Subdividing the digital divide: differences in internet access and use among rural residents with medical limitations

The impact of digital governance on the health of rural residents: the mediating role of governance efficiency and access to information

Background

Digital transformation in rural areas has become a key policy priority worldwide. China is also implementing a digital village strategy and actively promoting the digital transformation of rural governance to improve the well-being of rural residents. The literature suggests that digital governance is linked to health, but the mechanisms behind this relationship remain unclear.

Methods

Using data from the 2021 China Land Economic Survey (CLES), this paper examines the impact of digital governance on the health, longevity, and mental health of rural residents. To enhance the robustness of the conclusions, this paper also introduces a dual machine learning model to solve the endogeneity problem of the model.

Conclusion and discussion

This study concludes that digital governance has a significant positive impact on the health of rural residents. This finding remains consistent even after addressing endogeneity issues and conducting numerous robustness tests. Mechanistic analyses indicate that digital governance can enhance rural residents' health by improving village governance (environmental governance) and increasing the efficiency of access to personal information. Further analysis reveals that digital governance significantly increases the life expectancy of rural residents but that its effect on mental health is not significant. This study provides new insights into how digital governance affects health, with important implications for health policy development.

Barriers to Remote Burn Care Delivery: An Analysis of Burn Center Proximity and Access to Critical Telehealth Infrastructure

ABSTRACT

Mounting evidence supports the use of telehealth to improve burn care access and efficiency. However, barriers to telehealth use remain throughout the United States and may disproportionately affect specific populations, such as rural and non-English-speaking patients. This study analyzes the association between physical proximity to burn care and determinants of telehealth access.The relationship between telehealth-associated measures and proximity to burn care was analyzed with linear regression analysis. County-level data was sourced from the Agency for Healthcare Research and Quality's Social Determinants of Health Database (2020) and the American Community Survey (2021). County-level distances to the nearest American Burn Association (ABA)-verified burn center were calculated based on verified centers listed in the ABA burn center directory (n = 59). A subsequent analysis was performed on income-stratified datasets available for subset counties.Distance was negatively correlated with access to a smartphone (P < 0.0001), broadband internet (P < 0.0001), and cellular data plan (P < 0.0001) and positively correlated with the percent of households with no computing device (P < 0.0001) and no internet access (P < 0.0001). Analysis of income-stratified data revealed similar results. The percent population not speaking English well (P < 0.0001) at all (P = 0.0009) and the proportion of limited English-speaking households (P = 0.0001) decreased as a function of distance.People living furthest from an ABA-verified burn center in the United States are less likely to have adequate access to critical telehealth infrastructure compared to their counterparts living closer to a burn center. However, income impacts overall access and the degree to which access changes with proximity. Conversely, language-associated barriers decrease as distance increases.

Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients

OBJECTIVE

Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis.

METHOD

Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates.

RESULTS

Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04).

CONCLUSION

Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.

Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study

Objectives

This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women.

Methods

Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method.

Results

Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms.

Conclusion

There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.

Digital Determinants of Health: Health data poverty amplifies existing health disparities-A scoping review

Artificial intelligence (AI) and machine learning (ML) have an immense potential to transform healthcare as already demonstrated in various medical specialties. This scoping review focuses on the factors that influence health data poverty, by conducting a literature review, analysis, and appraisal of results. Health data poverty is often an unseen factor which leads to perpetuating or exacerbating health disparities. Improvements or failures in addressing health data poverty will directly impact the effectiveness of AI/ML systems. The potential causes are complex and may enter anywhere along the development process. The initial results highlighted studies with common themes of health disparities (72%), AL/ML bias (28%) and biases in input data (18%). To properly evaluate disparities that exist we recommend a strengthened effort to generate unbiased equitable data, improved understanding of the limitations of AI/ML tools, and rigorous regulation with continuous monitoring of the clinical outcomes of deployed tools.

Internet Healthcare Policy Analysis, Evaluation, and Improvement Path: Multidimensional Perspectives

Internet healthcare is a crucial component of the healthcare industry's digital transformation and plays a vital role in achieving China's Healthy China strategy and promoting universal health. To ensure the development of internet healthcare is guided by scientifically sound policies, this study analyzes and assesses current policy texts, aiming to identify potential issues and inadequacies. By examining 134 national-level policy documents, utilizing multiple research methods, including policy bibliometrics, content analysis, and the PMC Index Model, the study investigates policy characteristics, distribution of policy instruments, and evaluation outcomes related to internet healthcare. The study findings reveal that internet healthcare policies place emphasis on enhancing service quality, driving technological innovation, and promoting management standardization. Although policy instruments align with the current stage of internet healthcare development in China, they are plagued by imbalances in implementation. While policies are generally well-formulated, there are discernible discrepancies among them, necessitating the reinforcement and refinement of certain provisions. Hence, it is imperative to strategically optimize the amalgamation and implementation of policy instruments while concurrently endeavoring to achieve a dynamic equilibrium in policy combinations. Furthermore, policymakers should diligently refine the policy content pertaining to its nature and effectiveness in order to fully maximize policy utility.

Examining Disparities in Ownership and Use of Digital Health Technology Between Rural and Urban Adults in the US: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care.

OBJECTIVE

 To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey.

METHODS

 Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors.

RESULTS

The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers.

CONCLUSION

 We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

Video Games as a Complementary Therapy for Schizophrenia: A Systematic Review

BACKGROUND

Schizophrenia is a prevalent and serious disorder. Video games have shown potential as an aid in health care for people who suffer from schizophrenia. Although video games may contribute benefit in the treatment of schizophrenia, reviews on this topic are scarce. In this article, we systematically review the evidence concerning video game-based therapeutic interventions for people diagnosed with schizophrenia.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in the PROSPERO database. We searched 4 databases-PubMed, Web of Science, EMBASE, and clinicaltrials.gov-to identify original studies exploring video game-based therapeutic interventions for people with schizophrenia.

RESULTS

After initial screening, full-text review, and study selection, 11 articles were included in the review. Most studies used video consoles as the platform, with a minority using a personal computer. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas.

CONCLUSIONS

Cognitive training could be one of the main mechanisms underlying the usefulness and effectiveness of video game-based therapeutic interventions. Software optimization and greater collaboration between developers and health care professionals are some of the priorities for future research in this area.

