The Association Between Online Health Information-Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study

Impact of mobile Internet use on health-seeking behaviors: evidence from China

Introduction

Although health-seeking behaviors are crucial to China's healthcare delivery system, the influence of mobile Internet use in this context remains under-explored. This study aimed to comprehensively explore the influence of mobile Internet use on health-seeking behaviors, and meticulously examined the heterogeneity in health outcomes associated with the intersection between mobile Internet use and health-seeking behaviors.

Methods

We used nationally representative data derived from the China Family Panel Studies. Given that individuals typically make the decision to use mobile Internet autonomously, an instrumental variable regression methodology was adopted to mitigate potential selection biases.

Results

Our findings revealed that mobile Internet use significantly promoted self-medication and adversely affected the use of primary care facilities among Chinese adults. Furthermore, our findings highlighted the heterogeneous effects of mobile Internet use across diverse health demographic groups.

Conclusion

These findings underscore the importance of strategic planning and utilizing mobile Internet resources to steer individuals toward more appropriate healthcare-seeking behaviors.

Factors Impacting One-year Follow-up Visit Adherence after Bariatric Surgery in West China: A Mixed Methods Study

PURPOSE

Quality follow-up (FU) is crucial after bariatric surgery. However, poor adherence after surgery is prevalent. This research aimed to explore the factors related to FU adherence after bariatric surgery in West China.

MATERIALS AND METHODS

This study used a sequential explanatory mixed-methods research design. Participants (n = 177) were identified from the West China Hospital. Demographic information, disease profile, treatment information, and post-surgery FU information were obtained from the bariatric surgery database of the Division of Gastrointestinal Surgery of the West China Hospital. The survey data were analyzed using logistic regression. Semi-structured interviews with participants (n = 10) who had low adherence were conducted. The recording was transcribed verbatim and entered into qualitative data analysis software. Qualitative data were analyzed using a content analysis approach.

RESULTS

Multiple logistic regression revealed that living in Chengdu (OR, 2.308), being employed (OR, 2.532), non-smoking (OR, 2.805), and having less than five years of obesity (OR, 2.480) were positive predictors of FU adherence within one year. Semi-structured interviews suggested that factors related to adherence to FU were lack of motivation, lack of opportunity, insufficient ability, and beliefs regarding consequences.

CONCLUSION

Factors impacting one-year FU visit adherence after bariatric surgery include not only demographic and disease-related factors but also social and family factors. These results will provide evidence to support healthcare professionals in developing personalized postoperative FU management strategies.

Comparing ChatGPT and Bing, in response to the Home Blood Pressure Monitoring (HBPM) knowledge checklist

High blood pressure is one of the major public health problems that is prevalent worldwide. Due to the rapid increase in the number of users of artificial intelligence tools such as ChatGPT and Bing, it is expected that patients will use these tools as a source of information to obtain information about high blood pressure. The purpose of this study is to check the accuracy, completeness, and reproducibility of answers provided by ChatGPT and Bing to the knowledge questionnaire of blood pressure control at home. In this study, ChatGPT and Bing's responses to the HBPM 10-question knowledge checklist on blood pressure measurement were independently reviewed by three cardiologists. The mean accuracy rating of ChatGPT was 5.96 (SD = 0.17) indicating the responses were highly accurate overall, with the vast majority receiving the top score. The mean accuracy and completeness of ChatGPT were 5.96 (SD = 0.17) and 2.93 (SD = 0.25) and in Bing were 5.31 (SD = 0.67), and 2.13 (SD = 0.53) Respectively. Due to the expansion of artificial intelligence applications, patients can use new tools such as ChatGPT and Bing to search for information and at the same time can trust the information obtained. we found that the answers obtained from ChatGPT are reliable and valuable for patients, while Bing is also considered a powerful tool, it has more limitations than ChatGPT, and the answers should be interpreted with caution.

Online health information searching and health literacy among middle-aged and older adults: A cross-sectional study

Given the rapid increase in health information available, health literacy is now more important than ever when searching for health information online. Furthermore, health literacy and online health information searching are reported to be associated with support from others. In this study, we examined the associations of health literacy and social support with online health information searching among individuals in their 50s and 60s. Between March and May 2022, an anonymous self-administered questionnaire was administered among 750 middle-aged and older adults (age 50-69) living in northern Japan. The questionnaire items included personal characteristics, frequency of online health information searching, health literacy domains, and social support. A total of 237 respondents answered all the items (response rate: 31.6%). Multiple logistic regression analysis revealed that communicative health literacy was significantly associated with searching for information about illnesses and health promotion, while critical health literacy was significantly associated with searching for information about medical institutions. Controlling for personal characteristics, health literacy, was associated with online health information searching, suggesting that improving health literacy is important in a digital and information society.

