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

Self-care and associated factors of patients with permanent colostomies: A structural equation model

Objective

To investigate the structural relationships between eHealth literacy, health-promoting behaviors, depression, disease stigma, self-efficacy and self-care in Chinese patients with permanent colostomies.

Methods

A cross-sectional multi-stage random sampling study was conducted between October 2022 and July 2023. The study involved 280 participants with permanent colostomies recruited from four general hospitals in Yancheng City, China. Data were collected using a questionnaire package to assess model variables, including health-promoting behaviors, eHealth literacy, depression, disease stigma, self-efficacy and self-care. Structural equation modeling was employed to analyze the data.

Results

The model explained 81.8% of the total variance. Health-promoting behaviors (β ​= ​0.41, P ​< ​0.001), eHealth literacy (β ​= ​0.16, P ​< ​0.001), and depression (β ​= ​-0.17, P ​< ​0.001) influenced self-care directly. On the other hand, health-promoting behaviors, depression and disease stigma influenced self-care indirectly through self-efficacy mediation. The total, direct, and indirect effects of health-promoting behaviors and depression on self-care were 0.53 and -0.26, 0.41 and -0.17, and 0.12 and 0.09, respectively, in patients with colostomies.

Conclusions

This study highlights the importance of improving health-promoting behaviors, eHealth literacy, and self-efficacy in patients with colostomies. The study also suggests that reducing depression and disease stigma could enhance patients' self-care. Health care professionals can leverage these findings to develop appropriate programs to improve patients' self-care.

From experts' perspective, factors affecting the effectiveness of online educational programs in promoting the health literacy of MS patients: A grounded theory approach

BACKGROUND

Online educational programs have emerged as a promising tool for promoting health literacy (HL) among multiple sclerosis (MS) patients. However, identifying influencing factors is crucial for maximizing their effectiveness.

AIM

This study aimed to explain the factors affecting the effectiveness of online educational programs in promoting HL among MS patients in Iran.

METHODS

A qualitative methodology based on Grounded Theory (GT) was employed and participants were recruited using snowball sampling. A total of 17 experts, including patient educators and HL experts, were interviewed until theoretical saturation was achieved. Participants were selected from patient rehabilitation centers in Tehran and members of the Iran MS Society.

RESULTS

Analysis of the interview data revealed six contextual factors. These factors included socioeconomic status, healthcare infrastructure, technological accessibility and literacy, cultural and linguistic diversity, support networks and caregiver involvement, and health policy and regulatory environment.

CONCLUSIONS

Addressing socioeconomic disparities, improving technological access and literacy and fostering cultural sensitivity are essential steps to enhance the effectiveness and accessibility of these programs. Moreover, collaboration with caregivers and policymakers is crucial for creating an enabling environment that supports the successful integration of online health education initiatives into MS care.

PRACTICE IMPLICATIONS

Findings from this study can enhance the efficacy and productivity of online programs aimed at boosting HL among patients with specific conditions like MS.

Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial

Background

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC.

Objective

We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures.

Methods

STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions.

Results

Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59% vs benchmark: 50%), study assessment completion (9/10, 90% vs benchmark: 60%), dietitian appointment attendance (7/10, 70% vs benchmark: 60%), daily food intake logging adherence (6/10, 60% vs benchmark: 60%), and participant retention (10/10, 100% vs benchmark: 60%). Most participants rated the intervention as acceptable (8/10, 80% vs benchmark: 70%) and reported a high level of usability for dietitian services (10/10, 100%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study.

Conclusions

The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes.

Digital Health Literacy Questionnaire for Older Adults: Instrument Development and Validation Study

BACKGROUND

The integration of digital technology into older adult health and care has enhanced the intelligence of health and older adult care products and services while also transforming how seniors acquire and share health information. Assessing older adults' digital health literacy (DHL) is crucial for developing targeted interventions.

OBJECTIVE

This study aims to develop and validate a DHL assessment questionnaire for older adults. It also seeks to evaluate the questionnaire's scientific validity and feasibility among community-dwelling older adults in China, providing a reliable tool for assessing their level of DHL.

METHODS

A literature review, focus group discussions, and the Delphi method were used to construct the questionnaire item pool and perform item screening. Item analysis was conducted for comprehensive evaluation, and questionnaire validity was assessed through construct validity (exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity), content validity, and criterion-related validity. Reliability was analyzed using Cronbach alpha coefficient, split-half reliability, and test-retest reliability.

RESULTS

The study included 710 participants. Item analysis indicated that the questionnaire had strong discriminant validity. Correlation coefficient analysis showed that the item-total correlation coefficients ranged from 0.497 to 0.920 (P<.01). After multiple exploratory factor analyses, 6 common factors were extracted, with a cumulative variance contribution rate of 73.745%. Confirmatory factor analysis demonstrated a good model fit (χ2/df=2.803, root-mean-square error of approximation=0.071, comparative fit index=0.907, goodness-of-fit index=0.773, incremental fit index=0.908, Tucker-Lewis index=0.901, normed fit index=0.863). The questionnaire demonstrated favorable convergent validity, content validity, and criterion-related validity. The total Cronbach α coefficient was 0.976, with dimension-specific Cronbach α coefficients ranging from 0.819 to 0.952, indicating satisfactory internal consistency. Additionally, the test-retest reliability coefficient for the total questionnaire was 0.925, demonstrating good stability over time.

CONCLUSIONS

This study developed a questionnaire specifically designed to assess DHL in older adults through a scientifically rigorous and systematic process. The questionnaire demonstrates strong psychometric properties and can serve as an empirical tool for health professionals to design personalized intervention policies and enhance health service delivery.

Understanding Chinese adults' attitudes toward nurse prescribing: A national cross-sectional study

BACKGROUND

Limited studies have investigated the attitudes of Chinese adults toward the role of nurse prescribing, particularly based on population-based cross-sectional research.

OBJECTIVE

To investigate the associations of socio-demographic and health-related factors with the acceptance of the role of nurse prescribing.

DESIGN

A cross-sectional study.

SETTING

In China.

PARTICIPANTS

A total of 30,054 participants were included in this study.

METHODS

We employed univariate generalized linear model and multivariable generalized linear model analyses to explore the factors that were associated with the acceptance of the role of nurse prescribing.

RESULTS

Individuals of older age (β: 0.08, 95 % CI: 0.05-0.10) and residing in the Western region of China (β: 1.99, 95 % CI: 1.29-2.70), with average monthly household income per capita in the range of 3001-6000 (β: 2.58, 95 % CI: 1.84-3.32) and ≥ 6001 (β: 3.90, 95 % CI: 3.01-4.80), as well as those reporting higher levels of perceived social support (β: 0.46, 95 % CI: 0.35-0.56), better self-rated health status (β: 0.15, 95 % CI: 0.14-0.17), and increased eHealth literacy (β: 0.61, 95 % CI: 0.53-0.68), tend to demonstrate an inclination toward accepting nurse prescribing.

CONCLUSIONS

These findings provide valuable insights for healthcare policymakers and practitioners aiming to promote the integration of nurse prescribing into the Chinese healthcare system. Our results emphasize the need for targeted interventions to address barriers to acceptance and enhance the accessibility and utilization of nurse-prescribing services among diverse demographic characteristics.

eHealth Literacy and Trust in Health Information Sources

INTRODUCTION

The spread of health-related information across the internet necessitates an evaluation of public eHealth literacy, trust in different health information sources, including healthcare providers, and how eHealth literacy is related to trust in different sources.

METHODS

407 individuals participated in a web-based survey in the Tabuk region of Saudi Arabia. Univariate analysis was used to evaluate the relationships between eHealth literacy and demographic variables, and multiple linear regression was used to measure the relationship between eHealth literacy and trust in health information sources after adjustment for demographic factors.

RESULTS

The average eHealth literacy of the respondents was 27.17 out of 40. eHealth literacy levels were higher among females, younger age groups, those in the higher-education category, and those with a chronic disease or currently on medication. For 51.9% of participants, physicians and healthcare workers were their main source of health information, while 40% considered the internet their main source. None of the study participants perceived physicians and healthcare workers as untrustworthy, and social media was the least trusted source. eHealth literacy was not related to trust in physicians and health workers but was positively associated with trust in specialized health websites and negatively associated with trust in social media.