Rural Latino health and the built environment: a systematic review

Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

Re-Prioritizing Digital Health and Health Literacy in Healthy People 2030 to Affect Health Equity

The U.S. Healthy People 2030 health objective-setting process has taken place in an inequitable social structure with significant implications for health literacy, health equity, and population health. The draft 2030 objectives have greatly reduced the number of digital health and health literacy objectives, meaning our national agenda is poised to capture only a fraction of what will evolve in digital and health literacy between 2020 and 2030. This paper synthesizes two decades of Healthy People data on health literacy and digital health objectives, highlights the digital health and health literacy trends and disparities that persist and proposes remedies to ensure that health literacy and digital health issues receive the attention they deserve in the next decade. These remedies can inform policies, research, and interventions that touch health communication and digital health issues.

The Doctor Will "Friend" You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features

OBJECTIVES

Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents' preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents' preferred weight management app features and elicit facilitators and barriers to app use.

METHODS

Using the qualitative content analysis method, 14 interviews with adolescents with overweight/obesity were conducted in rural and urban pediatric offices in South Carolina. Eligibility criteria included being 13 to 17 years old, having a body mass index at or above the 85th percentile for age and sex, and having access to a smartphone or tablet. Semistructured key informant interviews were conducted from May to October 2017. Participants were presented with three popular mobile health apps and asked to complete tasks and comment on their various features and usability. Summative content analysis coding was performed on interview transcripts, and interviews were conducted until thematic saturation was reached.

RESULTS

Seventy-one percent of participants were from a rural practice, 64% were White, and 86% had a body mass index higher than the 95th percentile. Familiarity with similar apps and accessibility of apps on their smartphones promoted app use. The need for wireless Internet, operating difficulties, or privacy concerns were barriers. Nutritional education, physical activity tracking, and social connection were desirable app features.

CONCLUSIONS

Adolescents have expressed preferred app features to help them manage weight; however, further work is needed to see whether these features are effective.

Size matters: locality of residence and media use in later life

Various factors determine the use of media in later life. Nevertheless, spatial inequalities among older media users have been accorded little attention in academic research. This study aimed to explore differences in variety (number) and intensity (duration) of both traditional and new media use among older adults residing in various types of localities. Data were obtained from the second wave of the ACT (Ageing + Communication + Technology) cross-national survey, comprising 7,927 internet users aged 60 and over from seven countries. The statistical analyses used in the study were chi-square and analysis of variance tests, and linear regression as a multivariate technique. The results indicated that spatial differences concern variety of media use to a greater extent than its intensity, especially with regard to use of traditional media via new devices. Overall, residents of large cities exhibited greater variety and intensity of media use than did their counterparts from smaller localities, especially rural ones. These findings supported the social stratification hypothesis – according to which individuals from more-privileged social backgrounds have better media literacy, use media to a greater extent and benefit from its use more than people from disadvantaged groups. The findings should be considered by practitioners and policy makers.

Prioritizing Benefits: A Content Analysis of the Ethics in Dementia Technology Policies

BACKGROUND

As the global prevalence of dementia rises, care costs impose a large burden on healthcare systems. Technology solutions in dementia care have the potential to ease this burden. While policies exist to guide and govern the use of dementia care technologies, little is known about how ethical considerations are incorporated into these documents.

OBJECTIVE

The goal of this study was to examine ethics-related content in dementia care technology policies.

METHODS

We used a two-step data mining approach to collect a sample of dementia technology policies. Policy documents were analyzed using emergent content analysis. Following the coding of the sample, thematic categories were organized using the principles of biomedical ethics as a framework.

RESULTS

A total of 23 policy documents from four Alzheimer associations in four countries were included in our analysis. General ethics considerations and themes related to beneficence were mentioned in 96% of the documents. Thematic categories related to justice were present in 74% of the sample, themes related to non-maleficence appeared in 52% of documents, and themes related to autonomy appeared in 43% of the sample.

CONCLUSION

While ethical considerations are present in existing policies for dementia care technology, these considerations revolve primarily around the benefit of the technologies. Further efforts are needed to provide formal guidance that incorporates both benefits and potential harms.

Interrelationship between Interpersonal Interaction Intensity and Health Self-Efficacy in People with Diabetes or Prediabetes on Online Diabetes Social Platforms: An In-Depth Survey in China

Objective: The peer interaction-based online model has been influential in the recent development of diabetes management. This model "extends and innovates" the traditional mode of doctor-patient guidance, transforming it into a mode in which both doctor-patient guidance and patient-patient interaction coexist; this new mode has the added advantage of offering "extended continual intervention." This study contributes to research on extending diabetes management models by investigating how patients with diabetes or prediabetes interact in online health communities, focusing on the interrelationship between self-efficacy characteristics and online participation during patient-patient interactions. Methods: In this cross-sectional study, participants with diabetes of various severities completed an electronic questionnaire, which was formulated with a revised classical scale. The questionnaire was disseminated through diabetes online health communities. Its content covered the respondent's general condition, self-evaluation of their self-efficacy, and participation in online health communities, specifically with respect to factors such as the time spent in online information each day, the number of groups joined, and the extent of interaction in diabetes online health communities, etc. The main observation indicators were the participants' self-efficacy, their extent of online participation, and the characteristics of online health communities. Descriptive statistics, chi-square test, linear trend estimation, and ordinal logistic regression were used to explore the relationship between the three indicators. Results: The self-efficacy scores ( x ¯ ± s) were 51.9 ± 9.12, and 59.1% of interviewed participants had self-efficacy scores greater than the mean. Overall, most participants (96%) considered online diabetes social platforms to be helpful. Groups differed with respect to interaction mode, which indicated that people with high self-efficacy tend to employ various modes of interaction. Participants with high self-efficacy were also more likely to live in cities (p < 0.05) and be married (p < 0.05) and tended to spend more time paying attention to group information (p < 0.05), spend more time viewing group information (p < 0.05), and have a greater degree of interaction with group members (p < 0.05). Information sources for the different grades of participants was primarily obtained from social media. Conclusion: Among people with diabetes, the frequency and intensity of online interaction might positively affect self-efficacy and, by implication, diabetes self-management. Diabetics with high self-efficacy also tend to have positive online interaction and adopt different ways of interaction. In addition, the diabetes information sources of the respondents mainly come from social networks, most of the respondents think that online social networking sites have a positive impact on diabetes self-management, which shows that social network plays an important role in diabetes information source of diabetics. However, the design of online health communities has room for improvement, specifically with respect to the provision of information that patients require. As an interesting side note, among people with diabetes or prediabetes, those who lived in urban area and were married, those who paid more attention to group information, and those who actively participated in interactions tended to have relatively high self-efficacy. The results suggest that people with diabetes have higher-quality self-care when they engage in online health community interactions; such benefits cannot be obtained from treatment in a hospital. In general, enhanced self-efficacy in people with diabetes enables them to more readily acquire diabetes-related knowledge. Online interaction with diabetics, who has the same experience, can not only get more information, but also have a sense of identity and belonging, which enhances self-efficacy and further urges them to actively participate in online interaction. Therefore, online health communities are an important supplement to the clinical treatment of diabetes mellitus and clinicians can take advantage of the educational function of online diabetes groups in their provision of tailored diabetes interventions and take into account the factors that affect the self-efficacy of diabetics (including the frequency and intensity of online interaction, age, marital status, residential area, etc.), to provide tailored diabetes interventions for diabetics. Such a use of online diabetes groups can strengthen diabetes self-management.

