey at Primary Healthcare Centers in the Aseer Region

BACKGROUND

Acute otitis media (AOM) in children aged 5 years old and younger poses a critical health concern, affecting both the general health of children and the emotional well-being of parents. The objective of this study was to evaluate parental understanding, attitudes, and experiences related to AOM and its management, including the use of antibiotics without physician prescription.

METHOD

A cross-sectional study was carried out during the months of May and June of 2023. To collect data for this study, a validated questionnaire was converted into a Google form and given to parents of children aged 5 years and younger who sought healthcare for their children in primary healthcare centers in Abha city, Aseer region, Saudi Arabia.

RESULTS

A total of 406 parents participated in this study, 64.8% of them were women and 45.3% of them were in the age range of 25 to 34 years. The majority (90.1%) resided in urban areas and a significant proportion (72.2%) had a university education. Among the respondents, 22.7% agreed that bacteria are the cause of AOM, while 21.7% agreed that it is caused by viruses. A total of 51.0% acknowledged the need for antibiotics in the management of AOM. In terms of treatment, 84.5% and 83.5% believed that analgesics and antibiotics, respectively, were the most effective for otalgia. A substantial portion, 43.1%, 34.7%, and 37.7%, respectively, believed that antibiotics could reduce pain, relieve fever, and prevent recurrence. Almost three-quarters sought medical advice primarily from paediatricians and 37.7% obtained information about AOM from the Internet. Furthermore, almost a third (28.8%) chose not to wait for the physician's appointment and immediately administered antibiotics without the physician's prescription due to concerns about disease progression. Approximately two fifths (38.4%) requested physicians to prescribe antibiotics, a pattern that was in agreement with the actual rate of antibiotic prescriptions (38.4%).

CONCLUSIONS

A notable deficiency in knowledge and unsafe practices about AOM and its management is evident among parents in the Aseer region. This underscores the pressing need for an educational program aimed at improving parental health literacy regarding otitis media causes and treatments, as well as its preventive measures.

Demand of and Access to Health Messages Through Mass Media in the Rural Community of Eastern Ethiopia: A Mixed Method Study

Background

The demand for health-related information has increased dramatically in recent years. Media is crucial in reaching health messages to audiences, especially those who are distant and rural. Therefore, the study aimed to assess demands, access, and factors associated with access to health messages through mass media in the rural community of Kersa District of East Hararghe, Eastern Ethiopia.

Methods

A mixed-methods study was conducted from October 15 to November 20, 2020. A quantitative cross-sectional and a qualitative phenomenological study design were applied. A total of 578 participants were included by using a systematic sampling technique. Collected data were entered into Epidata version 3.1 and analyzed using SPSS version 22.0. A multivariate logistic regression analysis model was used and reported using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was set at p <0.05. For qualitative, six-focused group discussions (FGDs) were used and then analyzed thematically.

Results

Overall, the demand of and access to health messages through mass media was 32.5% (95% CI=28.5-34.2%) and 26.6% (95% CI=24.6-28.7%), respectively. Factors such as having electric services (AOR=2.36, 95% CI=2.13-5.41), having a mobile phone (AOR=4.56, 95% CI=4.32-8.73), exposure to TV (AOR=4.73, 95% CI=1.03-11.62), and exposure to social media and printed media (AOR=5.24, 95% CI=1.07-15.63), a preference for programs such as news, current affairs, entertainment, health and educational were 2.37, 9.47, 4.75 and 7.55 times more likely to access health messages (AOR=2.37, 95% CI=1.00-5.61; AOR=9.47, 95% CI=3.54-25.34; AOR=4.75, 95% CI=1.23-18.38; and AOR=7.55, 95% CI=3.12-8.66, respectively). Qualitative findings, participants demand for health messages from health workers, radio, and the main source for accessing the message was the radio.

Conclusion

Approximately one in every three and one in every four rural communities in the study area had demand, and access to health messages through mass media, respectively. As a result, all stakeholders should emphasize and strengthen expanding methods of reaching health messages using mass media.

Diagnosis Disclosure and Peer-to-Peer Information Seeking Among COVID-19-Infected Social Media Users: Survey of US-Based Adults

BACKGROUND

Research examining online health communities suggests that individuals affected by chronic health conditions can obtain valuable information and social support through participation in peer-to-peer web-based information exchanges, including information sharing and seeking behaviors. The risks and rewards of these same behaviors in the case of acute illnesses, such as COVID-19, are less well understood, though there is reason to believe that individuals with COVID-19 and other acute illnesses may accrue similar benefits.

OBJECTIVE

This study examines the propensity of American adults to disclose and discuss their COVID-19 diagnosis and symptoms on social media while actively infected with the SARS-CoV-2 virus, as well as to engage in peer-to-peer information seeking in order to better understand the illness that they are experiencing. Additionally, this study seeks to identify the motivations for these behaviors as well as their subsequent impacts on perceived social connectedness and health anxiety in patients with COVID-19.

METHODS

We conducted a representative survey of 2500 US-based adults using a sample purchased through an industry-leading market research provider. Participants were selected through a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, ethnicity, and political affiliation. Responses were analyzed from 946 participants who reported having an active social media account and testing positive for COVID-19 at least once since the start of the pandemic.

RESULTS

The results show that only a small portion of social media users (166/946, 18%) chose to disclose and discuss their COVID-19 diagnosis while infected with the virus. However, among those who did, an overwhelming majority (206/251, 82%) said that doing so helped them feel more connected and supported while infected with the virus. A larger percentage of the 946 respondents (n=319, 34%) engaged in peer-to-peer information seeking while infected with COVID-19. Among those who did, a large majority (301/319, 94%) said that doing so was "helpful," but more than one-third (115/319, 36%) said that reading about other people's experiences made them "more worried" about having COVID-19, while 33% (108/319) said that it made them "less worried." Illness severity and political affiliation were significant predictors of both information sharing and seeking.