CONCLUSIONS

The findings suggest that the public tends to prefer and trust physicians and other healthcare workers as a primary source of health information, regardless of their eHealth literacy levels. A higher eHealth literacy level was associated with trust in specialized health websites and distrust in social media.

Health literacy in adults with a spinal cord injury or disorder: An updated and expanded systematic review

BACKGROUND

The importance of health literacy in personal health management is widely recognised in the general population, yet remains poorly understood in some patient groups, including people with spinal cord injury or disorder (SCI/D).

OBJECTIVES

The systematic review had two objectives: (1) to determine the health literacy levels of individuals with SCI/D, and (2) to identify facilitators and barriers to developing health literacy in this group.

METHODS

Seven databases (CINAHL, Embase, Emcare, ProQuest, PsycINFO, PubMed, and Web of Science) were searched from inception, with an updated search completed on January 21, 2025. Study quality was evaluated (QualSyst Checklist) and both quantitative and qualitative research narratively summarised by our research aims.

RESULTS

Seven quantitative studies and one qualitative study (N = 2471 participants) published from 2005 to 2022 were included. All demonstrated good methodological rigour. Most participants reported having sufficient health literacy. Those with higher health literacy were more likely to have higher education and socio-economic advantage, and to experience better physical and mental health outcomes. Evidence regarding the role of SCI/D variables in developing health literacy capacity was limited.

CONCLUSIONS

Health literacy remains an under-researched topic in the SCI/D literature. Further studies are needed to examine how health literacy can impact health behaviours and overall health for this group. This research would also benefit from focusing on personal experiences of health literacy development.

The Cross-Sectional Association of Health Literacy With Healthy Lifestyle Behaviors in the Turkish Population: A Systematic Review and Meta-Analysis

OBJECTIVE

To meta-analytically investigate the cross-sectional association between health literacy (HL) and healthy lifestyle behaviors (HLBs) in the Turkish population.

DATA SOURCE

Web of Science, PubMed, Scopus, EBSCO, DergiPark, TRDizin, and Türkiye Council of Higher Education Thesis Center.

EXCLUSION CRITERIA

Not accessible in Turkish or English in full text; not on the Turkish population; addressed e-HL, digital HL, mobile HL or corporate HL; addressed HL in a specific context; did not seek any association between HL and HLBs.

INCLUSION CRITERIA

Cross-sectional studies that reported a correlation coefficient or any convertible equal statistical measure for the association between HL and HLBs.

DATA EXTRACTION

Two reviewers independently screened the articles, extracted the data from the included studies into a structured form and assessed their methodological quality.

DATA SYNTHESIS

We conducted meta-analyses and reported the characteristics, outcomes, and quality assessment of studies.

RESULTS

Of 3833 records accessed we included 52 that fulfilled the eligibility criteria. Our primary findings demonstrated positive low-to-moderate associations between HL and health-promoting behaviors (r = .32 [CI:.30-.35; I2 = .00]), HL and physical activity (r = .23 [CI:.18-.27; I2 = .12]), and HL and vaccination (r = .12 [CI:.07-.17; I2 = .00]). In contrast, HL was not significantly associated with non-smoking (r = .02 [CI:-.02-.36; I2 = .09]), healthy diet (r = .02 [CI:-.01-.06; I2 = .00]), and screening (r = .07 [CI:.04-.11; I2 = .07]). However, our sensitivity and meta-regression analysis results suggested that the association of HL with healthy diet seems to increase with age. On the other hand, we failed to find any convincing evidence of any of the included variables affecting the association between HL and all types of HLBs (r = .17, I2 = 95.81%).

CONCLUSION

HL has the potential to improve the HLBs of Turkish individuals, however, there is a need for better understanding of the possible underlying determinants of the association between them.

Decomposition and comparative analysis of urban-rural differences in eHealth literacy among nursing students: A multisite cross-sectional study

BACKGROUND

Investigating the urban-rural differences in eHealth literacy among Chinese nursing students is imperative for enhancing healthcare education and practice. This study aimed to investigate the factors that contribute to urban-rural differences in eHealth literacy among Chinese nursing students and measure their respective contributions.

DESIGN

A multisite cross-sectional study.

SETTINGS

In China.

PARTICIPANTS

A total of 967 nursing students were involved in this study.

METHODS

Multivariate linear regression models were used to explore the associations between sociodemographic and health-related factors and the eHealth literacy of Chinese nursing students. Additionally, Blinder-Oaxaca decomposition was employed to scrutinize the factors attributing to the urban-rural differences in eHealth literacy among Chinese nursing students, elucidating their respective contributions.

RESULTS

The mean eHealth literacy score for urban nursing students (mean: 20.26, SD: 3.61) exceeded that of rural nursing students (mean: 19.53, SD: 3.56) (p < 0.001). Blinder-Oaxaca decomposition analysis indicated that 84.82 % of the urban-rural differences in eHealth literacy among nursing students can be explained. The urban-rural differences are primarily explained by family health (40.05 %).

CONCLUSIONS

The study emphasizes the importance of tailoring educational curricula to address urban-rural differences in eHealth literacy among nursing students in China. Specifically, incorporating content related to family health in educational programs is crucial.

Association between health-promoting lifestyle and electronic health literacy among Iranian university students

BACKGROUND

E-health literacy is the skill of searching, finding, understanding, and evaluating health information from electronic information sources and using this information to diagnose or treat a health disorder. Adequate health literacy results informed decision-making, and reduced health risks. This study aims to investigate the relationship between eHealth literacy and health-promoting behaviors among students at Khalkhal University of Medical Sciences.

METHOD

This descriptive-analytical study was conducted with students who were selected using a census method. Three questionnaires were used: a demographic questionnaire, the Norman and Skinner eHealth literacy questionnaire, and the Walker Health-Promoting Lifestyle Questionnaire. Data were analyzed using SPSS version 26. Pearson correlation coefficients, independent t-tests, and analysis of variance were employed for comparisons. Multiple linear regression models were used to examine the relationship between eHealth literacy and health-promoting lifestyle, adjusting for some demographic variables.

RESULTS

A total of 255 participants were included in the study. The mean eHealth literacy score was 25.55 (SD = 6.4), and the mean health-promoting lifestyle score was 127.74 (SD = 23.59). There was a statistically significant difference in eHealth literacy scores based on economic status (P < 0.004). Pearson correlation analysis revealed a statistically significant correlation between the total eHealth literacy score and the health-promoting lifestyle score (r = 0.43, p < 0.001). According to the linear regression model, eHealth literacy significantly predicts health-promoting behaviors (β = 1.63, p < 0.001). Thus, each unit increase in eHealth literacy was associated with a 1.63 unit increase in the health-promoting lifestyle score.

CONCLUSION

The level of eHealth literacy and health-promoting lifestyle are both above moderate. Nevertheless, more work needs to be done to improve eHealth literacy, and health-related behaviors. It is recommended that new educational programs integrated into the curriculum for students including how to search the Internet, introduction to health-related databases, and a lesson on health-promoting behaviors.

Influence of social support on technophobia in older adults in urban communities: the mediating role of self-efficacy and e-health literacy, a cross-sectional study

OBJECTIVES

To explore the chained mediating role of self-efficacy and e-health literacy in the association between social support and technophobia in older adults in urban communities.

DESIGN

A cross-sectional study conducted from June 2023 to April 2024.

SETTING

This study was conducted in three districts of Taiyuan City, Shanxi Province, China.

PARTICIPANTS

The study enrolled 1658 older adults (> 60 years old) in urban communities in Taiyuan.

METHODS

The analyses included assessments using the technophobia, e-health, self-efficacy and social support scales, and the mediating effects of these indices were investigated using Model 6 in SPSS V.26.

RESULTS

The level of technophobia in older adults was found to be moderately high. Technophobia was negatively correlated with social support, self-efficacy and e-health literacy. Stepwise regression analysis showed that age, residential situation, health and the frequency of electronic device use were risk factors for technophobia (p<0.05). Social support could influence technophobia directly (β=-0.266). In addition, self-efficacy (β=-0.080) and e-health literacy (β=-0.098) significantly mediated the relationship between social support and technophobia.

CONCLUSION

Social support was found to affect technophobia in older adults via the independent or chained mediating effects of self-efficacy and e-health literacy.

Measuring Digital Health Literacy in Older Adults: Development and Validation Study

BACKGROUND

New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults' digital health literacy levels.