Associations of online health information seeking with health behaviors of cancer survivors

Objective

To examine the effects of online health information seeking (OHIS) behavior on five health behaviors (regular physical activity, less sedentary, calorie checking, no alcohol consumption, and no smoking) among adult cancer survivors in the United States.

Methods

A cross-sectional analysis was conducted with adult cancer survivors (≥18 years old) from Cycles 2, 3, and 4 of the Health Information National Trends Survey (HINTS). The respondents self-reported OHIS, and the data on the five health behaviors were pooled to perform descriptive and multivariable logistic regression analyses using Stata 17.0.

Results

Of the 1245 adult cancer survivors, approximately 74% reported OHIS behavior for themselves within the previous year of the survey. We found that OHIS was significantly and positively associated with the level of physical activity (odds ratio [OR] = 1.53, p = .002) and calorie checking (OR = 1.64, p = .001), but not with sedentary behavior, smoking, and alcohol consumption after adjusting for age, sex, race/ethnicity, education, income, body mass index (BMI), marital status, depression, and general health.

Conclusions

Findings from this study suggest that most cancer survivors used various forms of digital tools and platforms to seek health information. The study also demonstrated an independent impact of OHIS behavior on physical activity and calorie checking. Healthcare professionals may need to encourage and guide cancer survivors to seek credible eHealth information and further utilize digital health tools as a platform for care delivery, promoting health behaviors and preventing adverse health outcomes among cancer survivors.

Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study

BACKGROUND

Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research.

OBJECTIVE

First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health.

METHODS

The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results.

RESULTS

When compared with previous generations, Generation Z respondents (995/1862, 53.44%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: β=.192, P<.001; older population: β=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: β=.070, P=.002; older population: β=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall.

CONCLUSIONS

This study examined and compared the health information-seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors.

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

BACKGROUND

Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected.

OBJECTIVE

We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines?

METHODS

We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE).

RESULTS

Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001).

CONCLUSIONS

Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.

Baseline eHealth Behaviors of Service Members: A Retrospective, Cross-Sectional Analysis of Patient Portal Use Before the Pandemic

INTRODUCTION

The use of electronic health (eHealth) tools has the potential to support the overall health, wellness, fitness status, and ability to deploy worldwide of active duty service members (SMs). Additionally, the Coronavirus Disease 2019 pandemic forced healthcare organizations to quickly convert to virtual care settings to decrease face-to-face interactions and increase access to healthcare using technology. The shift to virtual care and the push to increase use of eHealth tools heightened the need to understand how military members interact with eHealth tools. Little is known about the factors that influence SMs use of eHealth tools and if having a health condition increases or decreases use. To evaluate these factors, we completed a cross-sectional, retrospective analysis on a sample of 198,388 active duty SMs aged 18 to 68 years.

MATERIALS AND METHODS

We used two Military Health System (MHS) data sources-Tricare Online (TOL) Patient Portal 2018 audit logs and outpatient electronic health record data. Using eHealth behaviors identified in the audit logs, we evaluated and compared individual characteristics (i.e., "gender", "age", "race", and "marital status"), environmental factors (i.e., "rank", "military branch", and "geographic location"), and six available health conditions (i.e., congenital health defects, amputation, anxiety, sleep, traumatic brain injury, and depression). Since moderate usage of eHealth tools is linked to improved health outcomes, adherence, communication, and increased consumer satisfaction, a logistic regression model was developed to find the factors most associated with moderate (3-11 logins per year) use of the portal.

RESULTS

Electronic health use increased by SMs with underlying health conditions or if they were managing family member health. Most SMs who used the TOL Patient Portal were of ages 25-34 years, White, and married. The mean age is 32.53 for males and 29.98 for females. Over half of the TOL Patient Portal SM users utilized the portal one to two times. Most SMs used the TOL Patient Portal in Virginia, Texas, California, Florida, North Carolina, Georgia, and Maryland. The highest use was during the months of March to May. Frequent patient portal actions include searching for appointments, viewing health information, viewing medical encounters, and refilling medications. Although SMs with congenital health defects, anxiety, sleep issues, and depression have higher patient portal use rates, SMs with depression have a negative association with using the patient portal at a "moderate" rate. Viewing family member health information and searching for appointments were strongly associated with patient portal moderate use.