Communication strategies for designing Facebook advertising campaigns to recruit rural participants to develop healthcare delivery interventions

Background:

Little is known about designing research recruitment campaigns that connect with underserved, geographically isolated rural populations. A theoretically informed process is needed to assist research teams and practitioners in their evaluation of Facebook’s feasibility as a recruitment tool and development of online materials for recruiting rural adults into healthcare delivery intervention development studies.

Methods:

We drew from research and theory in communication and incorporated process analysis techniques to develop replicable procedures for designing and evaluating Facebook campaigns for rural recruitment. We describe our process and illustrate using two case studies.

Results:

Campaigns received approximately 1000 link clicks from the target rural demographic and successfully enrolled participants using Facebook as a primary method of recruitment. The rural tobacco intervention development study received a total of 477 link clicks, cost only $155.80, and enrolled three (23%) of its 13 participants from Facebook. The rural mental health intervention development study received a total of 518 link clicks, cost only $233.28, and enrolled 178 participants.

Conclusions:

Our process yielded two successful recruitment campaigns. Facebook was an affordable and efficacious strategy for enrolling adults in behavioral research studies on tobacco and mental health. Future work should apply these theoretical techniques to additional study topics and evaluate specific message features associated with recruitment.

An Online Pain Education Program for Working Adults: Pilot Randomized Controlled Trial

Background

Pain is a common public health concern, and the pain situation among the general population is serious in mainland China. Working adults commonly experience pain because of long sitting times, a lack of free time, and exercise. A lack of pain-related knowledge is also a significant factor. Educational and therapeutic programs delivered online were used more often in Western countries, and accessible programs in China are limited, especially for pain management. Therefore, we carried out an online pain education program for working adults to self-manage pain. The program was delivered through WeChat, a popular and secure social media with a large population base in China.

Objective

This study aimed to (1) provide pain-related knowledge and self-relief strategies, (2) help participants reduce pain and improve pain-related emotional well-being, and (3) explore participants’ learning performance and the acceptability of the online pain education program.

Methods

This was a randomized controlled trial. Chinese adults aged between 16 and 60 years with full-time employment, with pain in the past 6 months, and without any mental illness were recruited using snowball sampling through the internet and were randomly allocated to an experimental group and a control group in 1:1 ratio after the baseline assessment. The 4-week educational program that included basic knowledge of pain, pharmacological and nonpharmacological treatments, and related resources was provided only to the experimental group. Outcomes of pain, depression, anxiety, stress, and pain self-efficacy were measured at baseline (T0), posttreatment (T1), and 1-month follow-up (T2). Participants’ acceptability and satisfaction were explored after completing the educational program.

Results

In total, 95 eligible participants joined in the program: 47 in the experimental group and 48 in the control group. Neck and shoulder, head, and back were most commonly reported pain sites with high pain scores. Pain intensity and interference of the experimental group were significantly reduced after the educational program. Depression, anxiety, and stress clinically improved and pain self-efficacy improved after the educational program. The difference in depression, anxiety, stress, and pain self-efficacy within a group or between groups was not statistically significant; however, clinical improvements were demonstrated. A significant correlation between dosage of the intervention and pain intensity and depression was demonstrated. After completing the educational program, more than half of the participants showed acceptance of and satisfaction with the program, and they were willing to recommend the program to others.

Conclusions

Our findings highlight the significant potential of this online education program in the treatment of pain.

Trial Registration

ClinicalTrials.gov NCT03952910; https://clinicaltrials.gov/ct2/show/NCT03952910

The Association of Internet Use with Wellbeing, Mental Health and Health Behaviours of Persons with Disabilities

Introduction: There is strong evidence that people with disabilities suffer from a significant digital divide. However, there are reports indicating that Internet use may result in many benefits for those with disabilities. The aim of the study was to assess the impact that the use of the Internet has on the wellbeing and health behaviours of persons with disabilities. Methods: An analysis was carried out using the dataset obtained from Social Diagnosis, a panel study undertaken on a nationally representative sample. The records of persons with disabilities were retrieved from the dataset which was established in 2015. An analysis of the association between Internet use and the wellbeing, mental health and health behaviours of the respondents was undertaken. The variables reflecting the self-assessment of their own life and experience of loneliness were treated as being indicators of their wellbeing and the prevalence of suicidal thoughts or making use of psychological help as indicators of mental health. The health behaviours analysed in the study included smoking, excessive consumption of alcohol and undertaking physical activity. For all these variables, multivariate logistic regression models were developed. The effect of Internet use was adjusted for sociodemographic variables and the degree of disability. An analysis was performed after applying post-stratification weights available from the Social Diagnosis study. Results: The weighted study group consisted of 2529 people having a mean age of 59.33 ± 16.89 years. The group included 20.71% (N = 524) respondents with a mild, 41.58% (N = 1052) with a moderate, and 26.54% (N = 671) with a severe disability. The proportion of Internet users was 37.07% (N = 937). In all the regression models, Internet use had a significant impact on the dependent variables. After adjustment for sociodemographic variables and the degree of disability, the Internet users more frequently assessed their lives as happy (odds ratio, 95% confidence interval: 1.86, 1.47–2.37) and less frequently experienced loneliness (0.63, 0.49–0.81) or suicidal thoughts (0.47, 0.35–0.65). In addition, they needed psychological help less frequently (0.50, 0.35–0.72). Interestingly, Internet users undertook some form of physical activity or sport more often (2.41, 1.87–3.13) and fewer smoked cigarettes (0.70, 0.54–0.91) or consumed alcohol excessively (0.32, 0.19–0.56). Conclusions: The use of the Internet by people with disabilities was associated with improved wellbeing, better mental health and more beneficial health behaviours. These findings support the development of intensive actions to reduce the digital divide for the population of people with disabilities.