OBJECTIVE

This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample.

METHODS

We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses.

RESULTS

A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity.

CONCLUSIONS

This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels.

Improving the health literacy of persons with epilepsy

Improving health literacy can improve health. This essay reviews the resources available to help improve epilepsy health literacy, including websites, drug inserts/labels/information leaflets, patient educators, handouts, plain language, lay summaries, and other efforts to close the gaps between research and epilepsy health literacy.

"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.

The impact of digital literacy in enhancing individuals' health in China

BACKGROUND

Health is the cornerstone of individual well-being and a vital factor in socioeconomic development. In an increasingly digitalized world, digital literacy has emerged as one of the indispensable abilities, which not only pertains to an individual's capacity to acquire, analyze, evaluate, and utilize information but also profoundly influences their health behaviours, health decisions, and overall well-being. This paper uses the 2020 China Family Panel Studies (CFPS) data to explore digital literacy's impact on individuals' health.

METHODS

By using the Entropy-TOPSIS method, this paper calculates digital literacy as a three-dimensional construct and adopts Ordered Probit and OLS models to analyze the impact of digital literacy on physical and mental health. Additionally, this paper employs the Two-Stage Least Squares (2SLS) to address endogeneity issues. The indirect effects of income, employment quality, and informal social support on individual's digital literacy and health nexus are also examined by the mediation effect model.

RESULTS

The results indicate that digital literacy positively impacts individuals' physical and mental health, which was confirmed by several robustness tests. The heterogeneity analysis shows that digital literacy is more effective in enhancing the health of middle-aged and older groups as well as rural individuals in China. According to mechanism analysis, digital literacy can enhance individuals' health by boosting income, improving employment quality, and expanding informal social support; however, the effects vary on physical and mental health.

CONCLUSION

Several policy suggestions emanate from the findings. To enhance the positive impact of digital literacy on individuals' health, the policy makers should emphasize on enhancing digital literacy particularly in rural areas and older age groups, bridging the digital divide, refining employment services and embracing a healthy concept of online social networking.

Effectiveness of eHealth literacy interventions: a systematic review and meta-analysis of experimental studies

BACKGROUND

eHealth Literacy (eHL) is a set of competencies and skills encompassing the knowledge, comfort and perceived ability to identify, evaluate and apply electronic health information to health problems. Given its role in the appropriate use of health technologies, ensuring equitable access to health information and improving patient outcomes, this study aims to systematically retrieve, qualitatively and quantitative pool and critically appraise available experimental evidence on the effectiveness of eHL interventions across different population groups.

METHODS

Following the PRISMA guidelines, we conducted a systematic review in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov, including original experimental studies quantifying the effectiveness of interventions aimed at increasing eHL, as assessed by the eHealth Literacy Scale (eHEALS) or other validated scales. We performed a random-effects model meta-analysis comparing changes in eHL levels before and after the interventions, and between the intervention and control groups. Heterogeneity was assessed using I2 statistics.

RESULTS

Out of the 504 studies retrieved, 15 studies conducted between 2011 and 2023 met the inclusion criteria. Target populations of eHL interventions included adults in 7 studies, older people in 5 and young people in 4. The meta-analysis included 10 studies that used the eHEALS. Participants showed a mean increase in eHEALS scores of 5.81 points (95% CI = 3.36-8.26, N = 1025) following the eHL interventions compared to the pre-intervention period. In the analysis between the intervention and control groups, we found a statistically significant difference in eHL improvement in favour of the intervention group, with mean eHEALS scores 3.62 points (95% CI = 1.63-5.60, N = 1258) higher in the intervention group than in the control groups. Subgroup analyses by intervention type, stratified by Collaborative Learning (CL) or Individualistic Learning (IL) showed significant increases in eHealth Literacy in the pre-post intervention analysis (CL: UMD = 5.19, CI = 0.01-10.38, N = 402; IL: UMD = 6.05; CI = 3.14-8.97, N = 623) and in the intervention vs. control analysis in the IL group (DMD = 4.98; CI = 1.77-8.12, N = 540).

CONCLUSIONS

Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights for evidence-based intervention design targeted to different population groups.

How to facilitate peer support - learnings from the development of a peer support program for people with T2DM via instant messaging service to improve diabetes self-management

This study explores the use of Instant Messaging Services (IMS) for peer support among individuals with Type 2 Diabetes Mellitus (T2DM). Leveraging the popularity of IMS within the affected age group, the DiabPeerS study implemented a peer support intervention aimed at improving long-term blood glucose levels (HbA1c) in a randomized controlled trial (RCT). This article describes the development and acceptance of the IMS intervention used in the DiabPeerS study. The intervention included a communication strategy and content designed for lay moderators to facilitate group interaction among people with Type 2 Diabetes mellitus (PWT2D). The intervention's acceptance was determined by conducting participant interviews, moderator meetings, and analysis of IMS chat protocols. Results indicate that the intervention was well-received, with participants engaging in meaningful exchange about diabetes self-management (DSM). However, those less familiar with online communication may benefit from preparational training and initial face-to-face meetings could enhance group cohesion. This research offers insights into the practical application of IMS for diabetes peer support, highlighting both its benefits and room for improvement.

The Digital Health Competencies in Medical Education Framework: An International Consensus Statement Based on a Delphi Study

Importance

Rapid digitalization of health care and a dearth of digital health education for medical students and junior physicians worldwide means there is an imperative for more training in this dynamic and evolving field.

Objective

To develop an evidence-informed, consensus-guided, adaptable digital health competencies framework for the design and development of digital health curricula in medical institutions globally.

Evidence Review

A core group was assembled to oversee the development of the Digital Health Competencies in Medical Education (DECODE) framework. First, an initial list was created based on findings from a scoping review and expert consultations. A multidisciplinary and geographically diverse panel of 211 experts from 79 countries and territories was convened for a 2-round, modified Delphi survey conducted between December 2022 and July 2023, with an a priori consensus level of 70%. The framework structure, wordings, and learning outcomes with marginal percentage of agreement were discussed and determined in a consensus meeting organized on September 8, 2023, and subsequent postmeeting qualitative feedback. In total, 211 experts participated in round 1, 149 participated in round 2, 12 participated in the consensus meeting, and 58 participated in postmeeting feedback.

Findings

The DECODE framework uses 3 main terminologies: domain, competency, and learning outcome. Competencies were grouped into 4 domains: professionalism in digital health, patient and population digital health, health information systems, and health data science. Each competency is accompanied by a set of learning outcomes that are either mandatory or discretionary. The final framework comprises 4 domains, 19 competencies, and 33 mandatory and 145 discretionary learning outcomes, with descriptions for each domain and competency. Six highlighted areas of considerations for medical educators are the variations in nomenclature, the distinctiveness of digital health, the concept of digital health literacy, curriculum space and implementation, the inclusion of discretionary learning outcomes, and socioeconomic inequities in digital health education.

Conclusions and Relevance

This evidence-informed and consensus-guided framework will play an important role in enabling medical institutions to better prepare future physicians for the ongoing digital transformation in health care. Medical schools are encouraged to adopt and adapt this framework to align with their needs, resources, and circumstances.

Prospective relationship between electronic health literacy and health-promoting lifestyle among Chinese older adults: A three-wave longitudinal study

BACKGROUND

Improving older people's health-promoting lifestyle (HPL) may slow the progression of health conditions and improve quality of life. Electronic health (eHealth) literacy is increasingly important for individuals managing health in the digital age. Previous cross-sectional studies have shown a positive association between eHealth literacy and HPL among older adults. However, no longitudinal studies have examined the association over time, their temporal relationship, and the potential underlying mechanisms.

OBJECTIVES

To examine the longitudinal association and temporal relationship between eHealth literacy and HPL among older adults, and to explore their underlying mechanisms based on the Integrated Model of eHealth Use (iMeHU).

METHODS

This longitudinal study was conducted among older adults in Jiangxi Province, China, from February to November 2022. Data were collected at baseline (T1) and 3-month (T2) and 6-month follow-up (T3), using online self-reported questionnaires. Older people's eHealth literacy and HPL were measured using the Digital Health Literacy Instrument and Health-Promoting Lifestyle Profile-II. Statistical analyses included Linear mixed model (LMM), cross-lagged panel model (CLPM), longitudinal mediation analysis, and multi-group analysis.