CONCLUSIONS

The findings suggest that the benefits (and risks) associated with online health communities are germane to patients with acute illnesses such as COVID-19. It is recommended that public health officials and health care providers take a proactive approach to cultivating professionally moderated forums supporting peer-to-peer engagement during future outbreaks of COVID-19 and other acute illnesses in order to improve patient outcomes and promote social support and connectedness among infected patients.

Users' Motivations for Facebook Unfriending During the COVID-19 Pandemic: Survey Study

BACKGROUND

Social networking sites (SNSs) such as Facebook have been central to the global exchange of health-related information throughout the COVID-19 pandemic, but during this time, increased web-based interactions proved to be a source of stress and conflict for many SNS users. Prior research suggests that many users have engaged in significant boundary regulation during this period, using behaviors such as unfriending to refine and reorient their social networks in response to pandemic-related information.

OBJECTIVE

This study aimed to examine Facebook unfriending during and in relation to the first year of the pandemic to better understand how SNS users have managed and maintained their social networks around the COVID-19 pandemic. On the one hand, unfriending may be motivated by an attempt to protect the utility and accuracy of a user's informational environment. On the other hand, it may be motivated by a desire to tune out alternative viewpoints and opinions. Both motivations may have significant implications for public health discourse and outcomes.

METHODS

A sample of 824 active Facebook users (drawn from a representative survey of 1000 American adults) was analyzed using a series of logit regression models. Survey respondents were selected using a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by the region of the country) for sex, age, race, ethnicity, and political affiliation.

RESULTS

In total, 31.7% (261/824) of active Facebook users unfriended at least one account over COVID-19 pandemic-related posts during the first year of the pandemic. The most common reasons for unfriending included "making political comments about COVID-19" (191/824, 23.2%) and "posting information that was inconsistent with public health guidelines" (162/824, 19.7%). As hypothesized, reliance on Facebook for COVID-19 pandemic-related news and information was associated with a greater likelihood of unfriending, particularly in response to information that was inconsistent with public health guidelines. Political factors (particularly partisan intensity) were also predictive of unfriending, especially in the case of COVID-19 pandemic-related disagreements.

CONCLUSIONS

Both information utility concerns and political factors were associated with a greater likelihood of COVID-19 pandemic-related unfriending, although the magnitude of the effects associated with utility appears to be greater. Although utility-motivated unfriending may lead to more reliable health information experiences for some SNS users, the tendency of consumers to assess accuracy and credibility on the basis of partisan predilections obscures this finding and warrants further consideration.

Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study

BACKGROUND

Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.

OBJECTIVE

This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.

METHODS

We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.

RESULTS

Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.

CONCLUSIONS

This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

The Correlation Among COVID-19 Vaccine Acceptance, the Ability to Detect Fake News, and e-Health Literacy

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has seen a rise in the spread of misleading and deceptive information, leading to a negative impact on the acceptance of the COVID-19 vaccine and public opinion. To address this issue, the importance of public e-Health literacy cannot be overstated. It empowers individuals to effectively utilize information technology and combat the dissemination of inaccurate narratives.

OBJECTIVE

This study aimed to investigate the relationship between the ability to identify disingenuous news, electronic health literacy, and the inclination to receive the COVID-19 immunization.

METHODS

In this descriptive-analytical cross-sectional study conducted during summer 2021 in Isfahan, Iran, 522 individuals older than age 18 years, seeking medical attention at health centers, were surveyed. The participants were selected through a meticulous multistage cluster sampling process from the pool of individuals referred to these health centers. Along with demographic information, data collection instruments included the standard e-Health literacy questionnaire and a researcher-developed questionnaire designed to identify misinformation. The collected questionnaires were entered into SPSS 24 for statistical analysis, which included the Kruskal-Wallis test, the Chi-square test, the Spearman test, and logistic regression models.

KEY RESULTS

The study findings revealed a statistically significant relationship between acceptance of the COVID-19 vaccine and the ability to identify deceptive news. An increase of one unit in the score for recognizing misinformation led to a 24% and 32% reduction in vaccine hesitancy and the intention to remain unvaccinated, respectively. Furthermore, a significant correlation was found between the intention to receive the vaccine and e-Health literacy, where an increase of one unit in e-Health literacy score corresponded to a 6% decrease in the intention to remain unvaccinated. Additionally, the study found a notable association between the ability to detect false and misleading information and e-Health literacy. Each additional point in e-Health literacy was associated with a 0.33% increase in the capacity to identify fake news (Spearman's Rho = 0.333, p < .001).

CONCLUSION

The study outcomes demonstrate a positive correlation between the COVID-19 vaccine acceptance, the ability to identify counterfeit news, and proficiency in electronic health literacy. These findings provide a strong foundation for policymakers and health care practitioners to develop and implement strategies that counter the dissemination of spurious and deceitful information related to COVID-19 and COVID-19 immunization. [HLRP: Health Literacy Research and Practice. 2023;7(3):e130-e138.].