Meeting the needs of underserved populations: setting the agenda for more inclusive citizen science of medicine

In its expansion to genomic, epidemiological and biomedical research, citizen science has been promoted as contributing to the democratisation of medical research and healthcare. At the same time, it has been criticised for reinforcing patterns of exclusion in health and biomedicine, and sometimes even creating new ones. Although citizen science has the potential to make biomedical research more inclusive, the benefits of current citizen science initiatives are not equally accessible for all people-in particular those who are resource-poor, located outside of traditional networks of healthcare services, or members of minorities and marginalised groups. In view of growing public investments in participatory research endeavours, we argue that it should be considered more explicitly if, and how, citizen science could help make research more inclusive, contribute to the public good, and possibly even lead to better and more equitable healthcare. Reflecting on emerging ethical concerns for scientific conduct and best medical practice, we propose a set of relevant considerations for researchers, practitioners, bioethicists, funders and participants who seek to advance ethical practices of citizen-led health initiatives, and address profound differences in position, privilege and power in research.

Problematic smartphone use and related factors in young patients with schizophrenia

INTRODUCTION

The present study aimed to examine smartphone use in young patients with schizophrenia and to explore factors that may affect the severity of problematic smartphone use.

METHODS

A total of 148 schizophrenia patients aged 18 to 35 years completed self-administered questionnaires exploring sociodemographic characteristics; Smartphone Addiction Scale (SAS), the Big Five Inventory-10 (BFI-10), the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS), and the Rosenberg Self-Esteem Scale (RSES). All were also assessed using the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) Scale and the Personal and Social Performance (PSP) Scale.

RESULTS

The mean subject age was 27.5 ± 4.5 years. No significant differences in the SAS scores occurred between gender, jobs, and level of education. The Pearson r-correlation test showed that the SAS scores were significantly positively correlated with HADS anxiety, PSS, and BFI-10 neuroticism scores; it was negatively correlated with RSES, BFI-10 agreeableness, and conscientiousness scores. In the stepwise linear regression analysis, the severity of PSU was significantly associated with both high anxiety and low agreeableness.

DISCUSSION

Our results suggest that specific groups of patients with schizophrenia may require special care to prevent problematic smartphone use.

Willingness to use smartphone apps for lifestyle management among patients with schizophrenia

Mobile technology is a popular intervention mode for patients with schizophrenia because of its accessibility and functionality. We examined patients' willingness to use smartphone apps for lifestyle management and its effect on self-reported lifestyle habits. Five hundred fifty-five inpatients from various mental health institutions participated. Willingness to use smartphone apps was associated with age, education, income, device type, and body mass index. Positive opinions on smartphone app use were significantly associated with willingness to use apps, which was significantly associated with dietary and living habits. Thus, improving willingness to use apps can help patients improve their lifestyle, potentially preventing relapse.

Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study

BACKGROUND

Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals.

OBJECTIVE

The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC.

METHODS

We carried out a qualitative descriptive study of Kaiser Permanente Colorado's established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use.

RESULTS

Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants' intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use.

CONCLUSIONS

Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use.

The Use of Mobile Health to Assist Self-management and Access to Services in a Rural Community

The purpose of this study was to explore the barriers to and needs for using mobile health technology to assist low-income Asian American and Pacific Islander participants living in rural Hawaii in their healthcare. Three focus groups consisting of patients, family support/significant others, and providers (N = 19) were conducted to assess the unique needs of low-income Asian American and Pacific Islander patients in rural Hawaii. The electronic health literacy scale was also used among participants in the patients and family support/significant other groups. The total electronic health literacy means were 23.57 (SD = 9.71) among participants in the patient group, 34.50 (SD = 7.78) in the family support/significant others group, and 35.67 (SD = 4.56) in the providers group. The qualitative analysis yielded categories with three main themes: value of mobile health, stumbling blocks to mobile health, and mobile health wish list and subthemes. Practice implications include uses of these findings to integrate future versions of mobile health that will promote effective communication and information specifically to diverse low-income populations.

The Association Between Technology Use and Health Status in a Chronic Obstructive Pulmonary Disease Cohort: Multi-Method Study

Background

Telemedicine and electronic health (eHealth) interventions have been proposed to improve management of chronic obstructive pulmonary disease (COPD) for patients between traditional clinic and hospital visits to reduce complications. However, the effectiveness of such interventions may depend on patients’ comfort with technology.

Objective

The aim was to describe the relationship between patient demographics and COPD disease severity and the use of communication-related technology.

Methods

We administered a structured survey about the use of communication technologies to a cohort of persons in the COPDGene study at one midwestern hospital in the United States. Survey results were combined with clinical and demographic data previously collected as part of the cohort study. A subsample of patients also completed eHealth simulation tasks. We used logistic or linear regression to determine the relationship between patient demographics and COPD disease severity and reported use of communication-related technology and the results from our simulated eHealth-related tasks.

Results

A total of 686 patients completed the survey and 100 participated in the eHealth simulation. Overall, those who reported using communication technology were younger (P=.005) and had higher incomes (P=.03). Men appeared less likely to engage in text messaging (P<.001) than women. Patients who spent more time on tasks in the eHealth simulation had greater odds of a COPD Assessment Test score >10 (P=.02) and walked shorter distances in their 6-minute walk tests (P=.003) than those who took less time.

Conclusions

Older patients, patients with lower incomes, and less healthy patients were less likely to report using communication technology, and they did not perform as well on our simulated eHealth tasks. Thus, eHealth-based interventions may not be as effective in these populations, and additional training in communication technology may be needed.

Adherence with physical activity monitoring wearable devices in a community-based population: observations from the Washington, D.C., Cardiovascular Health and Needs Assessment

Wearable mobile health (mHealth) technologies offer approaches for targeting physical activity (PA) in resource-limited, community-based interventions. We sought to explore user characteristics of PA tracking, wearable technology among a community-based population within a health and needs assessment. In 2014-2015, we conducted the Washington, D.C., Cardiovascular Health and Needs Assessment in predominantly African-American churches among communities with higher obesity rates and lower household incomes. Participants received a mHealth PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n = 99) were 59 ± 12 years, 79% female, and 99% African-American, with a mean body mass index of 33 ± 7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed "PA device users." Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data collection hub may feasibly target PA in resource-limited communities.

Digital divide among people with disabilities: Analysis of data from a nationwide study for determinants of Internet use and activities performed online

Introduction

The Internet is both an opportunity as well as a challenge for people with disabilities. However, this segment of the population is usually indicated among social groups experiencing digital divide. The study is focused on the analysis of factors determining Internet usage and undertaking specific activities online among people with disabilities based on a nationwide study performed in 2013 in Poland.

Methods

Secondary analysis was performed on the data of persons who declared disability status in 2013 “Social Diagnosis” study. Multivariate logistic regression models were developed for the use of the Internet and performing three types of activities online.