RESULTS

611 participants were included at T1; 464 (75.9%) completed the follow-ups at T2 and T3. The LMM results suggested that older individuals with higher eHealth literacy levels showed better HPL over time (adjusted β = 0.31, 95%CI: 0.27-0.35, p < 0.001), after adjusting for covariates. CLPMs supported that eHealth literacy could predict older people's improved HPL subsequently, but not the reverse. Attitude towards eHealth mediated the relationship from eHealth literacy to improved HPL, with a mediated proportion of 17.2%. In addition, the prospective relationships were stronger and only significant in older patients.

CONCLUSIONS

From a longitudinal perspective, this study highlighted the important roles of eHealth literacy and attitude towards eHealth in improving older people's HPL, especially for the patients. The findings provide robust evidence and practical implications to develop targeted interventions.

How does mHealth benefit older Chinese adults' quality of life? Examining the roles of eHealth literacy, health motivation, and patient activation

Background

China is experiencing a rapid increase in its aging population, leading to the emergence of significant challenges to improve the quality of life (QoL) of older adults. The study aims to explore the potential benefits of using mobile health technology in improving the QoL for older Chinese adults.

Method

This study utilized a subsample of adults aged 60 and above from a cross-sectional, population-based national survey conducted among Chinese adults (N = 852). A moderated mediation analysis was conducted to investigate the impact of mHealth use on older Chinese adults' QoL, focusing on the mediating roles of eHealth literacy and patient activation and the moderating effect of motivation for health promotion and prevention.

Result

The results indicate that mHealth use directly enhances the QoL of older Chinese adults (β = .061, p < .001), and this effect is mediated by eHealth literacy and patient activation (β = .057, Boots 95% CI [.044, .072]). Furthermore, motivation for health promotion and prevention moderates the relationship between eHealth literacy and patient activation (β = .133, p < .001).

Conclusion

These results demonstrate the positive impact of mHealth use on the QoL of older Chinese adults and reveal the underlying mechanisms involving mental and physical factors. These findings underscore the significance of increased attention to promoting mHealth use among older Chinese adults and provide a new way to enhance eHealth literacy and patient activation by encouraging the adoption of mHealth products.

Advancing African American and hispanic health literacy with a bilingual, personalized, prevention smartphone application

Many online health information sources are generic and difficult to understand, but consumers want information to be personalized and understandable. Smartphone health applications (apps) offer personalized information to support health goals and reduce preventable chronic conditions. This study aimed to determine how the HealthyMe/MiSalud personalized app (1) engaged English-speaking African American and Spanish-speaking Hispanic adults, and (2) motivated them to set goals and follow preventive recommendations. Our study adds to the literature on digital health, health information seeking, and prevention. We used a multi-method approach, including community and participatory design principles, to learn about potential African American and Hispanic adult health app users and evaluate the app in two usability tests and a 12-month field test. Ninety-six African American and Hispanic adults downloaded the HealthyMe/MiSalud app and used it for a minimum of 36 weeks. We found they wanted personalized information on core prevention topics, and their health histories and goals affected how they rated topic relevance. African American females ages 18-34 were more likely to save an article aligned with family health history, and African American females aged 35-49, males age 50-64, and African American males overall were more likely to save an article aligned with their health goals. Our study revealed that a prevention app with personalized recommendations can support health information seeking and health literacy. These findings can help app developers, public health practitioners, and researchers when designing apps for groups of varying identities.

[Health literacy: Definition, assessment tools, state of the art in Europe, health consequences and ways to improve it]

The term "littératie" is derived from the English word "literacy", which refers to knowledge and skills in the fields of reading, writing, speech (or other means of communication) and calculation that allow people to be efficient and integrated into society. Health literacy is a recent concept that relies on the ability to find, understand, evaluate and communicate information in ways that promote, maintain and improve the health of the individual in various settings over the course of life. The objectives of this review are first of all to realize an overview on the health literacy of populations in Europe. Then, we propose to study the link between health literacy and health status (risk behaviors, chronic diseases, morbi-mortality, adherence to care and medical monitoring) and to study its medico-economic impact. We also analyzed the association between personalized therapeutic education and health literacy. Finally, we propose a review of the means put in place in the care system to improve the health literacy of the patients we manage.

The moderating role of e-health literacy and patient-physician communication in the relationship between online diabetes information-seeking behavior and self-care practices among individuals with type 2 diabetes

BACKGROUND

This study examined the moderating role of e-health literacy (eHL) and patient-physician communication in the relationship between online diabetes information-seeking behavior (online DISB) and self-care practices.

METHODS

A total of 1143 individuals with type 2 diabetes mellitus completed a cross-sectional survey assessing sociodemographic characteristics, data relating to diabetes clinical history, online DISB, eHL (eHealth Literacy Scale), aspects of patient-physician communication (IPC survey), patient self-care (Self-Care Inventory-Revised), and medication adherence (measure of adherence to prescribed diabetes medications). The data were analyzed using both bivariate (correlation) and multivariate (multiple linear regression) analyses using maximum likelihood estimation procedures in Mplus.

RESULTS

Our results showed online DISB significantly predicted diabetes self-care (p < 0.001) and medication adherence behaviors (p = 0.005). Lower Hurried Communication (p < 0.001, p = 0.03), higher Elicited Concerns (p = 0.005, p = 0.03), higher Explained Results (p = 0.03, p = 0.008), and higher eHL (p = 0.02, p = 0.02) were significantly associated with better self-care and medication adherence. Explained Results and eHL moderated the relationship between online DISB and both self-care and medication adherence.

CONCLUSIONS

Findings support the role of patient eHL and patient-physician communication in amplifying the positive impact of online DISB on patients' behavioral outcomes in diabetes.

Spatiotemporal dynamic and regional differences of public attention to vaccination: An empirical study in China

BACKGROUND

Internet searches offer an indicator of public attention and possible demand for certain things. Studying the spatiotemporal characteristics of the public's concern for vaccination can determine the spatiotemporal distribution of demand for vaccines in China, and capture the changes in the health awareness of the Chinese population, thus informing future vaccination strategies.

METHODS

Based on the collection of Baidu search indices for vaccination-related keywords in 363 cities in China, This paper seeks to explore the spatiotemporal changes and regional differences in public attention toward vaccination in China by using the seasonal index, seasonal concentration index, Herfindahl index, Moran index, and Dagum Gini coefficient.

RESULTS

The following findings are presented. First, there are significant seasonal fluctuations and unbalanced monthly distributions of vaccination-related public attention in China. Second, the public attention in Chinese cities shows the spatial characteristics of "leading in the east, followed by the central, western and northeastern regions". The spatial correlation of attention has been strengthened, and the high-high clusters are mainly distributed in the Beijing-Tianjin-Hebei (BTH), Yangtze River Delta (YRD), and Greater Bay Area (GBA) urban agglomerations. Third, regional differences in overall public attention narrowed in China, with intra-regional differences narrowing in seven regions (Northwest China, Central China, and so on), and intra-regional differences increasing in East China. The dominant role in the Gini coefficient changes from transvariation intensity to inter-regional differences.

CONCLUSION

Major public health emergencies stimulate the public's attention to health topics. Although the short-term increase in vaccination-related public attention was not observed to translate into a long-term increase in public vaccine literacy, the seasonal and regional differences in vaccination-related public attention in China have significantly narrowed before and after COVID-19, suggesting that the imbalance between public health literacy levels has improved.

Evaluation of the quality of depression-related information on Chinese websites and video platforms: a cross-sectional comparative analysis

Objectives

We aimed to assess the quality of information regarding depression on Chinese websites and popular video platforms.

Methods

We conducted searches on website platforms (Baidu, Bing) and video platforms (Bilibili, Douyin) using search terms "depression", "depressive disorder", "depression treatment", "depressive anxiety", "depressed patient", and "depressive symptoms". We collected the first 50 results with each search term in each platform. Each website and video included in this study was assessed using The DISCERN instrument (DISCERN), Journal of American Medical Association benchmark criteria (JAMA), Hexagonal Radar Schema (HRS), and Global Quality Scores (GQS).