The Impact of Social Media on Preventive Behavior During the COVID-19 Outbreak in South Korea: The Roles of Social Norms and Self-Efficacy

Social media are important channels to propagate health information and influence preventive behavior during a public health crisis, as witnessed during the coronavirus pandemic (COVID-19). This study explored the association between social media use and preventive behavior during the outbreak of COVID-19 in South Korea. Using the national survey data (N = 1,500), the study examined the mediating role of social norms in the association between social media use for news and information about COVID-19 and preventive behavior. In addition, the study tested the moderating effect of self-efficacy on the mediating path of social media use for preventive behavior via social norms. Conducting a moderated mediation analysis method, this study found that social norms mediated the relationship between social media use and preventive behavior (b = 0.046). Moreover, the study revealed that the indirect relationship between social media use and preventive behavior through social norms becomes stronger as an individual's level of self-efficacy decreases (low: b = 0.044, middle: b = 0.036, and high: b = 0.030). The study provides empirical evidence of the beneficial impact of social media use on preventive behavior. The findings of the study recommend promoting messages on social norms through social media for facilitating preventive behavior.

Paediatric hospitalizations over three waves of COVID-19 (February 2020 to May 2021) in Italy: determinants and rates

Background

After a pneumonia outbreak in late 2019 in China, a new virus related to the Coronaviridae strain, called Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was identified as the pathogen of an emerging disease known as COronaVIrus Disease 19 (COVID-19). Preliminary evidence outlines a higher prevalence in adults and lower susceptibility in children. However, recent epidemiologic research highlighted that transmissibility and susceptibility among children and adolescents become higher due to new virus variants. Infections among youth arises with mainly respiratory and gastrointestinal symptoms and malaise. Nevertheless, critical illness affects new-borns and fragile children, requiring hospitalization and possibly intensive care support. Aim of this study was to examine the impact of COVID-19 pandemic on hospital admissions among children and adolescents aged 0 to 17 years over three waves of COVID-19 (from February 2020 to May 2021) in Piedmont, a large Italian region, and to investigate the possible determinants of hospitalizations.

Methods

A meta-analysis for risk assessment was performed over three waves of COVID-19 (from February 2020 to May 2021). Data were extracted from the official Italian National Information System and ISTAT.

Results

Overall, 442 paediatric patients were enrolled and admissions concerned mostly the age group 0-4 years (60.2%). Trends of hospitalization showed a slight increase of paediatric admissions already in March 2020 and a rise during second and third waves (November 2020, March 2021). Paediatric age-grouped hospitalizations (0-4; 12-17; 5-11) reproduced an analogous trend. The children and adolescent hospitalization rate appeared lower than overall population with a moderate slope of increase in comparison with population slope. Monthly hospitalization rate (per 100,000) of children and adolescents aged 0-17 years reproduced the increasing trend of hospitalization numbers. This trend was influenced, in particular, by the trend of hospitalization rates for children aged 0-4 years. The meta-analysis for risk assessment showed a decreased likelihood of rescue of hospitalizations in female, 5-11 and 12-17 age groups. Conversely, the meta-analysis showed a positive association between foreign nationality and hospitalizations.

Conclusions

Our results show a comparable trend of paediatric hospital admissions for COVID-19 and of the entire population hospitalizations over three waves. COVID-19 hospital admissions increase with a bimodal age distribution and the most admissions are among patients aged ≤4 or 5-11 years. Significant predictive factors of hospitalization are identified.

COVID-19 Vaccine-Related Information on the WeChat Public Platform: Topic Modeling and Content Analysis

BACKGROUND

The COVID-19 vaccine is an effective tool in the fight against the COVID-19 outbreak. As the main channel of information dissemination in the context of the epidemic, social media influences public trust and acceptance of the vaccine. The rational application of health behavior theory is a guarantee of effective public health information dissemination. However, little is known about the application of health behavior theory in web-based COVID-19 vaccine messages, especially from Chinese social media posts.

OBJECTIVE

This study aimed to understand the main topics and communication characteristics of hot papers related to COVID-19 vaccine on the WeChat platform and assess the health behavior theory application with the aid of health belief model (HBM).

METHODS

A systematic search was conducted on the Chinese social media platform WeChat to identify COVID-19 vaccine-related papers. A coding scheme was established based on the HBM, and the sample was managed and coded using NVivo 12 (QSR International) to assess the application of health behavior theory. The main topics of the papers were extracted through the Latent Dirichlet Allocation algorithm. Finally, temporal analysis was used to explore trends in the evolution of themes and health belief structures in the papers.

RESULTS

A total of 757 papers were analyzed. Almost all (671/757, 89%) of the papers did not have an original logo. By topic modeling, 5 topics were identified, which were vaccine development and effectiveness (267/757, 35%), disease infection and protection (197/757, 26%), vaccine safety and adverse reactions (52/757, 7%), vaccine access (136/757, 18%), and vaccination science popularization (105/757, 14%). All papers identified at least one structure in the extended HBM, but only 29 papers included all of the structures. Descriptions of solutions to obstacles (585/757, 77%) and benefit (468/757, 62%) were the most emphasized components in all samples. Relatively few elements of susceptibility (208/757, 27%) and the least were descriptions of severity (135/757, 18%). Heat map visualization revealed the change in health belief structure before and after vaccine entry into the market.

CONCLUSIONS

To the best of our knowledge, this is the first study to assess the structural expression of health beliefs in information related to the COVID-19 vaccine on the WeChat public platform based on an HBM. The study also identified topics and communication characteristics before and after the market entry of vaccines. Our findings can inform customized education and communication strategies to promote vaccination not only in this pandemic but also in future pandemics.