Results

Among 3,556 respondents with disability 51.02% were females, 25.19% 65 years of age and over and 33.05% were Internet users. The predictors of Internet usage included the degree of disability, place of residence, level of education, marital status, occupational status, net income, use of health care service and the use of mobile phone. The odds ratio that a person with disability belonging to the oldest category will use the Internet was only 0.04 (95% CI 0.02–0.09), when compared to the youngest category. The odds that a person with disability from the highest category of education will use the Internet were 18 times higher than in the case of persons with only basic education (OR 18.17, 95% CI 11.70–28.21). Common predictors of online activities (accessing websites of public institutions, checking and sending emails, publishing own content on the Internet) included age category and net income.

Conclusions

People with disabilities in Poland are facing a significant digital divide. The factors determining the use of the Internet in this group are similar to those of the general population. On the other hand, people with disabilities who are active online, access diversified types of services including presentation of their own content online.

Diversity in Older Adults' Use of the Internet: Identifying Subgroups Through Latent Class Analysis

Background

As for all individuals, the Internet is important in the everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus nonusers and consequences of Internet use and nonuse. Older adults are a heterogeneous group, which may implicate that their use of the Internet is diverse as well. Older adults can use the Internet for different activities, and this usage can be of influence on benefits the Internet can have for them.

Objective

The aim of this paper was to describe the diversity or heterogeneity in the activities for which older adults use the Internet and determine whether diversity is related to social or health-related variables.

Methods

We used data of a national representative Internet panel in the Netherlands. Panel members aged 65 years and older and who have access to and use the Internet were selected (N=1418). We conducted a latent class analysis based on the Internet activities that panel members reported to spend time on. Second, we described the identified clusters with descriptive statistics and compared the clusters using analysis of variance (ANOVA) and chi-square tests.

Results

Four clusters were distinguished. Cluster 1 was labeled as the “practical users” (36.88%, n=523). These respondents mainly used the Internet for practical and financial purposes such as searching for information, comparing products, and banking. Respondents in Cluster 2, the “minimizers” (32.23%, n=457), reported lowest frequency on most Internet activities, are older (mean age 73 years), and spent the smallest time on the Internet. Cluster 3 was labeled as the “maximizers” (17.77%, n=252); these respondents used the Internet for various activities, spent most time on the Internet, and were relatively younger (mean age below 70 years). Respondents in Cluster 4, the “social users,” mainly used the Internet for social and leisure-related activities such as gaming and social network sites. The identified clusters significantly differed in age (P<.001, ω²=0.07), time spent on the Internet (P<.001, ω²=0.12), and frequency of downloading apps (P<.001, ω²=0.14), with medium to large effect sizes. Social and health-related variables were significantly different between the clusters, except social and emotional loneliness. However, effect sizes were small. The minimizers scored significantly lower on psychological well-being, instrumental activities of daily living (iADL), and experienced health compared with the practical users and maximizers.

Conclusions

Older adults are a diverse group in terms of their activities on the Internet. This underlines the importance to look beyond use versus nonuse when studying older adults’ Internet use. The clusters we have identified in this study can help tailor the development and deployment of eHealth intervention to specific segments of the older population.

Age and gender considerations for technology-assisted delivery of therapy for substance use disorder treatment: A patient survey of access to electronic devices

BACKGROUND

Technology-assisted treatment (TAT) can be an effective supplement to established face-to-face therapy modalities with a growing literature in substance use disorder (SUD) treatment. TAT access, interest, and familiarity are potential limitations to the use and efficacy of these approaches to treatment.

METHODS

174 participants in outpatient SUD treatment were administered a survey regarding technology device and Internet access, and interest in engaging in TAT SUD counseling (SUDC). The group was dichotomized by mean age and gender to examine potential variations in in these subgroups.

RESULTS

Forty-three (43%) of participants were female, and the mean age was 44.8 years, and 89% of participants had Internet access. 83% of participants were interested in TAT for SUD counseling; 81% expected it to be at least "moderately helpful." 34% of participants noted they would choose to continue face-to-face therapy exclusively. 91% of participants had cell phones, but only 50% could access data or the Internet via their handheld device. 80% of participants stated they would be interested in trying SUDC via their phone. Women had a higher preference for computer-based SUDC than men, with gender being significantly correlated with TAT perceive helpfulness.

CONCLUSION

These findings suggest that patients in outpatient SUD treatment have access to resources for TAT implementation, although access was not always readily available. Future research will be needed to determine whether the technology that this population possesses will be able to support the evolving TAT modalities and whether interest in TAT across age and gender groups equalizes over time.

Sexual and gender minority's social media user characteristics: Examining preferred health information

The authors examined the influence of social media involvement on health issues in sexual and gender minorities (SGMs). Demographic and technological characteristics of social media users and nonusers were identified, and the influence of social media involvement on these factors was assessed for its potential to influence health information needs and preferences. A survey of 2,274 SGM individuals revealed that age, sexual orientation, number of Internet access points, and use of smartphones predicted levels of social media involvement. Results suggest that a broader range of traditional and nontraditional communication channels is needed to meet a diversity of health information needs in SGMs.

Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies

Background

eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them.

Objectives

The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI.

Methods

Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data.

Results

Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users’ literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI.

Conclusions

eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI.

eHealth patient-provider communication in the United States: interest, inequalities, and predictors

OBJECTIVE

Health-related Internet use and eHealth technologies, including online patient-provider communication (PPC), are continually being integrated into health care environments. This study aimed to describe sociodemographic and health- and Internet-related correlates that influence adult patients' interest in and electronic exchange of medical information with health care providers in the United States.

METHODS

Nationally representative cross-sectional data from the 2014 Health Information National Trends Survey ( N  = 3677) were analyzed. Descriptive statistics and multivariable regression analyses were performed to examine associations between patient-level characteristics and online PPC behavior and interests.

RESULTS

Most respondents were Internet users (82.8%), and 61.5% of information seekers designated the Internet as their first source for health information. Younger respondents (<50 years), Hispanics, those from higher-income households, and those perceiving access to personal health information as important were more likely to be interested in online PPC. Despite varying levels of patient interest, 68.5% had no online PPC in the last year. However, Internet users (odds ratio, OR = 2.87, 95% CI, 1.35-6.08), college graduates (OR = 2.92, 95% CI, 1.42-5.99), and those with frequent provider visits (OR = 1.94, 95% CI, 1.02-3.71) had a higher likelihood of online PPC via email or fax, while Hispanics and those from higher-income households were 2-3 times more likely to communicate via text messaging or phone/mobile apps.

CONCLUSION

Patients' interest in and display of online PPC-related behaviors vary by age, race/ethnicity, education, income, Internet access/behaviors, and information type. These findings can inform efforts aimed at improving the use and adoption of eHealth technologies, which may contribute to a reduction in communication inequalities and health care disparities.