Results

A total of 177 websites, 216 Bilibili videos, and 244 Douyin videos were included. Among all the platforms, websites had the highest median scores on DISCERN and HRS, at 33 and 2 respectively, but were still classified as "poor" and "very poor" according to the classification. Bilibili, Douyin, and websites had median scores of 3, 2, and 2 respectively in JAMA, indicating a moderate level of quality. Bilibili, Douyin, and websites all had a median score of 2 for GQS, and were of poor quality. Only the percentage score for JAMA was more than half of the weighted score, while none of the other scales reached half of the score. The median percentage scores of the websites in DISCERN, HRS, and GQS were higher than those of Bilibili and Douyin (P < 0.001). Compared to other sources, news media on websites and medical organizations on videos demonstrated higher quality (all P values < 0.05).

Conclusions

The findings of the study indicated an overall low quality of online depression information. Collaborative efforts between platforms and professionals are necessary to improve the comprehensiveness and quality of depression-related information available online. In addition, the platform needs to prioritize optimizing the algorithm of recommendations and present real high-quality health information to the audience.

Parents' or Guardians' Knowledge, Attitudes and Practices in the Prevention and Management of Childhood Myopia

INTRODUCTION

The aim of this study was to assess the knowledge, attitude, and practices (KAP) of parents or guardians regarding the prevention and management of childhood myopia.

METHODS

This cross-sectional study was conducted at the Department of Ophthalmology in the First Affiliated Hospital of Soochow University (Suzhou, China) between August 2023 and November 2023. Parents or guardians who willingly volunteered to take part in the study were surveyed using a self-designed questionnaire.

RESULTS

A total of 571 participants returned valid questionnaires, among whom 288 respondents (50.44%) fell within the 31- to 40-year age group and 474 respondents (83.01%) were identified as myopic. The mean KAP scores for the knowledge, attitude and practices dimensions were 23.34 ± 3.05 (possible range: 0-26), 46.47 ± 4.02 (possible range: 12-60), and 40.52 ± 7.07 (possible range: 11-54), respectively. Structural equation modeling analysis indicated that education had a direct effect on knowledge (estimate = 0.41, P = 0.038), while knowledge directly influenced both attitude (estimate = 0.40, P < 0.001) and practices (estimate = 0.36, P < 0.001). Also, attitude was found to have a direct impact on practices (estimate = 0.45, P < 0.001).

CONCLUSIONS

Parents or guardians had adequate knowledge, a positive attitude, and proactive practices towards the prevention and management of childhood myopia, which might be affected by their educational level. This comprehensive understanding of parental perspectives highlights the potential for targeted interventions in clinical settings to further enhance pediatric eye care.

Exploring the Relationship Between eHealth Literacy and Diabetes Knowledge, Self-Efficacy, and Self-Care Behaviors in Chinese Diabetic Patients: A Cross-Sectional Study

BACKGROUND

The importance of online educational resources enhancing self-management among patients is underscored by the growing prevalence of diabetes. It is crucial to comprehend how patients with diabetes in China seek diabetes-related information and use mobile applications (apps) designed for diabetes management. Although the Knowledge-Attitude-Practice theory plays an integral role in diabetes management, in-depth studies on eHealth literacy (eHL) and Knowledge-Attitude-Practice in populations with diabetes remain scarce.

PURPOSE

This study was developed to provide insights into the online information-seeking behaviors of and diabetes apps used by individuals living with diabetes by exploring the relationships among eHL, diabetes knowledge, self-efficacy, and self-care behaviors.

METHODS

A cross-sectional survey was conducted from November 2022 to June 2023 on 380 inpatients with diabetes at the Yantai Yuhuangding Hospital in Shandong Province. The participants voluntarily completed surveys covering sociodemographic characteristics, diabetes status, diabetes app usage, online diabetes information searching, eHL, diabetes knowledge, self-efficacy, and self-care behaviors. Structural equation modeling analyses were employed to assess model fitness and the interrelationships between latent constructs and observable variables.

RESULTS

Of the 380 participants, 57.1% (217/380) reported actively seeking diabetes information online, whereas only 3.7% (14/380) had used diabetes apps. eHL was shown to have a direct effect on diabetes knowledge (β = 0.377, p < .001) but no direct impact on self-care behaviors (β = 0.017, p = .860). However, an indirect effect on self-care behaviors was observed via diabetes knowledge and self-efficacy.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this study indicate that, despite widespread online information-seeking behavior, diabetes app utilization remains limited in China. Also, the findings indicate enhancing patients' eHL contributes to more comprehensive diabetes knowledge. Furthermore, eHL was shown to influence self-care behaviors via diabetes knowledge and self-efficacy. A self-managed intervention strategy should be developed to improve eHL that utilizes internet resources to improve patients' knowledge and self-efficacy and promote better self-care behaviors.

Study protocol: A national cross-sectional study on psychology and behavior investigation of Chinese residents in 2023

Introduction

This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi-center and large-sample cross-sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically.

Methods

The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one-on-one and face-to-face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis.

Discussion

Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population.

Trial Registration

This study was filed in the National Health Security Information Platform (Record No.: MR-37-23-017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review

AIM

To explore what Internet-based breastfeeding peer support offers to breastfeeding parents.

DESIGN

Integrative review.

DATA SOURCES AND REVIEW METHODS

A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted.

RESULTS

The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices.

CONCLUSION

Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging.

IMPACT

These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

This was an integrative review therefore no patient or public contribution was necessary.

Assessment of the psychometric properties of the eHealth Literacy Scale for Brazilian adolescents

With the increase in digitalization of adolescents and health services, the population must demonstrate digital health literacy skills to be able to navigate online health information, as well as identify, evaluate, and apply relevant information. The present study aimed to investigate the psychometric properties of the adapted version of the eHealth Literacy Scale (eHEALS-BrA) for Brazilian adolescents. This study was conducted between September 2022 and May 2023, involving a total of 260 adolescents aged 13 to 19, with a mean age of 15.64 years (SD = 1.84), all of whom were enrolled in public schools in Brazil. Structural validity was evaluated by confirmatory factor analysis (CFA). The reliability of the instrument was assessed using Cronbach's alpha (α) and McDonald's omega (ω), and test-retest reliability. Questionnaires about sociodemographic aspects, health-related characteristics, and internet use were administered and used as discriminant validation measures. Convergent Validity was determined by correction with the domains of the World Health Organization Quality of Life-Bref (WHOQOL-Bref) instrument. For test-retest reliability, 67 participants completed the eHEALS-BrA a fortnight later. The average eHEALS-BrA score was 28.05 points (SD = 5.05). CFA revealed that the model with the best fit had a single factor (χ2 = 49.884 [df = 20, p = 0.0002], CFI = 0.934, TLI = 0.908, RMSEA = 0.076(CI:0.05-0.10), and SRMR = 0.045). The instrument demonstrated good reliability, with satisfactory internal consistency (α and ω = 0.71) and stability (ICC = 0.82, 95% CI:0.70-0.89). The eHEALS-BrA was correlated with the physical, psychological, and environmental domains of the WHOQOL-Bref (p = 0.001) (convergent validity). Higher scores were found among male adolescents, individuals who practiced physical activity, those with better self-rated health, those who considered the internet useful for searching for health information (discriminant validity), and those with better self-rated skills related to using the internet (convergent validity) (p < 0.05). The eHEALS-BrA demonstrated adequate psychometric properties for measuring digital health literacy in Brazilian adolescents.

Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data

BACKGROUND

Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine.

OBJECTIVE

This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data.

METHODS

Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders.

RESULTS

A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders.

CONCLUSIONS

The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics.

A Cross-Sectional Study Identifying Medication Adherence Technologies (MATech) in Sweden Using Behavior Change Techniques

Background

Poor medication adherence is a well-recognized problem, and behavior change techniques (BCTs) have shown promise in improving patient adherence to prescribed drug treatment. Through the utilization of medication adherence technologies (MATech), these BCT interventions could be delivered effectively in a person-centered way. MATech can be defined as systems, services or physical devices (hardware), with a digital component, used to support patients in their drug utilization. However, there is a lack of knowledge regarding their availability and to what extent they apply evidence-based BCTs.

Purpose

This study aimed to identify and describe MATech with BCT interventions available in the Swedish language.