Predicting College Students’ Preventative Behavior During a Pandemic: The Role of the Health Belief Model, Source Credibility, and Health Literacy

In this study, we examined the effects of perceived source credibility of the Centers for Disease Control (CDC) and college student health literacy in predicting the likelihood of enacting preventative behaviors related to mitigating COVID-19. Using the Health Belief Model (HBM) as an explanatory tool, we analyzed how perceived source credibility and health literacy levels predict college students’ likelihood to enact preventative behaviors during a public health crisis. Sample population entirely consisted of undergraduate students enrolled in a basic communication course at a large, southern university. The participants completed survey questionnaires about their perceived health literacy, health beliefs, trust in the CDC, perceptions of COVID-19, and demographic measures during the fall 2020 semester. A multiple regression analysis revealed that (a) HBM predictors, health literacy and CDC source credibility accounted for 44% of the variance in likelihood of enacting preventative health behaviors, and (b) health literacy, CDC source credibility, and perceived severity were all positive predictors of enacting preventative health behaviors, while (c) perceived barriers negatively predicted enactment of preventative health behaviors. Perceived susceptibility and perceived benefits were not significant predictors of college student risk mitigation. Our data suggests the importance of health literacy and source credibility in predicting college students’ likelihood to enact preventative behaviors during public health crises.

COVID-19 messages targeting young people on social media: content analysis of Australian health authority posts

Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) shared by Australian health departments. Posts targeting young people with COVID-19 information were extracted from all eight Australian State and Territory health department Facebook, Instagram and TikTok accounts over 1 month of the Delta outbreak (September 2021) and analysed thematically. In total, 238 posts targeting young people were identified from 1059 COVID-19 posts extracted. All eight health departments used Facebook, five used Instagram and only one used TikTok. The majority of posts implicitly targeted young people; only 14.7% explicitly mentioned age or 'young people'. All posts included accompanying visuals; 77% were still images like photos or illustrations whilst 23% were moving images like videos and GIFs. Communication techniques included calls to action (63% of posts), responsive communication (32% of posts) and positive emotional appeal (31% of posts). Social marketing techniques catering to young people were used to varying extents despite receiving higher levels of engagement; 45% featured emojis whilst only 16% used humour, 14% featured celebrities and 6% were memes. Priority groups like ethnic/cultural groups and chronic health/disability communities were rarely targeted in this communication. The findings indicate a lack of health communication on social media directed towards young people, highlighting an opportunity for increased use of platforms like TikTok and trends popular with young people online.

Parasocial relationship in the context of the COVID-19 pandemic: A moderated mediation model of digital media exposure on political trust among Chinese young people

How to retain people's trust in the government becomes a critical topic during the COVID-19 pandemic. Research on media use and government public relations has proliferated in the past several decades. However, there is a paucity of research investigating political trust in the context of a public health crisis as a communicative process from a relational perspective. This study examined collectivism and parasocial relationships as two potential mechanisms linking digital media exposure to political trust in the context of the COVID-19 pandemic. A sample of 465 Chinese young adults aged between 18 and 35 responded to anonymous questionnaires regarding digital media exposure to Nanshan Zhong, collectivism, parasocial relationships, COVID-19 political trust, and general political trust. The results suggested that the formation of parasocial relationships with Nanshan Zhong mediated the impact of digital media exposure on COVID-19 political trust and general political trust, respectively. Meanwhile, the indirect associations were moderated by collectivism. Through repeated exposure to news of Nanshan Zhong on multiple digital media, individuals with higher levels of collectivism were more likely to develop parasocial relationships with him, which subsequently resulted in increased political trust.

Comparison of the baseline characteristics and influencing factors of successful smoking cessation before and during the coronavirus disease pandemic

INTRODUCTION

Travel and living environment restrictions, which may have positive or negative effects on smoking-related behaviors, were implemented to limit the COVID-19 pandemic. This study aimed to compare the baseline clinical characteristics and smoking cessation (SC) rate at 3 months of patients in an SC clinic in Hunan Province, China before and during the COVID-19 pandemic and identify influencing factors of successful SC.

METHODS

Healthy patients at the SC clinic aged ≥18 years before the COVID-19 pandemic and during the COVID-19 pandemic were divided into groups A and B, respectively. The two groups’ demographic data and smoking characteristics were compared, and SC interventions were applied by the same medical staff team through telephone follow-up and counselling during the SC procedure.

RESULTS

Groups A and B included 306 and 212 patients, respectively, with no significant differences in demographic data. The SC rates of group A (pre COVID-19) and group B (during the COVID-19 pandemic) at 3 months were 23.5% and 30.7%, respectively, after the first SC visit. Those who chose to quit immediately or within 7 days were more successful than those who did not choose a quit date (p=0.002, p=0.000). Patients who learned about the SC clinic via network resources and other methods were more likely to succeed than those who learned about the clinic from their doctor or hospital publications (p=0.064, p=0.050).

CONCLUSIONS

Planning to quit smoking immediately or within 7 days of visiting the SC clinic and learning about the SC clinic via the network media or other methods improved the likelihood of successful SC. SC clinics and the harm of tobacco should be promoted via network media. During consultation, the smokers should be encouraged to quit smoking immediately and establish an SC plan, which would help them to quit smoking.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Impact of educational intervention regarding COVID-19 on knowledge, attitude, and practice of students before dental school re-opening

BACKGROUND AND AIM

Lack of knowledge on COVID-19 among people and healthcare staff significantly impacts late management and its rapid transmission. Dental students must be aware of the exact preventive instructions due to their close contact with patients and clinical work in the dental setting during the pandemic. This interventional study aimed to investigate the effectiveness of designed educational content regarding COVID-19 on Iranian dental students' knowledge, attitudes, and practices at Alborz University of medical sciences.

MATERIALS AND METHODS

A total of 88 dental students were investigated in this study. Educational content was designed based on the clinical guidelines regarding COVID-19 in dentistry. The content was presented to dental students as a three-hour webinar. In addition, the online, validated questionnaire was obtained from the students as pre, post, and follow-up surveys.