Availability of information in Public Health on the Internet: An analysis of national health authorities in the Spanish-speaking Latin American and Caribbean countries

INTRODUCTION

Access to reliable and quality health information and appropriate medical advice can contribute to a dramatic reduction in the mortality figures of countries. The governments of the Americas are faced with the opportunity to continue working on this challenge, and their institutional presence on their websites should play a key role in this task. In a setting where the access to information is essential to both health professionals and citizens, it is relevant to analyze the role of national health authorities. Given that search engines play such a key role in the access to health information, it is important to specifically know - in connection to national health authorities - whether health information offered is easily available to the population, and whether this information is well-ranked in search engines.

METHODS

Quantitative methods were used to gather data on the institutional presence of national health authorities on the web. An exploratory and descriptive research served to analyze and interpret data and information obtained quantitatively from different perspectives, including an analysis by country, and also by leading causes of death. A total of 18 web pages were analyzed. Information on leading causes of death was searched on websites of national health authorities in the week of August 10-14, 2015.

RESULTS

The probability of finding information of national health authorities on the 10 leading causes of death in a country, among the top 10 results on Google, is 6.66%. Additionally, ten out the 18 countries under study (55%) do not have information ranked among the top results in Google when searching for the selected terms. Additionally, a total of 33 websites represent the sources of information with the highest visibility for all the search strategies in each country on Google for the ten leading causes of death in a country. Two websites, the National Library of Medicine and Wikipedia, occur as a result with visibility in the total of eighteen countries of the sample.

CONCLUSIONS

Taking into consideration that providing reliable and quality information on these topics to the population should be one of the priorities of national health authorities, these results suggest that national health authorities need to take measures to try to better position their contents.

Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States

PURPOSE

The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency.

METHODS

Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics.

FINDINGS

In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77).

CONCLUSIONS

The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.

Patterns of Communication Technology Utilization for Health Information Among Hispanics in South Carolina: Implications for Health Equity

Background: Language, culture, geographic, social, and economic factors are associated with health disparities. Among more recent Hispanic immigrants, limited English proficiency and immigration status are barriers to health information and healthcare access. Improved access to culturally and linguistically tailored health information through technology could potentially enhance healthcare access and health outcomes. However, little is known about health information-seeking through technology among Hispanics in recent settlement areas.

Purpose: The aim of this exploratory study was to describe patterns of self-reported utilization of technology for health information-seeking among the growing Hispanic population in South Carolina (SC) over a period of 5 years.

Methods: Descriptive, community-based, cross-sectional survey of 361 Hispanic adults residing in SC, conducted in 2011 and 2015/2016.

Results: Reflective of reported national trends, self-reported accessibility and utilization of cellphones increased (89–96.6%) among this sample. Although computer ownership decreased (58–53.9%), internet utilization for health information-seeking increased (45–57.8%); more than 80% of participants indicated that they considered the internet a “good source of health information.” The majority of participants in both time periods conducted health information searches in Spanish, although the reported access to English-language information increased over time.

Conclusions: These findings illustrate the increasing access and utilization of technology for health information among Hispanics in SC, underscoring the need for broader dissemination of culturally and linguistically appropriate health information through accessible technology, including Spanish language websites. Recommendations for future research include examining relationships between technology access, health service access and utilization, and health behaviors among Hispanics in diverse geographic and social contexts.

Diverse veterans' pre- and post-intervention perceptions of home telemental health for posttraumatic stress disorder delivered via tablet

Objectives Home telemental health services have the potential to overcome many individual and systemic barriers to care facing military veterans with posttraumatic stress disorder. However, little is known about the home telemental health-related attitudes and experiences of highly underserved rural or ethnically, racially diverse veterans. This study evaluated whether ethnically/racially diverse U.S. veterans residing in the rural Pacific Islands would find the delivery of evidence-based treatment for posttraumatic stress disorder via home telemental health tablet devices useful and helpful. Method Clinicians located in a central urban location delivered Cognitive Processing Therapy for posttraumatic stress disorder directly into patients' homes via a tablet device and secure WiFi connection. Pre- and post-treatment measures were collected from a clinical sample of 47 veterans (average age: 49.3 years). Most (74.4%) self-identified as being of ethnic/racial minority background. Attitudinal, satisfaction, and usability scales were collected from home telemental health engaging ( n = 29) and non-engaging ( n = 18) veterans. Results Ratings on measures of home telemental health comfort, satisfaction with care, and usability were uniformly positive. Veterans were equally open to receiving mental health services at home via home telemental health or in the clinic. In the case of services for a physical problem, however, veterans preferred in-clinic care. Following treatment, veterans' attitudinal scores increased on items such as "There is enough therapist contact in home telemental health interventions." However, a small portion of veterans (7%) reported having technical or privacy concerns. Conclusion The provision of evidence-based posttraumatic stress disorder treatment directly into the patients' homes proved feasible and was well received by the large majority of rural ethnically/racially diverse veterans.

The use of EORTC measures in daily clinical practice-A synopsis of a newly developed manual

Cancer has increasingly become a chronic condition and the routine collection of patient-reported outcomes (PROs) like quality of life is widely recommended for clinical practice. Nonetheless, the successful implementation of PROs is still a major challenge, although common barriers to and facilitators of their beneficial use are well known. To support health care professionals and other stakeholders in the implementation of the EORTC PRO measures, the EORTC Quality of Life Group provides guidance on issues considered important for their use in daily clinical practice. Herein, we present an outline of the newly developed "'Manual for the use of EORTC measures in daily clinical practice", covering the following issues: * a rationale for using EORTC measures in routine care *selection of EORTC measures, timing of assessments, scoring and presentation of results * aspects of a strategic implementation * electronic data assessment and telemonitoring, and * further use of EORTC measures and ethical considerations. Next to an extensive overview of currently available literature, the manual specifically focuses on knowledge about EORTC measures to give evidence-based recommendations whenever possible and to encourage readers and end-users of EORTC measures to contribute to further needed high-quality research. The manual will be accessible on the EORTC Quality of Life Group website's homepage and will be periodically updated to take into account any new knowledge due to medical, technical, regulatory and scientific advances.

Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users

Background

More advanced methods and models are needed to evaluate the participation of patients and citizens in the shared health care model that eHealth proposes.

Objective

The goal of our study was to design and evaluate a predictive multidimensional model of eHealth usage.

Methods

We used 2011 survey data from a sample of 13,000 European citizens aged 16–74 years who had used the Internet in the previous 3 months. We proposed and tested an eHealth usage composite indicator through 2-stage structural equation modelling with latent variables and measurement errors. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage was calculated using health status and sociodemographic independent variables.