CONCLUSIONS

Our findings support top military initiatives to improve the overall health, wellness, and readiness of SMs while decreasing the MHS's overall cost of care while providing a foundation to compare "pre" and "post" pandemic eHealth behaviors. It is essential to note that SMs are more likely to use a patient portal to seek information or manage family member health. This key factor identifies the significance of family health promotion and readiness in the active duty SM's life. The long-term goal of our study is to build the foundation for delivering tailored health information and eHealth tools to promote health and readiness-centric patient engagement.

PFAS Contamination: Pathway from Communication to Behavioral Outcomes

ABSTRACTGuided by the risk information seeking and processing model, this study examines social cognitive variables that motivate individuals to actively seek and process information related to per- and polyfluoroalkyl substances (PFAS) contamination. Results indicate that information insufficiency, affective response, and informational subjective norms are positively related to information seeking and systematic processing, which are positively associated with policy support and intention to adopt risk mitigation behaviors. These findings suggest that when communicating the health risks of PFAS contamination to the general public, cognitive, affective, and normative factors are important initial steps to generate public interest in relevant information.

Health Orientation as a Psychographic Framework for Understanding Physical Exercise Behavior

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general.

Political views, health literacy, and COVID-19 beliefs and behaviors: A moderated mediation model

RATIONALE

Mitigating the spread of COVID-19 requires that people understand the need for and engage in protective behaviors. Given the complexity and rapid progression of media information about the pandemic, health literacy could be essential to acquiring the accurate beliefs, concern for societal risks, and appreciation of restrictive policies needed to motivate these behaviors. Yet with the increasingly politicized nature of COVID-related issues in the United States, health literacy could be an asset for those with more liberal views but less so for those with more conservative views.

OBJECTIVE

This study tested a hypothesized model proposing that political views moderate the associations of health literacy with COVID-19 protective behaviors as well as the mediational roles of accurate and inaccurate COVID-19 beliefs, concern for society, and governmental control attitudes.

METHODS

We surveyed residents in three diverse regions of California in June 2020 (N = 669) and February 2021 (N = 611). Participants completed measures of health literacy, political views, and COVID-19 beliefs and behaviors.

RESULTS

Moderated mediational analyses largely supported the proposed model with both samples. Health literacy was associated with more accurate COVID-19 beliefs, less inaccurate COVID-19 beliefs, greater concern for societal risks, more positive attitudes regarding restrictive government control, more protective behavior, less risky behavior, and stronger vaccine intentions; beliefs, concern for society, and governmental control attitudes mediated the health literacy-behavior relationships. As predicted, however, these associations of health literacy with adaptive beliefs, attitudes, and behaviors varied according to political views. The direct and mediated relationships were held for participants with more liberal views and, to a lesser extent, for those with moderate views, but they were weaker or absent for participants with more conservative views.

CONCLUSIONS

These findings contribute new evidence of processes linking health literacy with adaptive beliefs, attitudes, and behaviors and how social and political contexts can shape those processes.

The complementary and substitutive value of online health information

The Internet plays a significant role in health information searching, sharing and emotional support. However, scholars have devoted little attention to the complementary and substitute value of online health information from diseases, especially chronic diseases, health insurance, barriers to health resources and their interaction effects with income. This research uses data from the 2020 Health Information National Trends Survey (HINTS 2020), the latest HINTS survey that includes seeking online health information questions critical to this research. This paper proposes that the factors contributing to seeking online health information can be categorized into two modalities - complementary and substitutive. Concerning the complementary value, I argue that individuals with certain health conditions use online health information as a complementary health resource in addition to traditional health resources such as doctors to understand their health issues better. Online health information also functions as substitute information sources for individuals who have experienced more barriers to typical health information resources.

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning

BACKGROUND

The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors.

PURPOSE

To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics.

METHODS

In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2).

RESULTS

We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design.

CONCLUSIONS

By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.

Association between online health information-seeking and medication adherence: A systematic review and meta-analysis

Background

The evidence of the impact of online health information-seeking (OHIS) on health outcomes has been conflicting. OHIS is increasingly recognised as a factor influencing health behaviour but the impact of OHIS on medication adherence remains unclear.

Objectives

We conducted a systematic review and meta-analysis to examine the associations between OHIS and medication adherence.

Methods

We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology and Behavioural Science Collection for studies published up to December 2020. The inclusion criteria were studies that reported the associations of OHIS and medication adherence, quantitative design, reported primary data only, related to any health condition where medications are used and conducted on patients either in clinical or community settings. A meta-analysis was used to examine the association between OHIS and medication adherence.