RESULTS

A statistically significant difference between students' knowledge, attitudes, and practices were obtained before and after the intervention and the follow-up survey. 48.58% improvement in knowledge score, 6.37% in attitudes, and 17% in practice scores were observed.

CONCLUSION

Although this educational intervention significantly improved the knowledge, attitude, and practice of dental students, additional education and clinical training are mandatory for effective and safe dental practice management in future crises.

The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19

The purpose of this study was to identify the correlation between depression, anxiety, e-health literacy (eHL), and health-promoting behaviors among nursing students during the coronavirus disease 2019 (COVID-19) pandemic, and to identify the factors affecting health-promoting behaviors. A cross-sectional study was conducted online, recruiting 301 nursing students recruited from 4 universities in the Chungcheng Province and Daejeon Metropolitan City in South Korea between May 28 and June 30, 2021. Data were analyzed using SPSS WIN 27.0. The general characteristics of the study participants were analyzed by frequency and percentage, and the degree of depression, anxiety, eHL, and health-promoting behaviors were calculated as averages and standard deviations. Differences in health-promoting behaviors according to general characteristics were analyzed using independent t tests and analysis of variance, and a post hoc Scheffe test was conducted. Correlations between depression, anxiety, eHL, and health-promoting behaviors were measured using Pearson correlation matrices. Stepwise multiple regression was performed to identify factors affecting health-promoting behaviors. During the COVID-19 pandemic, the average level of depression and anxiety was reported to be 3.93 (4.71) and 3.40 (4.30), respectively; 33.2% of nursing students experienced more than mild depression and 29.2% experienced anxiety. The average eHL level was 3.91 (0.56), and the average of health-promoting behaviors was 2.43 (0.45). Depression was positively correlated with anxiety (R = 0.734, P < .001) and negatively correlated with health-promoting behaviors (r = -0.198, P = .001), whereas eHL had a positive correlation with health-promoting behaviors (R = 0.347, P < .001). The factors affecting health-promoting behaviors were religion (β = -0.160, standard error [SE] = 0.048), current health status (β = -0.097, SE = 0.032), frequency of searching the Internet for health-related information in a week (β = -0.070, SE = 0.026), interest in health (β = -0.191, SE = 0.039), and critical eHL (β = 0.243, SE = 0.040); the explanatory power was 27.4%. Results demonstrate that during the COVID-19 pandemic, higher depression and anxiety among nursing students decreased health-promoting behaviors, while higher eHL increased health-promoting behaviors, and eHL was a major factor affecting health-promoting behaviors. These results contribute to the provision of basic data for the development of nursing intervention programs and educational strategies that can establish correct health-promoting behaviors by managing depression and anxiety among nursing students and improving eHL.

Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia.

METHODS

Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14.

RESULTS

After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic.

CONCLUSION

This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021293681.

The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis

BACKGROUND

With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors.

OBJECTIVE

To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis.

METHODS

The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale.

RESULTS

Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors.

CONCLUSIONS

Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.

The prevalence of eHealth literacy and its relationship with perceived health status and psychological distress during Covid-19: a cross-sectional study of older adults in Blekinge, Sweden

BACKGROUND AND AIMS

eHealth literacy is important as it influences health-promoting behaviors and health. The ability to use eHealth resources is essential to maintaining health, especially during COVID-19 when both physical and psychological health were affected. This study aimed to assess the prevalence of eHealth literacy and its association with psychological distress and perceived health status among older adults in Blekinge, Sweden. Furthermore, this study aimed to assess if perceived health status influences the association between eHealth literacy and psychological distress.

METHODS

This cross-sectional study (October 2021-December 2021) included 678 older adults' as participants of the Swedish National Study on Aging and Care, Blekinge (SNAC-B). These participants were sent questionnaires about their use of Information and Communications Technology (ICT) during the COVID-19 pandemic. In this study, we conducted the statistical analysis using the Kruskal-Wallis one-way analysis of variance, Kendall's tau-b rank correlation, and multiple linear regression.

RESULTS

We found that 68.4% of the participants had moderate to high levels of eHealth literacy in the population. Being female, age [Formula: see text] years, and having a higher education are associated with high eHealth literacy ([Formula: see text]). eHealth literacy is significantly correlated ([Formula: see text]=0.12, p-value=0.002) and associated with perceived health status ([Formula: see text]=0.39, p-value=0.008). It is also significantly correlated ([Formula: see text]=-0.12, p-value=0.001) and associated with psychological distress ([Formula: see text]=-0.14, p-value=0.002). The interaction of eHealth literacy and good perceived health status reduced psychological distress ([Formula: see text]=-0.30, p-value=0.002).

CONCLUSIONS

In our cross-sectional study, we found that the point prevalence of eHealth literacy among older adults living in Blekinge, Sweden is moderate to high, which is a positive finding. However, there are still differences among older adults based on factors such as being female, younger than 75 years, highly educated, in good health, and without psychological distress. The results indicated that psychological distress could be mitigated during the pandemic by increasing eHealth literacy and maintaining good health status.

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

The role of digital health in revolutionizing healthcare delivery and improving health outcomes in conflict zones

The provision and planning for healthcare delivery in conflict is a pressing imperative. Healthcare within these environments is naturally complex, given the entanglement of affected populations, militaries and oft-deteriorating public services. The field of digital health, placed at the intersection of healthcare and technology, has the power to revolutionize healthcare delivery and improve health outcomes worldwide. Its impact is particularly significant in conflict zones, where it can address the unique challenges faced by these regions. Violence, damaged infrastructure, restricted mobility, forced migration, and overstretched healthcare facilities are all hallmarks of conflict zones that demand novel approaches to addressing them. Health care delivery is being revolutionized by the introduction of digital health technology in conflict zones, which are improving access, emergency response capacities, health information management, and mental health assistance. Doctors and aid organizations can more easily overcome challenges and reach out to underserved populations in these regions because to digital technological improvements. Recent decades have seen a shift in the nature of conflict, and with it, a corresponding shift in the range of digital health solutions available to address geographical, epidemiological, and clinical gaps. The purpose of this letter is to inquire into the application of digital health in conflict zones and its potential to lessen the pressing healthcare needs of affected communities.