Results

The dimensions with more explanatory power of eHealth usage were health Internet attitudes, information health Internet usage, empowerment of health Internet users, and the usefulness of health Internet usage. Some 52.39% (6811/13,000) of European Internet users’ eHealth usage was more intensive (greater than the mean). Users with long-term health problems or illnesses (OR 1.20, 95% CI 1.12–1.29) or receiving long-term treatment (OR 1.11, 95% CI 1.03–1.20), having family members with long-term health problems or illnesses (OR 1.44, 95% CI 1.34–1.55), or undertaking care activities for other people (OR 1.58, 95% CI 1.40–1.77) had a high propensity toward intensive eHealth usage. Sociodemographic predictors showed that Internet users who were female (OR 1.23, 95% CI 1.14–1.31), aged 25–54 years (OR 1.12, 95% CI 1.05–1.21), living in larger households (3 members: OR 1.25, 95% CI 1.15–1.36; 5 members: OR 1.13, 95% CI 0.97–1.28; ≥6 members: OR 1.31, 95% CI 1.10–1.57), had more children <16 years of age (1 child: OR 1.29, 95% CI 1.18–1.14; 2 children: OR 1.05, 95% CI 0.94–1.17; 4 children: OR 1.35, 95% CI 0.88–2.08), and had more family members >65 years of age (1 member: OR 1.33, 95% CI 1.18–1.50; ≥4 members: OR 1.82, 95% CI 0.54–6.03) had a greater propensity toward intensive eHealth usage. Likewise, users residing in densely populated areas, such as cities and large towns (OR 1.17, 95% CI 1.09–1.25), also had a greater propensity toward intensive eHealth usage. Educational levels presented an inverted U shape in relation to intensive eHealth usage, with greater propensities among those with a secondary education (OR 1.08, 95% CI 1.01–1.16). Finally, occupational categories and net monthly income data suggest a higher propensity among the employed or self-employed (OR 1.07, 95% CI 0.99–1.15) and among the minimum wage stratum, earning ≤€1000 per month (OR 1.66, 95% CI 1.48–1.87).

Conclusions

We provide new evidence of inequalities that explain intensive eHealth usage. The results highlight the need to develop more specific eHealth practices to address different realities.

Health-Specific Information and Communication Technology Use and Its Relationship to Obesity in High-Poverty, Urban Communities: Analysis of a Population-Based Biosocial Survey

BACKGROUND

More than 35% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may substitute for or complement community-based resources for weight management. However, little is currently known about health-specific ICT use among urban-dwelling people with obesity.

OBJECTIVE

We describe health-specific ICT use and its relationship to measured obesity among adults in high-poverty urban communities.

METHODS

Using data collected between November 2012 and July 2013 from a population-based probability sample of urban-dwelling African American and Hispanic adults residing on the South Side of Chicago, we described patterns of ICT use in relation to measured obesity defined by a body mass index (BMI) of ≥30 kg/m(2). Among those with BMI≥30 kg/m(2), we also assessed the association between health-specific ICT use and diagnosed versus undiagnosed obesity as well as differences in health-specific ICT use by self-reported comorbidities, including diabetes and hypertension.

RESULTS

The survey response rate was 44.6% (267 completed surveys/598.4 eligible or likely eligible individuals); 53.2% were African American and 34.6% were Hispanic. More than 35% of the population reported an annual income of less than US $25,000. The population prevalence of measured obesity was 50.2%. People with measured obesity (BMI≥30 kg/m(2)) were more likely to report both general (81.5% vs 67.0%, P=.04) and health-specific (61.1% vs 41.2%, P=.01) ICT use. In contrast, among those with measured obesity, being told of this diagnosis by a physician was not associated with increased health-specific ICT use. People with measured obesity alone had higher rates of health-specific use than those with comorbid hypertension and/or diabetes diagnoses (77.1% vs 60.7% vs 47.4%, P=.04).

CONCLUSIONS

In conclusion, ICT-based health resources may be particularly useful for people in high-poverty urban communities with isolated measured obesity, a population that is at high risk for poor health outcomes.

Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach

BACKGROUND

Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions.

OBJECTIVE

The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods.

METHODS

To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts.

RESULTS

Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on 10.1±1.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations, given improvements were made to device training, hub accessibility, and device feedback.

CONCLUSIONS

PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions, and preferences.

CLINICALTRIAL

TRIAL REGISTRATION

ClinicalTrials.gov NCT01927783; https://clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/6f8wL117u).

Mobile Phone Ownership and Endorsement of "mHealth" Among People With Psychosis: A Meta-analysis of Cross-sectional Studies

There is currently growing interest in using mobile phones to support the treatment of psychotic disorders, such as schizophrenia. However, the widespread implementation of these interventions will ultimately depend upon patients' access to mobile devices and their willingness to engage with mobile health ("mHealth"). Thus, we conducted a systematic review and meta-analysis to assess mobile phone ownership and interest in mHealth among patients with psychosis. An electronic search of Ovid MEDLINE, Embase, PsycINFO, CENTRAL, AMED, Health Technology Assessment Database, and Health Management Information Consortium Database was conducted, using search terms synonymous with mobile phones and psychotic disorders. The initial literature search yielded 2572 results. Fifteen studies matched eligibility criteria, reporting data from 12 independent samples of psychiatric patients (n = 3227). Data pertaining to mobile phone ownership, usage, and opinions on mHealth among patients with psychotic disorders were extracted from these studies, and meta-analytic techniques were applied. The overall mobile phone ownership rate was 66.4% (95% CI = 54.1%-77.6%). However, we found strong statistical evidence that mobile phone ownership has been significantly increasing since 2007, and the rate among patients surveyed in the last 2 years was 81.4% (n = 454). Furthermore, in surveys of mHealth acceptability, the majority of patients responded in favor of using mobile phones to enhance contact with services and support self-management. Considering the increasing availability of mobile phones and the broad acceptability of mHealth among patients, there is now a need to develop and evaluate mHealth interventions to enhance healthcare services for people with psychosis.

Evaluation of electronic patient-reported outcome assessment with cancer patients in the hospital and at home

BACKGROUND

Patient-reported outcomes (PRO) provide a more comprehensive picture of patients' quality of life than do mere physicians' ratings. Electronic data collection of PRO offers several advantages and allows assessments at patients' homes as well. This study reports on patients' personal internet use, their attitudes towards electronic and web-based PRO assessment (clinic-ePRO and home-ePRO) and the feasibility of these two assessment modes.

METHODS

At the Medical University of Innsbruck and Kufstein County Hospital, cancer patients who participated in clinic-ePRO/home-ePRO were asked to complete a comprehensive evaluation form on their personal internet usage, attitudes towards and the feasibility of routine clinic-ePRO/home-ePRO with the Computer-based Health Evaluation System (CHES) software.