Results

A total of 17 studies involving 24,890 patients were included in this review. The study designs and results were mixed. In the meta-analysis, there was no significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS and medication adherence. In the sub-group analysis of people living with HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612, 95% CI 1.266-2.054, p < 0.001).

Conclusions

The current evidence of an association between OHIS and medication adherence is inconclusive. This review highlights methodological issues on how to measure OHIS objectively and calls for in-depth exploration of how OHIS affects health decisions and behaviour.

Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS

Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.

Internet Use, Electronic Health Literacy, and Hypertension Control among the Elderly at an Urban Primary Care Center in Thailand: A Cross-Sectional Study

This study aimed to explore the internet usage and electronic health literacy (eHL) among adults aged 60 and older with hypertension and to explore the associations between eHL and blood pressure control. A cross-sectional survey was conducted at an out-patient primacy care clinic in the urban city center of Chiang Mai, Thailand. eHL was measured using the eHealth Literacy Scale (eHEALS). Logistic regression was used to identify the association between eHL and blood pressure, adjusting for age and sex as a priori confounders and key sociodemographic factors previously identified in univariable analysis. A total of 110 older adult patients with a history of diagnosed hypertension agreed to participate. The mean age of the participants was 67 years old. Fifty-six participants (50.9%) had used the internet in their lifetime. Among internet users, 37 out of 56 participants (66%) could be classified as having high eHL. However, there was insufficient evidence for associations among internet use, eHL and hypertension control. This result potentially creates new opportunities for eHealth education and interventions. Efforts to produce centralized clear, reliable health information targeting this demographic would be worthwhile to help manage chronic diseases such as hypertension in Thailand in the future.

Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey

INTRODUCTION

Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors.

METHODS

A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population.

RESULTS

Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79).

DISCUSSION

The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.

Linking health information seeking to patient-centered communication and healthy lifestyles: an exploratory study in China

The existing research routinely measures the influence of health information-seeking behavior (HISB) as a whole, which does not capture the complexity and diversity of media channel usage in HISB. The influence of HISB on patient's lifestyle behaviors and the mediation process through patient-centered communication (PCC) in medical encounters has been understudied in previous literature. Drawing from Street's three-stage model, this study conducted a secondary analysis of the Health Information National Trends Survey in China to investigate the influences of HISB across five different media outlets (e.g. information-oriented media, entertainment-oriented media, search engines, social media and mobile health applications) on two types of healthy lifestyles (e.g. physical activity, fruit and vegetable consumption), by the mediation of PCC. PROCESS path-analysis with bootstrapping estimation was used to test the hypothesized relationships. The results revealed that HISB is positively related to PCC, and PCC positively predicts frequent engagement in healthy lifestyles. Moreover, PCC partially mediates the effect of information-oriented media HISB on healthy lifestyles and fully mediates the effect of HISB through the other four media sources. This study highlights the essential stage of PCC transferring HISB to engagement in healthy lifestyles and draws attention to the varying influences of media channels carrying different characteristics.

Factors Driving Users’ Engagement in Patient Social Network Systems

Participatory medicine and e-health help to promote health literacy among non-medical professionals. Users of e-health systems actively participate in a patient social network system (PSNS) to share health information and experiences with other users with similar health conditions. Users’ activities provide valuable healthcare resources to develop effective participatory medicine between patients, caregivers, and medical professionals. This study aims to investigate the factors of patients’ engagement in a PSNS by integrating and modifying an existing behavioral model and information system model (i.e., affective events theory (AET) and self-determination theory (SDT)). The AET is used to model the structure, the affective aspects of the driven behavior, and actual affective manifestation. The SDT is used to model interest and its relations with behavior. The data analysis and model testing are based on structural equation modeling, using responses from 428 users. The results indicate that interest and empathy promote users’ engagement in a PSNS. The findings from this study suggest recommendations to further promote users’ participation in a PSNS from the sociotechnical perspective, which include sensitizing and constructive engagement features. Furthermore, the data generated from a user’s participation in a PSNS could contribute to the study of clinical manifestations of disease, especially an emerging disease.

Health Literacy and Physical Activity: A Systematic Review

BACKGROUND

The importance of health literacy (HL) in health promotion is increasingly clear and acknowledged globally, especially when addressing noncommunicable diseases. This paper aimed to collect and summarize all current data from observational studies generating evidence of the association between HL and physical activity (PA) and to analyze intervention studies on the promotion of PA to ascertain whether HL moderates the efficacy of such intervention.