Cut-off value of the eHEALS score as a measure of eHealth skills among rural residents in Gansu, China

Background

In this study, our aim was to quantify eHealth literacy and determine a cut-off value for eHEALS scores that signifies adequate eHealth literacy among rural residents in Gansu, China.

Methods

This cross-sectional investigation encompassed 18 rural areas across three cities-Lanzhou, Wuwei, and Dingxi-in Gansu. A total of 451 residents were recruited and underwent evaluations for both eHealth literacy and eHealth skills, utilizing the eHEALS and self-constructed tasks, respectively. A receiving operator characteristic curve was plotted with eHealth skills as the dependent variable and eHealth literacy levels as the independent variable, aiming to determine a cut-off value for eHEALS indicating adequate eHealth literacy and evaluate its predictive capacity.

Results

Among the 451 respondents, 10.9% did not possess a personal electronic device with Internet access, while 6.4% owned but had never used them. Within the remaining 373 residents, the mean eHealth literacy score was 25.85 (SD:10.93), item scores ranged from 3.12 (SD:1.45) to 3.42 (SD:1.60). Completion rates for three eHealth skills varied from 39.1% to 59.8%. The cut-off value was 29.5 determined by the Youden index. The area under the receiver operating curve was 0.829, with a sensitivity of 86.7%, and a specificity of 66.8%.

Conclusions

Our findings emphasized that eHealth literacy among rural residents remains at a low level. Moreover, we identified a cut-off value of 29.5 for eHEALS scores that signifies adequate eHealth literacy within this demographic.

Association of social capital with self-perceived eHealth literacy among community-dwelling older people: Age and gender differences

Background

Studies have confirmed that social factors, including social capital and eHealth literacy, are important in later life. Currently, few studies are available for determining the relationship between social capital and eHealth literacy, and whether such a relationship exists among older people and there are age and gender differences in the relationship remain unclear. Consequently, this study aimed to investigate the association between social capital and eHealth literacy, specifically examing its variations in age and gender.

Methods

A cross-sectional study of 4,257 residents aged ≥ 60 years and dwelling in the community was conducted across four cities in China. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social capital, and eHealth literacy. Generalized linear models were employed to assess these associations.

Results

There were 4,218 respondents (age 71.9 ± 7.2 years; 64.8% women). Overall, social participation, social connection, trust, cohesion, and reciprocity were all statistically associated with eHealth literacy (p < 0.05), while such an association was not observed for social support (p > 0.05). Specifically, a higher level of social participation was associated with better eHealth literacy scores among participants aged 70-79 years (p < 0.001), and a higher level of social connection was associated with better eHealth literacy scores for those aged 60-69 and 70-79 years (p < 0.001). Meanwhile, no gender differences in the associations were found.

Conclusion

There is an association between social capital and eHealth literacy in older men and women. The association varis with age. The findings provide a reference for developing targeted measures to improve self-perceived eHealth literacy among older people. It is essential for achieving active and healthy aging and developing the knowledge and understanding of relevant theories, concepts, and evidence within the field of health and social capital.

COVID-19-related fear, stress and depression in school principals: impacts of symptoms like COVID-19, information confusion, health-related activity limitations, working hours, sense of coherence and health literacy

BACKGROUND

School principals have been reported to have a higher prevalence of burnout and psychological problems than their colleagues. During the pandemic, extra workload and pressure from unprecedented situations potentially cause fear, stress and depression. Therefore, we aimed to explore associated factors of stress, fear of COVID-19 (F-CoV-19S) and depressive symptoms among school principals.

METHODS

A cross-sectional online survey was conducted in Taiwan from 23 June to 16 July 2021. Data of 413 school principals were collected, including socio-demographic factors, COVID-19-related factors, work-related information, health status, sense of coherence (SoC), health literacy (HL), F-CoV-19S, stress and depression. Multiple linear and logistic regression models were utilized to explore associations.

RESULTS

School principals with symptoms like COVID-19 (S-COVID-19-S), or with health-related activity limitations had a higher score of stress (B = 0.92; p = .039) (B = 1.52; p < .001) and a higher depression likelihood (OR = 3.38; p < .001) (OR = 3.06; p < .001), whereas those with a better SoC had a lower stress score (B = -1.39; p < .001) and a lower depression likelihood (OR = 0.76; p = .020). School principals confusing about COVID-19-related information had a higher score of stress (B = 2.47; p < .001) and fear (B = 3.77; p < .001). The longer working time was associated with a higher fear score (B = 1.69; p = .006). Additionally, school principals with a higher HL score had a lower stress score (B = -1.76; p < .001), a lower fear score (B = -1.85; p < .001) and a lower depression likelihood (OR = 0.53; p = .043).

CONCLUSIONS

Health-related activity limitations, S-COVID-19-S, COVID-19-related information confusion and longer working hours were positively associated with at least one mental health problem (e.g. stress, fear and depression), whereas better SoC and HL showed the benefits to mitigate fear, stress and depressive symptoms in school principals. Our study provides evidence for appropriate strategies to improve principals' mental health during the pandemic.Key messages:School principals with health-related activity limitations or with symptoms like COVID-19 were more likely to be stressed and depressed.Higher levels of stress and fear were observed in school principals who confused about COVID-19-related information, and who had longer working time than before the pandemic.Better sense of coherence and higher health literacy could potentially mitigate the fear, stress and depressive symptoms in school principals.