RESULTS

In total, 113 patients completed the evaluation form for clinic-ePRO (Ø 45 years, SD 14) and 45 patients for home-ePRO (Ø 58 years, SD 10; 33.1 per cent inclusion rate for this sample). Most patients expressed willingness to complete routine clinic-ePRO assessments in the future (94.7 per cent of clinic-ePRO patients and 84.4 per cent of home-ePRO patients) and to discuss their data with attending physicians (82.2 per cent, home-ePRO patients only). Overall, patients preferred the software over paper-pencil questionnaires (67.2 per cent of clinic-ePRO patients and 60 per cent of home-ePRO patients) and experienced it as easy to use. Only a few minor suggestions for improvement were made (e.g. adjustable font sizes).

CONCLUSIONS

The use of clinic-ePRO/home-ePRO was in general shown to be feasible and well accepted. However, to be more inclusive in the implementation of clinic-ePRO/home-ePRO, educational programs concerning their particular benefit in oncology practice potentially could enhance patients' attitudes towards, and consequently their acceptance of and compliance with electronic PRO assessments.

Assessing Ebola-related web search behaviour: insights and implications from an analytical study of Google Trends-based query volumes

Background

The 2014 Ebola epidemic in West Africa has attracted public interest worldwide, leading to millions of Ebola-related Internet searches being performed during the period of the epidemic. This study aimed to evaluate and interpret Google search queries for terms related to the Ebola outbreak both at the global level and in all countries where primary cases of Ebola occurred. The study also endeavoured to look at the correlation between the number of overall and weekly web searches and the number of overall and weekly new cases of Ebola.

Methods

Google Trends (GT) was used to explore Internet activity related to Ebola. The study period was from 29 December 2013 to 14 June 2015. Pearson’s correlation was performed to correlate Ebola-related relative search volumes (RSVs) with the number of weekly and overall Ebola cases. Multivariate regression was performed using Ebola-related RSV as a dependent variable, and the overall number of Ebola cases and the Human Development Index were used as predictor variables.

Results

The greatest RSV was registered in the three West African countries mainly affected by the Ebola epidemic. The queries varied in the different countries. Both quantitative and qualitative differences between the affected African countries and other Western countries with primary cases were noted, in relation to the different flux volumes and different time courses. In the affected African countries, web query search volumes were mostly concentrated in the capital areas. However, in Western countries, web queries were uniformly distributed over the national territory. In terms of the three countries mainly affected by the Ebola epidemic, the correlation between the number of new weekly cases of Ebola and the weekly GT index varied from weak to moderate. The correlation between the number of Ebola cases registered in all countries during the study period and the GT index was very high.

Conclusion

Google Trends showed a coarse-grained nature, strongly correlating with global epidemiological data, but was weaker at country level, as it was prone to distortions induced by unbalanced media coverage and the digital divide. Global and local health agencies could usefully exploit GT data to identify disease-related information needs and plan proper communication strategies, particularly in the case of health-threatening events.

Electronic supplementary material

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Determinants of frequent Internet use in an urban kidney transplant population in the United States: characterizing the digital divide

CONTEXT

The Internet is a staple of electronic communication and is essential to the emerging telemonitoring and health information technology interventions for adults with chronic diseases.

OBJECTIVE

To identify determinants of frequent Internet use in an urban kidney transplant population in the United States.

DESIGN

A single center, cross-sectional survey study.

SETTING

An urban Midwestern transplant center.

PARTICIPANTS

78 pretransplant and 177 posttransplant patients.

MAIN OUTCOME MEASURES

Frequent Internet use, defined as using the Internet more than 5 hours per week.

RESULTS

Only 38% of participants reported being frequent Internet users. Non-Hispanic blacks and participants who reported their race/ethnicity as "other" were significantly less likely than whites to report being frequent Internet users. Women were 59% less likely than men to be frequent users of the Internet. Those who reported having kidney disease for more than 3 years were more likely to report being frequent Internet users. As education increased, Internet use increased. As age increased, Internet use decreased.

CONCLUSION

Alternatives to electronic information sources and/or additional resources should be considered for those who may fall in the so-called digital divide.

Media and Technology Use Among Hispanics/Latinos in New York: Implications for Health Communication Programs

OBJECTIVES

There is limited information about media and technology use, as well as health information-seeking patterns, specifically for Hispanics/Latinos at the state level. An understanding of access, usage patterns, and preferences for receiving health information is critical for state-level organizations to effectively reach and serve this growing population.

DESIGN

A telephone survey was developed to assess media and technology access, use patterns, health-seeking information patterns, and preferences for receiving health information. The survey was conducted in New York state from August 8 to November 4, 2013, using random digit dialing. The overall sample of 1350 included 412 Hispanic/Latino adults who are the focus of this study.

RESULTS

Most Hispanic/Latino respondents reported having at least one working computer at home (78 %) and using the Internet (84 %); almost all who had a computer reported having high-speed Internet service (90 %). Cell phone ownership was common (88 %), and many had a smartphone (71 %). Activities most likely to occur several times per day were sending text messages (61 %), using phone apps (49 %), using a search engine (40 %), using email (34 %), and using social networking sites (32 %). The most preferred channels of receiving health information were websites, mail, and television. Older respondents were significantly less likely to have the technologies, engage in technology activities, and prefer newer forms of information dissemination (i.e., text messages). Education and income were important predictors in some cases.

CONCLUSIONS

While most Hispanics/Latinos have access to various technologies, the reason for using those technologies and preferences for receiving health information most often varies by age and, sometimes, by education and income. Older adults tend to seek health information from traditional sources such as television and brochures, while younger adults favored newer technologies. Knowing preferences of the population can help ensure proper media channels are selected for dissemination of health information to Hispanic/Latino communities.

Relationship Between Parental and Adolescent eHealth Literacy and Online Health Information Seeking in Taiwan

This study examined the relationship between parental and adolescent eHealth literacy and its impact on online health information seeking. Data were obtained from 1,869 junior high school students and 1,365 parents in Taiwan in 2013. Multivariate analysis results showed that higher levels of parental Internet skill and eHealth literacy were associated with an increase in parental online health information seeking. Parental eHealth literacy, parental active use Internet mediation, adolescent Internet literacy, and health information literacy were all related to adolescent eHealth literacy. Similarly, adolescent Internet/health information literacy, eHealth literacy, and parental active use Internet mediation, and parental online health information seeking were associated with an increase in adolescent online health information seeking. The incorporation of eHealth literacy courses into parenting programs and school education curricula is crucial to promote the eHealth literacy of parents and adolescents.