METHODS

A comprehensive systematic literature search of observational studies investigating the association between HL and PA was performed. Intervention studies on the promotion of PA that also measured the HL levels of participants and its effect on the outcome of the intervention were also identified.

RESULTS

Of the 22 studies included in this review, 18 found a significant positive association between high HL and high levels of PA. The only intervention study among them indicated that HL was not a significant moderator of the intervention's effectiveness.

CONCLUSION

HL can enable individuals to make deliberate choices about their PA and thus contribute to preventing many chronic noncommunicable diseases. That said, low levels of HL do not seem to influence the efficacy of health promotion interventions.

Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis

BACKGROUND

The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions.

OBJECTIVE

The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose.

METHODS

With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015.

RESULTS

Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions.

CONCLUSIONS

Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.

The Use of Fitness Influencers' Websites by Young Adult Women: A Cross-Sectional Study

The growth of the fitness industry observed in the last decade has been accompanied by the emergence of an occupation as a social media fitness influencer. The most popular are able to accumulate millions of followers. The marketing potential of fitness influencers is a subject of interest, not only for the fitness industry but also for other sectors offering products related to health, wellness, or healthy nutrition. However, the activities of fitness influencers related to the promotion of physical activity and healthy lifestyle converge with the aims of those promoting public health. The main objective of this study was to make an assessment of the determinants of regular access to fitness influencers' sites (FIS) and their relationship with the health behaviors of young adult women. It was based on the data originating from an online survey on a representative sample of Polish women aged 18-35 years. Chi2 test, univariate, and multiply logistic regression models were used to determine the relationships between FIS and the variables related to the respondents' characteristics of and their health behaviors. FIS were accessed by 29.3% of respondents (n = 1030) at least once a week. It was found that those living in cities with a population ranging from 20,000 to 100,000 were more likely to access FIS than those living in rural areas. Similarly, greater access was made by those in a high-income household rather than those with the lowest income, by those with inadequate rather than those with problematic health literacy and by those with high rather than low e-health literacy. The use of FIS was significantly associated with the consumptions of fruit and vegetables (OR, 95%CI: 2.77, 2.01-3.82), physical activity (1.74, 1.27-2.38), breast self-examination (1.54, 1.11-2.13), and also with the greater use of e-cigarettes (1.63, 1.09-2.43) and increased consumption of alcohol (1.37, 1.01-1.88). In conclusion, as access to Internet resources run by fitness influencers was a prevailing predictor of young adult Polish women's health behaviors, FIS may play a potentially important role in promoting a healthy lifestyle in this population. However, it should be remembered that there are complex patterns of associations with specific behaviors, e.g., the use of e-cigarettes or alcohol consumption.

Sexual Identity and Racial/Ethnic Differences in Awareness of Heart Attack and Stroke Symptoms: Findings From the National Health Interview Survey

PURPOSE

Investigate sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

DESIGN

Cross-sectional.

SETTING

2014 and 2017 National Health Interview Survey.

SAMPLE

54 326 participants.

MEASURES

Exposure measures were sexual identity (heterosexual, gay/lesbian, bisexual, "something else") and race/ethnicity. Awareness of heart attack and stroke symptoms was assessed.

ANALYSIS

Sex-stratified logistic regression analyses to examine sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

RESULTS

Gay men were more likely than heterosexual men to identify calling 911 as the correct action if someone is having a heart attack (adjusted odds ratio [AOR] = 2.16, 95% CI: 1.18-3.96). The majority of racial/ethnic minority heterosexuals reported lower rates of awareness of heart attack and stroke symptoms than White heterosexuals. Hispanic sexual minority women had lower awareness of heart attack symptoms than White heterosexual women (AOR = 0.43, 95% CI: 0.25-0.74), whereas Asian sexual minority women reported lower awareness of stroke symptoms (AOR = 0.25, 95% CI: 0.08-0.80). Hispanic (AOR = 0.52, 95% CI: 0.33-0.84) and Asian (AOR = 0.35, 95% CI: 0.14-0.84) sexual minority men reported lower awareness of stroke symptoms than White heterosexual men.

CONCLUSION

Hispanic and Asian sexual minorities had lower rates of awareness of heart attack and stroke symptoms. Health information technology may be a platform for delivering health education and targeted health promotion for sexual minorities of color.

Advancing Cancer Control in San Francisco: Cancer Screening in Under-Represented Populations

INTRODUCTION

Cancer risk and screening data are limited in their ability to inform local interventions to reduce the burden of cancer in vulnerable populations. The San Francisco Health Information National Trends Survey was developed and administered to assess the use of cancer-related information among under-represented populations in San Francisco to provide baseline data for the San Francisco Cancer Initiative.