Methods

A cross-sectional survey study was conducted in 2023. After identifying potential MATech developers by contacting umbrella organizations in the private sector, public agencies and regions, and conducting an app search, a survey was distributed to 381 potential MATech developers. Included MATech were in Swedish, used by patients, incorporated a BCT intervention, and had survey response from the developer. The survey was based on the BCT taxonomy and the framework of attributes from the COST ENABLE project, and included questions regarding BCT features. Following correspondence with 189 potential developers, 32 with products of interest responded to the survey, and 21 MATech were identified (12 standalone software and nine hardware solutions).

Results

Among the 21 MATech identified, nine were hardware and ten were specifically designed for a particular disease or medication. The majority of technologies incorporated BCTs of reminding the patient to take the medication (81%), information about the treatment (71%) and providing feedback on the monitoring of medication adherence or clinical outcomes (76%).

Conclusion

Swedish-language MATech employing BCTs are available, encompassing both hardware and software solutions. There is a need to enhance the visibility of these technologies, enabling patients to discover and utilize the support they provide.

The level of electronic health literacy among older adults: a systematic review and meta-analysis

BACKGROUND

In the context of deeper integration of the internet and healthcare services, eHealth literacy levels have become an important predictor of public health outcomes and health-promoting behaviors. However, there is a lack of comprehensive understanding of eHealth literacy levels among older adults.

OBJECTIVE

To systematically assess the level of eHealth literacy among older adults.

METHODS

We conducted searches in MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (Sinomed) to collect survey studies on the eHealth literacy levels of the older adults, with a search timeframe from the establishment of the database to May 2024. The quality of the included literature was assessed using the Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS). Additionally, subgroup analysis and meta-regression were conducted to detect sources of heterogeneity. Funnel plots and Egger's test were used to assess publication bias.

RESULTS

A total of 48 relevant studies were included, including 45 cross-sectional, 2 cohort studies and 1 longitudinal study, comprising 33,919 older adults. The quality of the studies was all above moderate, with 10 high-quality publications. Meta-integration results showed that the eHealth literacy score of older adults was 21.45 (95% CI:19.81-23.08). Subgroup analysis showed that among the elderly population, females had lower eHealth literacy at 19.13 (95% CI:15.83-22.42), those aged 80 years and older had lower eHealth literacy at 16.55 (95% CI:11.73-21.38), and elderly individuals without a spouse and living alone had even lower eHealth literacy at 18.88 (95% CI:15.71-22.04) and 16.03 (95% CI:16.51-21.79). Based on region, eHealth literacy was lower among older adults in developing countries at 20.71 (95% CI:18.95-22.48). Meta-regression results indicate that sample size and region can significantly impact heterogeneity.

CONCLUSION

Our results found that the average eHealth literacy score of the elderly was 21.45, which was much lower than the passing level (≥ 32), suggesting that more attention should be paid to the eHealth literacy aspect of the elderly. Meanwhile, due to the limitation of the literature sources, the global representativeness of the results of this study still needs to be supported by more research data from other countries.

Relationships Among eHealth Literacy, Physical Literacy, and Physical Activity in Chinese University Students: Cross-Sectional Study

BACKGROUND

eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one's understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL.

OBJECTIVE

This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables.

METHODS

In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables.

RESULTS

The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t636=4.94; P<.001) and PL (t636=3.18; P<.001), but no significant differences were found in eHealth literacy (t636=1.23; P=.22).

CONCLUSIONS

The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.

Electronic health Literacy gaps among adults with diabetes in the United States: Role of socioeconomic and demographic factors

Background

Digital health technologies hold promises for enhancing healthcare and self-management in diabetes. However, disparities in Electronic Health Literacy (EHL) exist among diabetes populations. This study investigates EHL trends and demographic differences among adults with diabetes in the United States from 2011 to 2018.

Methods

We analyzed data from the 2011-2018 National Health Interview Study (NHIS) on 27,096 adults with diabetes. The primary outcome was EHL, determined by responses to internet usage questions. Trends in EHL were assessed using the Rao Scott Chi-Square Test. Multivariate logistic regression was used to investigate the association between EHL and various comorbidities, socioeconomic and demographic subgroups.

Results

Analytic sample (N = 27,096) represents 10.6 million adults (mean age 62.3, 52.5 % Females) in the USA surveyed between 2011 and 2018. The mean rate of EHL was 38.9 % and trended upward from 35.3 % to 46.8 % over the 2011-2018 period. In a fully adjusted logistic regression model, multiple socioeconomic factors were associated with EHL. Age was inversely associated with odds of EHL (aOR 0.95, 95 % CI: 0.95-0.95). Black individuals had lower odds of EHL compared to Whites (aOR 0.63, 95 % CI: 0.56-0.71). Low-income (<100 % and 100-200 % of federal poverty limit) were negatively associated with EHL. Furthermore, limited English proficiency was associated with lower odds of EHL (aOR 0.29, 95 % CI: 0.22-0.38).

Conclusion

The study identified ongoing disparities in EHL among adults with diabetes based on age, race/ethnicity, income, and language proficiency, highlighting the need for targeted interventions to improve digital health access for all.

Associations between Digital Skill, eHealth Literacy, and Frailty among Older Adults: Evidence from China

OBJECTIVES

Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Data were collected from a cross-sectional survey of older adults aged ≥60 years in China.

METHODS

We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation.

RESULTS

A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = -0.108; 95% CI, -0.151 to -0.065) and eHealth literacy (β = -0.153; 95% CI, -0.195 to -0.112) were negatively associated with frailty score (P < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty.

CONCLUSIONS AND IMPLICATIONS

Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy.

Health literacy of older adults with musculoskeletal problems: A systematic review

INTRODUCTION

People with poor Health Literacy (HL) find it difficult to understand medical information in their daily lives, participate in health-related decision making and comply with medical instructions. The physical effects of ageing on the musculoskeletal system have a direct impact on skills related to the management of health problems. Many older adults have limited HL, which impacts their ability to fully engage in their care and their health status. The aim of this study is to conduct a systematic review of the published research regarding the prevalence of low HL and its impact on health outcomes of older adults with musculoskeletal problems.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, this review examined all peer-reviewed studies published in English, with specific pre-selected eligibility criteria.

RESULTS

The combined searches yielded 1617 records of which 19 articles were eligible for inclusion. The percentage of low HL varied across the studies of this review, ranging from 14% to 67%. In most studies, however, patients with limited HL were about 1/3 of the participants. Patients of lower educational level, male gender, older age, lower income, unemployment and different country of origin had lower HL level. Low HL was also associated with worse health outcomes, especially adherence to treatment, pain, functionality and health status.

DISCUSSION

It is of major importance to conduct educational interventions aimed at enhancing HL in this patient group, as these will contribute to the empowerment and the promotion of appropriate health behaviors of these patients.

Effects of eHealth literacy on maternal and neonatal outcomes

eHealth literacy plays a crucial role during pregnancy, as maternal health behavior can influence health outcomes for both mother and child. This study assessed the impact of eHealth literacy on maternal-fetal health outcomes through a cross-sectional analysis of 1,265 pregnant women admitted to a tertiary maternity hospital in Turkey between April and July 2022. Data on sociodemographic information, obstetric variables, birth outcomes, Internet usage, and eHealth Literacy Scale (eHEALS) were collected. Kolmogorov-Smirnov, Mann - Whitney U, Kruskal-Wallis, and Spearman correlation were used for data analysis. The median age of women was 28 years, and the mean gestational age was 38.6 weeks. Median eHealth literacy score was 21 (range:8-40). Pregnant women who had planned pregnancies, received spousal support, attended 9-12 antenatal care visits, received vaccinations, adhered to iron and folic acid supplementation, engaged in regular physical activity, and maintained regular sleep patterns exhibited higher eHealth scores (all p < .001). eHEALS scores were higher in women who experienced normal vaginal deliveries (p < .001), while lower eHEALS scores were noted in those with comorbidities (p = .001). The study suggested that higher eHealth literacy among pregnant women was associated with improved health-promoting behaviors, more favorable health perceptions, increased utilization of health services, and better maternal and fetal outcomes.

Online Health Information Seeking, eHealth Literacy, and Health Behaviors Among Chinese Internet Users: Cross-Sectional Survey Study

BACKGROUND

The internet has become an increasingly vital platform for health-related information, especially in upper-middle-income countries such as China. While previous research has suggested that online health information seeking (OHIS) can significantly impact individuals' engagement in health behaviors, most research focused on patient-centered health communication.