The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study

Background

The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management.

Objective

The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic.

Methods

In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed.

Results

A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries.

Conclusions

Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

Using search trends to analyze web-based users' behavior profiles connected with COVID-19 in mainland China: infodemiology study based on hot words and Baidu Index

Background

Mainland China, the world's most populous region, experienced a large-scale coronavirus disease 2019 (COVID-19) outbreak in 2020 and 2021, respectively. Existing infodemiology studies have primarily concentrated on the prospective surveillance of confirmed cases or symptoms which met the criterion for investigators; nevertheless, the actual impact regarding COVID-19 on the public and subsequent attitudes of different groups towards the COVID-19 epidemic were neglected.

Methods

This study aimed to examine the public web-based search trends and behavior patterns related to COVID-19 outbreaks in mainland China by using hot words and Baidu Index (BI). The initial hot words (the high-frequency words on the Internet) and the epidemic data (2019/12/01-2021/11/30) were mined from infodemiology platforms. The final hot words table was established by two-rounds of hot words screening and double-level hot words classification. Temporal distribution and demographic portraits of COVID-19 were queried by search trends service supplied from BI to perform the correlation analysis. Further, we used the parameter estimation to quantitatively forecast the geographical distribution of COVID-19 in the future.

Results

The final English-Chinese bilingual table was established including six domains and 32 subordinate hot words. According to the temporal distribution of domains and subordinate hot words in 2020 and 2021, the peaks of searching subordinate hot words and COVID-19 outbreak periods had significant temporal correlation and the subordinate hot words in COVID-19 Related and Territory domains were reliable for COVID-19 surveillance. Gender distribution results showed that Territory domain (the male proportion: 67.69%; standard deviation (SD): 5.88%) and Symptoms/Symptom and Public Health (the female proportion: 57.95%, 56.61%; SD: 0, 9.06%) domains were searched more by male and female groups respectively. The results of age distribution of hot words showed that people aged 20-50 (middle-aged people) had a higher online search intensity, and the group of 20-29, 30-39 years old focused more on Media and Symptoms/Symptom (proportion: 45.43%, 51.66%; SD: 15.37%, 16.59%) domains respectively. Finally, based on frequency rankings of searching hot words and confirmed cases in Mainland China, the epidemic situation of provinces and Chinese administrative divisions were divided into 5 levels of early-warning regions. Central, East and South China regions would be impacted again by the COVID-19 in the future.

Exploring the health information seeking behavior of social media users under the background of COVID-19 pandemic: An empirical study based on social cognitive theory

With the outbreak of COVID-19 in late 2019, people's awareness of actively searching for health information has been growing. Coupled with the promotion of "Internet + medical and health," social media, as an important platform for health information dissemination, has become one of the important information sources for users to obtain health information. However, health information seeking behavior in public health emergencies are quite different from those in daily life. Therefore, the research question of this paper is to explore the influencing factors of health information seeking behavior of social media users in the context of COVID-19. To this end, based on the research framework of social cognition theory, this paper selects six variables to construct a structural equation modeling, including information and platform quality, experience, social support, emotional arousal, self-efficacy, and social media users' health information seeking behavior. The empirical study is carried out by collecting 219 valid questionnaires. The research results show that: (1) Information and platform quality, and use experience have a significant positive effect on emotional arousal; (2) Experience, social support, and emotional arousal have a significant positive effect on self-efficacy; (3) Emotional arousal and self-efficacy have a significant positive effect on social media users' health information seeking behavior. The research provides an important theoretical reference for social media users and operators to cope with the huge demand for health information in the post-COVID-19 era.

Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study

Background

QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users’ perspective has been stated, research carried out from this point of view is still scarce.

Objective

This study aimed to assess the usefulness of using QR codes with information to promote women’s health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this.

Methods

A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach α values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained.

Results

In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach α value was .81. Overall, 83.7% of the answers to the first domain and 56.4% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores.

Conclusions

Using QR codes in the gynecology clinics’ waiting rooms can help promote women’s health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries.

Literacy and Mental Health of Portuguese Higher Education Students and Their Use of Health Promotion Strategies during Confinement in the COVID-19 Pandemic

The pandemic of COVID-19 caused significant changes in economies and societies with a major impact on the entire education process. However, these changes did not invalidate a constant effort of adaptation. This cross-sectional, descriptive, and correlational study used an online questionnaire administered to students from various study cycles at higher education institutions in Portugal, with the aim of exploring the influence of literacy and mental health on the use of mental health promotion strategies during COVID-19 confinement. A total of 329 students from higher education institutions participated in this study, mostly from the age group 18-24 years (n = 272; 82.7%) and female (n = 265, 80.5%). The most mentioned health promotion strategies during this period included studying (n = 170; 51.7%); physical activities (n = 151, 45.9%); social networking (n = 124, 37.7%); cooking activities (n = 120, 36.5%); and listening to music (n = 118, 35.9%). Academic success is self-reported, and it is weakly correlated with the MHI5 (r = 0.103, p = 0.063). Students in the pre-graduate programs studied more during the times of the pandemic and used this activity as a mental-health-promoting strategy with a statistically significant difference (p = 0.033). Although it was difficult to improve health literacy related to COVID-19 in such a short period of time, there was a very strong motivation to access, understand, evaluate, communicate, synthesize, and apply information and knowledge to maintain mental health through self-care using health promotion strategies.

The new role of nursing in digital inclusion: Reflections on smartphone use and willingness to increase digital skills among Chinese older adults

OBJECTIVE

This study explores the willingness of older adults to use smartphones and improve their digital skills and encourages nursing to actively participate in bridging the digital divide.