METHODS

The survey instrument was developed through consultation with research and community partners and translated into 4 languages. Participants were recruited between May and September 2017 through community-based snowball sampling with quotas to ensure adequate numbers of under-represented populations. Chi-square tests and multivariate logistic regression were used between 2018 and 2019 to assess differences in screening rates across groups and factors associated with cancer screening.

RESULTS

One thousand twenty-seven participants were recruited. Asians had lower rates of lifetime mammogram (p=0.02), Pap test (p<0.01), and prostate-specific antigen test (p=0.04) compared with non-Asians. Hispanics had higher rates of lifetime mammogram (p=0.02), lifetime Pap test (p=0.01), recent Pap test (p=0.03), and lifetime prostate-specific antigen test (p=0.04) compared with non-Hispanics. Being a female at birth was the only factor that was independently associated with cancer screening participation (AOR=3.17, 95% CI=1.40, 7.19).

CONCLUSIONS

Screening adherence varied by race, ethnicity, and screening type. A collaborative, community-based approach led to a large, diverse sample and may serve as a model for recruiting diverse populations to add knowledge about cancer prevention preferences and behaviors. Results suggest targeted outreach efforts are needed to address disparate cancer screening behaviors within this diverse population.

Physical activity in persons with diabetes: its relationship with media use for health information, socioeconomic status and age

Although low socio-economic status (SES) persons with diabetes show low levels of physical activity (PA), there is limited knowledge regarding which media is effective in improving their PA. This study aimed to determine the appropriate media for providing PA-related information to persons with diabetes in low SES compared with those in high SES. The data of 770 persons with diabetes in low or high SES were extracted from Multimedia Audience Research Systems 2013, a nationwide cross-sectional study. The relationships among media use for health information (i.e. magazine, television and Internet use), PA, and high and low SES were examined using regression analysis. Additional analysis was conducted to examine whether the above relationships differ by age, which influences the use of media. The relationships of media use for health information with PA levels varied by SES; while television use was associated with increased PA levels, Internet use was associated with decreased PA levels in older, low SES persons with diabetes. The findings indicated that television can be a useful resource to provide PA-related information to low SES persons with diabetes and suggest the significance of choosing appropriate media to provide PA-related information for them.

Online health information in a rural residential population in Zhejiang Province, China: a cross-sectional study

OBJECTIVE

To determine the prevalence, degree of trust and usefulness of the online health information seeking source and identify associated factors in the adult population from the rural region of China.

DESIGN

A cross-sectional population-based study.

SETTING

A self-designed questionnaire study was conducted between May and June 2015 in four districts of Zhejiang Province.

PARTICIPANTS

652 adults aged ≥18 years (response rate: 82.8%).

PRIMARY OUTCOME MEASURES

The prevalence, degree of trust and usefulness of online health information was the primary outcome. The associated factors were investigated by χ² test.

RESULTS

Only 34.8% of participants had faith in online health information; they still tended to select and trust a doctor which is the first choice for sources of health information. 36.7% of participants, being called 'Internet users', indicated that they had ever used the internet during the last 1 year. Among 239 internet users, 40.6% of them reported having sought health information via the internet. And 103 internet users responded that online health information was useful. Inferential analysis demonstrated that younger adults, individuals with higher education, people with a service-based tertiary industry career and excellent health status used online health information more often and had more faith in it (p<0.001).

CONCLUSIONS

Using the internet to access health information is uncommon in the rural residential adult population in Zhejiang, China. They still tend to seek and trust health information from a doctor. Internet as a source of health information should be encouraged.

Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension

BACKGROUND

Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this study was to investigate the association between health literacy level and adherence to antihypertensive medications among Hispanic adults, who self-reported hypertension, controlling for potential covariates of adherence and/or health literacy.

METHODS

We conducted a cross-sectional survey of 1355 Hispanic adults, primarily Dominicans, who self-reported hypertension. Antihypertensive medication adherence and health literacy were evaluated along with covariates, including sociodemographic characteristics, depression, anxiety, and sleep disturbance. Linear regression models were created for health literacy, each covariate, and adherence. Factors found to be significantly associated with adherence in the individual regression models at a p value of < 0.20 were included in a hierarchical multiple linear regression model.

RESULTS

Overall, the majority of participants had low adherence levels to antihypertensive medications (88.4%; n = 1026) and inadequate health literacy (84.9%; n = 1151). When controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance, having adequate as compared to inadequate health literacy was associated with a higher adherence score (b = 0.378, p = 0.043). The full model explained 13.6% of the variance in medication adherence (p value < 0.001), but the unique contribution of health literacy to the model was minimal (R² change = 0.003).