OBJECTIVE

This study aims to examine how OHIS influences health behavior engagement among Chinese internet users, focusing on the role of eHealth literacy and perceived information quality in influencing relationships.

METHODS

An online cross-sectional survey was conducted in November 2021 among 10,000 Chinese internet users, using quota sampling based on sex, age, and urban and rural residence, in line with the 48th Statistical Report on Internet Development of China. Nonparametric tests were used to examine the differences in eHealth literacy across sociodemographic groups. Partial correlation analysis and stepwise linear regression were conducted to test the associations between key variables. Confirmatory factor analysis and structural equation modeling were conducted to test the hypotheses.

RESULTS

Our study identified significant disparities in functional and critical eHealth literacy between urban and rural residents across age groups, income levels, education backgrounds, and health conditions (all P<.001). In terms of sex and regional differences, we found higher functional literacy among female users than male users, and critical literacy varied significantly across different regions. The proposed structural model showed excellent fit (χ2404=4183.6, χ2404=10.4,P<.001; root mean square error of approximation value of 0.031, 95% CI 0.030-.031; standardized root mean square residual value of 0.029; and comparative fit index value of 0.955), highlighting reciprocal associations between 2 types of eHealth literacy and OHIS. Participants' functional eHealth literacy, critical eHealth literacy, and OHIS have positive impacts on their health behavioral engagement. Perceived information quality was found to mediate the influence of OHIS on health behavior (b=0.003, 95% CI 0.002-0.003; P<.001).

CONCLUSIONS

The study revealed the pathways linking sociodemographic factors, eHealth literacy, OHIS, and perceived information quality and how they together influenced health outcomes. The findings underscore the significance of enhancing eHealth literacy and improving information quality to promote better health outcomes among Chinese internet users.

The mediating impact of exercise frequency and duration on the relationship between digital health literacy and health among older adults: A cross-sectional study

Although several studies have discussed the relationships among digital health literacy, health, and exercise behavior, few have integrated these 3 factors into a single model. This study aims to address this research gap. This article aims to analyze the impact of digital health literacy on the health of older adults, as well as the mediating mechanisms related to exercise frequency and duration. A cross-sectional survey was conducted in Luoyang and Zhengzhou urban areas from December 2023 to January 2024. Utilizing random sampling methods, data were collected from 661 older adults through the "digital health literacy scale," "health scale," and "count of exercise duration and frequency" questionnaires. The data were processed by employing SPSS 20 and Process, v3.0, and analyzed through independent samples t test, 1-way ANOVA (F-test), and mediation testing methods. The results indicate that no statistical significance (P > .05) is observed in terms of the 3 dimensions of digital health literacy, exercise behavior, and health status among older adults with different genders, living conditions, educational backgrounds, and economic status. In contrast, statistical significance (P < .05) is observed in terms of exercise frequency and health status among older adults with varying levels of smoking and drinking. The 3 dimensions of digital health literacy among older adults statistically impact (P < .05) their exercise duration, frequency, and health. The dimension of access and assessment exerts the most significant influence on exercise duration (β = 0.415) and a considerable impact on health (β = 0.214). Furthermore, the impact of exercise duration and frequency on health status is statistically significant (P < .05). In terms of the interactive capability dimension, exercise frequency exerts the most significant influence (β = 0.199). Digital health literacy has a significant impact on the health of older adults. The duration and frequency of exercise play a partial mediating role between older adults' digital health literacy and their physical health status. Digital health literacy can encourage older adults to increase the duration and frequency of exercise, which, in turn, promotes their physical health.

Digital health literacy among undergraduate nursing students in China: associations with health lifestyles and psychological resilience

BACKGROUND

Digital health literacy (DHL) is pivotal for individuals to access trustworthy health information and make informed decisions, closely intertwined with health behaviors and psychological resilience-these factors collectively shape an individual's approach to health management. Despite extensive research on digital health literacy in broader populations, the specific dynamics of digital health literacy in relation to health behaviors and psychological resilience among undergraduate nursing students in China remain understudied, highlighting a gap that this research endeavors to address. This study aims to assess the levels of digital health literacy among undergraduate nursing students in China, and to explore its association with health lifestyles and psychological resilience, which are considered influential factors.

METHODS

Employing a descriptive cross-sectional research design, eligible Chinese nursing undergraduates were surveyed from June to October 2023. This study recruited a total of 418 undergraduate nursing students. After excluding 11 students on leave, 407 students participated in questionnaire completion and submission. The College Students' Digital Health Literacy Scale, Healthy Lifestyle Assessment Scale and The Psychological Resilience Scale were used in this study.

RESULTS

The mean scores for digital health literacy, health lifestyles, and psychological resilience were 74.78 ± 8.44, 127.14 ± 11.22, and 79.21 ± 11.02, respectively. Pearson correlation analysis results indicated that the correlations between digital health literacy and both health lifestyles (r = 0.707, P < 0.01) and psychological resilience (r = 0.638, P < 0.01) were statistically significant and positive. The multiple linear regression analysis revealed that volunteer activity experience, academic performance, physical fitness, psychological traits, health lifestyle, and psychological resilience significantly predicted digital health literacy (F = 58.091, P < 0.001, R² = 0.678, adjusted R² = 0.666). Specifically, excellent academic performance (β = 0.210, P < 0.001) and good physical fitness (β = 0.188, P = 0.002) were the strongest predictors of higher digital health literacy.

CONCLUSIONS

There is a correlation between the digital health literacy of nursing undergraduates and their health lifestyles and psychological resilience. Future research should consider interventions in digital health literacy for undergraduate nursing students in China from the perspectives of health lifestyles and psychological resilience.

Patients with axial spondyloarthritis reported willingness to use remote care and showed high adherence to electronic patient-reported outcome measures: an 18-month observational study

Remote monitoring using electronic patient reported outcomes (ePROs) in axial spondyloarthritis (axSpA) may improve self-management and reduce the need for consultations. However, knowledge regarding patients' willingness to use remote care and adherence to reporting ePROs is scarce. The objective of this study was to assess axSpA patients' willingness to use remote care and adherence to reporting of ePROs. The study was part of a three-armed randomized controlled trial testing digital follow-up strategies (The ReMonit study, NCT: 05031767). AxSpA patients in low disease activity were randomized to usual care, remote monitoring, or patient-initiated care. Demographics, clinical data, and patients' willingness to use remote care were collected at baseline. EPROs were reported either monthly or quarterly by the remote monitoring- and patient-initiated care group over 18 months, respectively. Adherence to reporting was calculated as number of ePROs completed divided by the total number requested. Mixed model logistic regression was utilized to assess factors associated with adherence to reporting of ePROs. In total 242 patients (median age 43 years, 75% males) were included. The majority (96%) reported high willingness to use remote care. Adherence to reporting ePROs remained high over 18 months by remote monitoring and patient-initiated care groups [median (IQR): 88% (77-100) vs. 83% (66-100)]. No patient characteristics were significantly associated with adherence to reporting of ePROs. The high degree of willingness and adherence to reporting ePROs over time indicates that the majority of axSpA patients with low disease activity are motivated to use remote care.

The Digital Health Revolution: Exploring the Impact of Online Cancer Information on Self-Reported Preventive Behaviors

Cancer, one of the leading causes of death worldwide, is a disease characterized by uncontrolled cell growth within the body. While there have been many improvements in the treatment of cancer clinically, there is now an urgent need to improve cancer-related communication. This study explores the impact of online health information, specifically cancer-related information and prevention, among members of the general public. Through a randomized survey, we examined what information leads people to take action to minimize their cancer risk and communicate with their providers. Through evaluation of the various modes of communication, we were able to provide insight into which are more effective and better received by members of the general public. Through this, ways of bettering these avenues of communication and strengthening the bond between them will be highlighted and more easily elaborated on by future studies. The results of our study indicated that 60% of participants asserted that they are motivated by online preventive information to take steps to limit their cancer risk, while only roughly 44% of participants overall agreed that their doctor has communicated with them about when proper cancer screenings should be scheduled for the future. Although patients may be turning to the Internet now more than ever due to various reasons, when comparing self-reported rates of comprehension among the study participants, 35% agreed that the cancer-related information they can access online is confusing, while fewer than 22% of participants agreed that the cancer-related information they receive directly from their doctor is confusing. This is indicative of the limitations the Internet may have when undertaking the role of being a medical resource, especially when acting as a replacement for in-person medical appointments where patients can communicate directly with their physicians. Ultimately, these results provide a unique perspective into how people receive, evaluate, and implement cancer-preventive steps and general health-related information in a post-COVID-19 world, where the Internet is now strongly embedded in healthcare.