METHODS

Subject analysis was used to conduct qualitative research, and 23 older adults were interviewed.

RESULTS

We identified four themes: (1) the current situation of smartphone use; (2) the digital dilemma of smartphone use; (3) social support for digital skills; and (4) the willingness to learn digital skills. Older adults in China are willing to accept and use smartphones for simple operations, and peer learning may be an effective way to improve their digital skills.

CONCLUSION

Community support is necessary to develop the digital skills of older adults with smartphones and reduce the digital divide to the greatest extent possible. Nursing may play a role in promoting digital inclusion for older adults.

The relationship between eHealth literacy, social media self-efficacy and health communication intention among Chinese nursing undergraduates: A cross-sectional study

Background

With the popularization of the Internet, it has become possible to widely disseminate health information via social media. Medical staff's health communication through social media can improve the public's health literacy, and improving the intention of health communication among nursing undergraduates is of great significance for them to actively carry out health communication after entering clinical practice.

Objective

To explore the relationship among eHealth literacy, social media self-efficacy, and health communication intention and to determine the mediating role of social media self-efficacy in the relationship between eHealth literacy and health communication intention.

Design

A cross-sectional descriptive correlation design was used in this study.

Participants

Stratified cluster sampling was used to select 958 nursing students from four nursing colleges in Jiangsu Province, China, from June to July 2021.

Methods

Data were collected using the eHealth Literacy Scale, the Social Media Self-efficacy Scale, and the Health Communication Intention Questionnaire. Sociodemographic data were also collected. Correlation analysis and regression analysis were used to determine the relationship between eHealth literacy, social media self-efficacy, and health communication intention.

Results

Health communication intention is positively correlated with eHealth literacy and social media self-efficacy. There is a significant positive correlation between eHealth literacy and health communication intention (β = 0.57, p < 0.001), and social media self-efficacy played a mediating role in the influence of eHealth literacy on health communication intention (the mediating effect accounted for 37.2% of the total effect).

Conclusion

The study found that eHealth literacy and social media self-efficacy had an impact on health communication intention. Because there is a correlation between eHealth literacy and social media self-efficacy and health communication intention, in order to promote health communication intention of nursing students, it is also important to cultivate eHealth literacy and social media self-efficacy of nursing students. In view of these results, targeted educational programs must be developed to improve eHealth literacy and social media self-efficacy among nursing undergraduates, thereby promoting their health information transmission.

Exploring low-income migrant workers' health information-seeking behavior during COVID-19 in Taiwan: A qualitative study

Background

COVID-19 pandemic is reported to exacerbate existing vulnerabilities of marginalized groups, and the lack of self-care can lead to the spread of the virus across society. Therefore, effective responses to the challenges imposed by the health crisis should consider the health information needs of migrant workers.

Objective

We aimed to explore how migrant low-income workers seek health information and how their health-related information needs were met during a health crisis. We also investigated migrant workers’ preferred information sources and types of content with the theoretical concept of health literacy to understand the development of health competencies among migrant workers.

Methods

We conducted semi-structured interviews with Thai low-income migrant workers. A total of 13 Thai migrant workers participated in the study, among whom five were undocumented. The interviews were audio-taped, transcribed, and analyzed with the thematic analysis approach.

Results

Our findings indicated that migrant workers’ health literacy and health information behavior could be improved through technology when facing a health crisis. We found that participants sought health information proactively to reduce their perceived risks. However, there is still space for design to support the ability to process jargon information and apply local policy, such as providing easy-to-understand, accurate, and timely information. The findings of this study provide some insights for the authority and technological design to respond to migrant workers’ health information needs.

Conclusions

This study acknowledges and understands the needs of vulnerable migrant workers in society. The findings of this study provide insights for the authority and technological design to respond to migrant workers’ health information needs. We also outline the areas worth further investigation, such as the communication between information seekers and providers, and the navigation of the healthcare system for migrants in the host country.

The role of mobile health technologies in promoting COVID-19 prevention: A narrative review of intervention effectiveness and adoption

Background

Researchers have found innovative ways of using mobile health (mHealth) technologies to prevent the spread of coronavirus disease 2019 (COVID-19). However, fewer studies have been done to determine their adoption and effectiveness.

Objective

This review summarises the published evidence on the effect of mHealth technologies on the adoption of COVID-19 preventive measures, prevention knowledge acquisition and risk perception as well as technology adoption features for COVID-19 prevention.

Methods

PubMed, IEEE and Google Scholar databases were searched for peer-reviewed literature from 1 January 2020 to 31 March 2022 for studies that evaluated the effect of mHealth technologies on COVID-19 preventive measures adoption, prevention knowledge acquisition and risk perception. Thirteen studies met the inclusion criteria and were included in this review. All the included studies were checked for quality using the mHealth evidence reporting and assessment (mERA) checklist.

Results

The review found out that the utilisation of mHealth interventions such as alert text messages, tracing apps and social media platforms was associated with adherence behaviour such as wearing masks, washing hands and using sanitisers, maintaining social distance and avoiding crowded places. The use of contact tracing was linked to low-risk perception as users considered themselves well informed about their status and less likely to pose transmission risks compared to non-users. Privacy and security issues, message personalisation and frequency, technical issues and trust concerns were identified as technology adoption features that influence the use of mHealth technologies for promoting COVID-19 prevention.

Conclusion

Utilisation of mHealth may be a feasible and effective way to prevent the spread of COVID-19. However, the small study samples and short study periods prevent generalisation of the findings and calls for larger, longitudinal studies that encompass diverse study settings.