CONCLUSIONS

Tailored interventions considering health literacy are needed to support medication adherence in order to improve hypertension outcomes of Hispanics. Additional studies are needed to identify and prioritize factors in the development of targeted and effective adherence interventions for Hispanics with hypertension.

Health Literacy in Web-Based Health Information Environments: Systematic Review of Concepts, Definitions, and Operationalization for Measurement

Background

Health literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts.

Objective

This study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments.

Methods

A systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures.

Results

On the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified.

Conclusions

The results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting.

Use of Web-Based Parent-Adolescent Health Promotion Program Among Puerto Ricans

BACKGROUND

Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information.

OBJECTIVE

The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent-adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents.

METHODS

This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent-adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed.

RESULTS

Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%).

DISCUSSION

Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.

Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Comparative risk assessment and cessation information seeking among smokeless tobacco users

INTRODUCTION

This research examined (1) smokeless tobacco users' comparative optimism in assessing the health and addiction risks of their own product in comparison with cigarettes, and (2) the effects of comparative optimism on cessation information-seeking.

METHODS

A nationally-representative sample from the 2015 Health Information National Trends Survey (HINTS)-FDA was employed.

RESULTS

The analyses revealed the presence of comparative optimism in assessing both health and addiction risks among smokeless tobacco users. Comparative optimism was negatively correlated with most cessation information-seeking variables. Health bias (the health risk rating gap between the subject's own tobacco product and cigarettes) was associated with decreased intent to use cessation support. However, the health bias and addiction bias (the addiction risk rating gap between the subject's own tobacco product and cigarettes) were not consistent predictors of all cessation information-seeking variables, when covariates of socio-demographics and tobacco use status were included. In addition, positive correlations between health bias and past/recent cessation-information searches were observed.

CONCLUSIONS

Optimisic biases may negatively influence cessation behaviors not only directly but also indirectly by influencing an important moderator, cessation information-seeking. Future interventions should prioritize dispelling the comparative optimism in perceiving risks of smokeless tobacco use, as well as provide more reliable cessation information specific to smokeless tobacco users.

Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review

BACKGROUND

Research indicates that parents influence their children's physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices.

OBJECTIVE

The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research.

METHODS

The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review.

RESULTS

The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children's PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children's PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children's PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children's PA.

CONCLUSIONS

Because this review found a very small number of studies examining the relationship between parenting styles and Latino children's PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group.

The Índice Flesch-Szigriszt and Spanish Lexile Analyzer to evaluate Spanish patient education materials in otolaryngology

OBJECTIVES/HYPOTHESIS

Evaluate the reading difficulty of Spanish patient education materials using the validated Índice Flesch-Szigriszt (INFLESZ) and Spanish Lexile Analyzer, and to identify relationships between English and Spanish readability formulas.

STUDY DESIGN

Cross-sectional analysis.

METHODS

All otolaryngology-related patient education articles written in Spanish from the health libraries of the top 10 US News & World Report-ranked hospitals, top 10 Doximity-ranked otolaryngology residencies, the American Academy of Otolaryngology-Head and Neck Surgery website, and the US National Library of Medicine online section on ears, nose and throat were collected. Reading difficulty was assessed using the INFLESZ and Spanish Lexile Analyzer. Additional readability assessments included the traditional English tools: Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Simple Measure of Gobbledygook score.

RESULTS

A total of 497 articles were reviewed. The average INFLESZ score for all articles was 57.75, which is considered normal and requires the reading ability of a student who finished Escuela Secundaria Obligatoria or 10th grade equivalent in the United States. The average Spanish Lexile measure for all articles was 1062L, equivalent to a reading level between the 6th and 12th grade. English readability tools calculated a more difficult reading level compared to Spanish tools when performed on the same text.

CONCLUSIONS

Current Spanish patient education materials in otolaryngology may be too difficult for the average Spanish-speaking reader to understand. Future improvements may be warranted to improve the readability of educational materials and increase health literacy.

LEVEL OF EVIDENCE

NA. Laryngoscope, 128:E21-E26, 2018.