Association between health-related behaviors and obstructive sleep apnea among Korean adults

We aimed to investigate the association between health-related behaviors and obstructive sleep apnea (OSA) among Korean adults. A cross-sectional design using national open data was employed. Data from 8,096 adults aged 40 years and above who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2021 were analyzed. The participants' OSA risk level was assessed using the STOP-Bang questionnaire. A logistic regression analysis was performed to investigate the association between health-related behaviors and high risk for OSA. The association between health-related behaviors and OSA risk remained significant for former smokers (OR = 1.643) and high-risk drinking (OR = 1.365), after adjusting for variables that showed significant differences in general and metabolic characteristics. Implementing lifestyle modifications is crucial for mitigating the health and societal impact of OSA. Understanding and addressing modifiable risk factors, including high-risk drinking and smoking, should be prioritized in nursing intervention. Nursing interventions are critical for preventing and managing OSA among Korean adults. Prioritizing high-risk behaviors through cessation programs and education is essential. Vulnerability of individuals living alone must be addressed through community outreach and support services. Emphasizing routine screenings for pre-hypertension and pre-diabetes, promoting balanced nutrition, and encouraging physical activity are crucial.

Lightweight Authentication Scheme for IoT Based E-Healthcare Service Communication

Remote Patient Monitoring (RPM) using Electronic Healthcare (E-health) is a growing phenomenon enabling doctors predict patient health such as possible cardiac arrests from identified abnormal arrythmia. Remote Patient Monitoring enables healthcare staff to notify patients with preventive measures to avoid a medical emergency reducing patient stress. However weak authentication security protocols in IoT wearables such as pacemakers, enable cyberattacks to transmit corrupt data, preventing patients from receiving medical care. In this paper we focus on the security of wearable devices for reliable healthcare services and propose a Lightweight Key Agreement (LKA) based authentication scheme for securing Device-to-Device (D2D) communication. A Network Key Manager on the edge builds keys for each device for device validation. Device authentication requests are verified using certificates, reducing network communication costs. E-health empowered mobile devices are store authentication certificates for future seamless device validation. The LKA scheme is evaluated and compared with existing studies and exhibits reduced operation time for key generation operation costs and lower communication costs incurred during the execution of the device authentication protocol compared with other studies. The LKA scheme further exhibits reduced latency when compared with the three existing schemes due to reduced communication costs.

Why fall for misinformation? Role of information processing strategies, health consciousness, and overconfidence in health literacy

Health misinformation, defined as false or misleading claims lacking scientific evidence, poses a significant threat to public health. This paper investigates factors associated with the failure to discern misinformation, including health consciousness, information processing strategies, and inaccurate self-assessments of health literacy. Through an online experiment involving 707 English-speaking U.S. participants (mean age = 43 years, 56.2% female), we found that misinformation beliefs about nutrition, vaccination, vaping, and cancer were significantly correlated, implying susceptibility across health topics. Greater susceptibility was associated with higher health consciousness, lower objective health literacy, more elaboration, and more selective scanning. Results provided evidence for the Dunning-Kruger effect and metacognitive monitoring errors, whereby confident individuals were unaware of inadequate health literacy and showed poor misinformation identification. Findings suggest that promoting both health literacy education and cognitive reflection skills among the general adult population could empower them to more critically evaluate online health information.

The experiences of daily smartphone use among older adults in Brazil: A grounded theory analysis

Background

Digital inclusion of older people is an important agenda for the future and well-being of the older population, as it represents a form of social inclusion with significant gains for healthy aging. The present study aimed to understand the experiences of Brazilian older adults who use smartphones and the implications in their daily lives.

Method

A qualitative study was developed using a constructivist grounded approach. Older people (≥60 years) with prior access to a smartphone were invited to participate in the study. Participation took place through semi-structured, audio-recorded interviews. Data collection and analysis occurred simultaneously using a constant comparative approach. Data management and analysis used the Atlas.ti® software.

Results

Overall, 37 older people participated, with an average age of 70.60 ± 6.95 years, predominantly female (n = 33), white (n = 25), married (n = 26) and retired (n = 27). The first sample group included 27 older people with family support and the second group included 10 older people without family support (who lived alone in their homes). A core category emerged from the data analysis-"Expanding the personal and social development of older adults through smartphone communication"-around which three main categories emerged: 1) The smartphone as "a window to the world"; 2) The problem of misinformation and fake news on virtual networks; 3) Technological paradoxes in the use of smartphones.

Conclusions

The digital transition associated with smartphone use brings unimaginable benefits to older adults who adopt positive habits to improve their well-being and expand their social connections, following efforts proposed by the Decade of Healthy Aging. However, older adults still face disparities and experience a significant digital divide, which represents a major challenge. Barriers to access are further aggravated in developing countries. We hope this study contributes to public health policies on digital inclusion and healthy aging.

Association between social capital, mental health, and digital health literacy among the university students in China: a multigroup analysis based on major difference

BACKGROUND

This study aimed to clarify medical-nonmedical difference on the relationship between social capital, mental health and digital health literacy of university students in China, and furtherly provide evidence-based suggestions on the improvement of the digital health literacy for the university students.

METHODS

The snowball sampling method was used to collect data from the university students (including medical students and nonmedical students) through online questionnaires, and finally 1472 university students were included for the data analysis, of whom, 665 (45.18%) were medical students, 807 (54.82%) were nonmedical students; 462 (31.39%) were male, 1010 (68.61%) were female. Mean value of the age was 21.34 ± 2.33 for medical students vs. 20.96 ± 2.16 for nonmedical students. Descriptive analysis, chi-square test analysis, one-way Analysis of Variance (conducted by SPSS) and structural equation modeling (conducted by AMOS) were employed to explore the difference on the relationship between social capital, mental health and digital health literacy between the medical students and nonmedical students.

RESULTS

The mean value of the digital health literacy was 36.27 (37.33 for medical students vs. 35.39 for nonmedical students). The SEM analysis showed that there was a statistically positive correlation between social capital and digital health literacy (stronger among the nonmedical students (0.317) than medical students (0.184)). Mental health had a statistically positive impact on the digital health literacy among medical students (0.242), but statistically significant correlation was not observed in nonmedical students (0.017). Social capital was negatively correlated with the mental health for both medical students and NMS (stronger among the nonmedical students (0.366) than medical students (0.255)). And the fitness indices of SEM were same between medical students and nonmedical students (GFI = 0.911, AGFI = 0.859, CFI = 0.922, RMSEA = 0.074).

CONCLUSION

The digital health literacy of the university student was relatively high. Both social capital and mental health could exert a positive effect on digital health literacy, while social capital was found to be positively associated with mental health. Statistical difference was found between medical students and nonmedical students on the above correlations. Implications were given on the improvement of the digital health literacy among university students in China.

The relationship between peer support and sleep quality among Chinese college students: the mediating role of physical exercise atmosphere and the moderating effect of eHealth literacy

Background

Poor sleep quality has emerged as a prevalent health issue among college students. This study aims to explore the mechanism of sleep quality among college students by constructing a moderated mediation model.

Methods

The Peer Support Scale, Physical Exercise Atmosphere Scale, eHealth Literacy Scale and Pittsburgh Sleep Quality Index were used to conduct a survey and analysis on 1,085 questionnaires, which were distributed among students from four universities in the northwest, northeast and central regions of China.

Results

(1) A significant pairwise correlation exists between peer support, physical exercise atmosphere, eHealth literacy and sleep quality (P < 0.001); (2) Physical exercise atmosphere plays a mediating role between peer support and sleep quality, with a mediating effect accounting for 28.08%; (3) eHealth literacy can significantly moderate the strength of the relationships between peer support and exercise atmosphere, between peer support and sleep quality, and between physical exercise atmosphere and sleep quality. This study revealed the relationship between peer support and sleep quality among college students and its influencing mechanism, and provided theoretical and practical basis for improving college students' sleep quality from the perspectives of peer support, physical exercise atmosphere, and eHealth literacy.

Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly

Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.