Deconstructing Cancer Patient Information Seeking in a Consumer Health Library Toward Developing a Virtual Information Consult for Cancer Patients and Their Caregivers: A Qualitative, Instrumental Case Study

Background

Cancer patients and their caregivers want information about their disease and are interested in finding health information online. Despite the abundance of cancer information online, it is often fragmented, its quality is highly variable, and it can be difficult to navigate without expert-level knowledge of the cancer system. The Patient & Family Library at the Princess Margaret Cancer Centre offers a broad collection of high-quality cancer health information and staff are available to help patrons refine their questions and explore information needs that they may not have considered.

Objective

The purpose of this research study was to deconstruct patrons’ information-seeking behaviors in the library to assess the feasibility of replicating the services provided in the library through a Web app, extending the service beyond the walls of the cancer centre. The specific aims of this research were to understand (1) how patrons approach information seeking in the library (interface design), (2) how patrons communicate their informational needs (information categorization and metadata requirements), and (3) what resources are provided to address the patrons’ information needs (collection development).

Methods

We employed a qualitative, instrumental case study to deconstruct patrons’ health information-seeking behavior. The study population included patients, the librarian, and library volunteers. Ethnographic observation was conducted at the library over 3 days and key informant interviews with library staff were conducted to address the first aim. A closed card-sorting activity was conducted to address the second aim and the library shift logs and Search Request Forms (SRFs) were reviewed to address the third aim.

Results

A total of 55 interactions were recorded during the ethnographic observation and nine semistructured interviews were conducted during the key informant interviews. Seven library patron personas were identified: (1) Newbie, (2) Seasoned, (3) Direct, (4) Window Shopper, (5) Collector, (6) Information Seeker, and (7) Distressed. A total of 83 participants completed the closed card-sorting exercise. The participants’ conceptual clusters within the similarity matrix overlapped with the groupings created by the librarian, with a few differences. A total of 161 entries in the library shift log and 65 SRFs were analyzed to determine what resources were given to patrons. Most resources that patrons received were available online (61%), although almost half of these required special access (47%).

Conclusions

The study findings suggest it is possible to replicate library functions in a Web app with a few exceptions that cannot be replicated online. These elements include access to journal articles or other content behind paywalls and the librarian’s ability to encourage further discussion through empathy and active listening. Discussion with the librarian could serve to refine and predict needs through observing information seekers and to provide immediate connection to spiritual care and psychosocial support for patrons in distress.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis

Background

Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context.

Objective

We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking.

Methods

Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis.

Results

We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared.

Conclusions

The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.

Exploration of Deaf People's Health Information Sources and Techniques for Information Delivery in Cape Town: A Qualitative Study for the Design and Development of a Mobile Health App

BACKGROUND

Many cultural and linguistic Deaf people in South Africa face disparity when accessing health information because of social and language barriers. The number of certified South African Sign Language interpreters (SASLIs) is also insufficient to meet the demand of the Deaf population in the country. Our research team, in collaboration with the Deaf communities in Cape Town, devised a mobile health app called SignSupport to bridge the communication gaps in health care contexts. We consequently plan to extend our work with a Health Knowledge Transfer System (HKTS) to provide Deaf people with accessible, understandable, and accurate health information. We conducted an explorative study to prepare the groundwork for the design and development of the system.

OBJECTIVES

To investigate the current modes of health information distributed to Deaf people in Cape Town, identify the health information sources Deaf people prefer and their reasons, and define effective techniques for delivering understandable information to generate the groundwork for the mobile health app development with and for Deaf people.

METHODS

A qualitative methodology using semistructured interviews with sensitizing tools was used in a community-based codesign setting. A total of 23 Deaf people and 10 health professionals participated in this study. Inductive and deductive coding was used for the analysis.

RESULTS

Deaf people currently have access to 4 modes of health information distribution through: Deaf and other relevant organizations, hearing health professionals, personal interactions, and the mass media. Their preferred and accessible sources are those delivering information in signed language and with communication techniques that match Deaf people's communication needs. Accessible and accurate health information can be delivered to Deaf people by 3 effective techniques: using signed language including its dialects, through health drama with its combined techniques, and accompanying the information with pictures in combination with simple text descriptions.

CONCLUSIONS

We can apply the knowledge gained from this exploration to build the groundwork of the mobile health information system. We see an opportunity to design an HKTS to assist the information delivery during the patient-health professional interactions in primary health care settings. Deaf people want to understand the information relevant to their diagnosed disease and its self-management. The 3 identified effective techniques will be applied to deliver health information through the mobile health app.

The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review

Background

The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population.

Objective

To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research.

Methods

We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic.

Results

Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52%), promoting health education (12 of 27, 44%), and/or describing social media users (12 of 27, 44%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44%). Healthy eating and active living received the second greatest focus (4 of 27, 15%).

Conclusions

Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health.