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Cheng YS, Lin CP, Chen LYA, Hwang WR, Lin YC, Chen YC. Short-Term Effects of an eHealth Care Experiential Learning Program Among Patients With Type 2 Diabetes: Randomized Controlled Trial. J Med Internet Res 2024; 26:e53509. [PMID: 39150761 PMCID: PMC11364949 DOI: 10.2196/53509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/07/2024] [Accepted: 06/21/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Type 2 diabetes is a chronic disease with a significant medical burden. eHealth care integrates medicine and technology to enhance the outcomes of such patients; however, adequate eHealth literacy (eHL) is necessary for that to happen. Fostering eHL is crucial for patients with diabetes to engage with eHealth care and receive quality care and timely support. Experiential learning theory can enhance patients' eHL and skills to use eHealth care technology in their daily care. OBJECTIVE This study explored the effectiveness of an eHealth care experiential learning program in improving eHL, patient health engagement, and eHealth care use status among patients with type 2 diabetes in 3 months. METHODS In this randomized controlled trial, patients under case management services from various clinics in Taiwan were randomly assigned to either the intervention group receiving the 6-session eHealth care experiential learning program or the control group receiving the usual care. Data were collected using structured questionnaires at 3 time points: pretest, postintervention, and 3 months after the intervention. Descriptive data were presented using frequency distribution, percentage, mean, and SD. The outcomes were analyzed using a generalized estimating equation method by intention-to-treat analysis. RESULTS A total of 92 participants (46 in each group) were recruited in this study. Of these, 86 completed the course and follow-up evaluations with a mean age of 62.38 (SD 12.91) years. After completing the intervention, the intervention group had significantly higher posttest scores in eHL (β=19.94, SE 3.52; P<.001), patient health engagement (β=.28, SE 0.13; P=.04), and eHealth use (β=3.96, SE 0.42; P<.001) than the control group. Furthermore, the intervention group maintained these significant improvements in eHL (β=18.19, SE 3.82; P<.001) and eHealth use (β=3.87, SE 0.49; P<.001) after 3 months. CONCLUSIONS Participating in the eHealth care experiential learning program resulted in significant improvements in eHL, patient health engagement, and eHealth use among patients with type 2 diabetes. Our interventional program can inform future clinical practice and policies to strengthen self-management skills and facilitate the use of health technology in caring for patients with chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT05180604; https://clinicaltrials.gov/ct2/show/NCT05180604.
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Affiliation(s)
- Yu-Shan Cheng
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Lu-Yen Anny Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Yi-Chun Lin
- Rong-Yang Clinic, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yuen E, Winter N, Savira F, Huggins CE, Nguyen L, Cooper P, Peeters A, Anderson K, Bhoyroo R, Crowe S, Ugalde A. Digital Health Literacy and Its Association With Sociodemographic Characteristics, Health Resource Use, and Health Outcomes: Rapid Review. Interact J Med Res 2024; 13:e46888. [PMID: 39059006 PMCID: PMC11316163 DOI: 10.2196/46888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Digital health literacy has emerged as a critical skill set to navigate the digital age. OBJECTIVE This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. METHODS A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: "measured digital health literacy," "digital literacy," "ehealth literacy," "e-health literacy," "electronic health literacy," or "internet health literacy" in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. RESULTS Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. CONCLUSIONS The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation.
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Affiliation(s)
- Eva Yuen
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
- Monash Health, Clayton, Australia
| | - Natalie Winter
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Feby Savira
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, Australia
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Catherine E Huggins
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Australia
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Lemai Nguyen
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
- Department of Information Systems and Business Analytics, Deakin Business School, Deakin University, Burwood, Australia
| | - Paul Cooper
- School of Medicine, Deakin University, Burwood, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Kate Anderson
- School of Health and Social Development, Deakin University, Burwood, Australia
- School of Computing Technologies, STEM College, RMIT University, Melbourne, Australia
| | - Rahul Bhoyroo
- Western Victoria Primary Health Network, Geelong, Australia
| | - Sarah Crowe
- Western Victoria Primary Health Network, Geelong, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
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Jiao W. Older Adults' Exposure to Food Media Induced Unhealthy Eating during the COVID-19 Omicron Lockdown? Exploring Negative Emotions and Associated Literacy and Efficacy on Shanghainese. Foods 2024; 13:1797. [PMID: 38928739 PMCID: PMC11203190 DOI: 10.3390/foods13121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic, propelled by the highly transmissible Omicron variant, had a global impact and significantly affected Shanghai, a major city in China. This study investigates how food media exposure influenced unhealthy eating habits among older adults during the COVID-19 lockdown in Shanghai, focusing on the roles of negative emotions, food literacy, health consciousness, and eating self-efficacy. The random sample comprised 400 individuals aged ≥50 years who lived in Shanghai from March to June 2022. A path and correlation analysis was performed. The exposure of older adults to food media resulted in the acceleration of unhealthy eating. The relationship was significantly exacerbated by food literacy and negative emotions. In contrast, eating self-efficacy and health consciousness effectively countered the media. The enhanced pathway from food-related media influence to eating habits through negative emotions or self-efficacy towards health awareness and food literacy showed significant effects. The findings provide insights for future research and public health strategies. Importantly, this study has practical significance for media professionals, public health decision-makers, and healthy food businesses regarding how to enhance older adults' cognition to respond to unhealthy eating crises.
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Affiliation(s)
- Wen Jiao
- School of Communication, Soochow University, Suzhou 215123, China
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Shaw G, Castro BA, Gunn LH, Norris K, Thorpe RJ. The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data. JMIR Mhealth Uhealth 2024; 12:e46656. [PMID: 38198196 PMCID: PMC10809169 DOI: 10.2196/46656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. OBJECTIVE The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). METHODS Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. RESULTS A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. CONCLUSIONS This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.
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Affiliation(s)
- George Shaw
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Bianca A Castro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Laura H Gunn
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Keith Norris
- The University of California Los Angeles Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
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Guo SHM, Lin JL, Hsing HC, Lee CC, Chuang SM. The Effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-Care, and Mobile eHealth Literacies Among Patients With Diabetes: Development and Evaluation Study. J Med Internet Res 2023; 25:e42497. [PMID: 38055321 PMCID: PMC10733817 DOI: 10.2196/42497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/23/2022] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The promotion of mobile health (mHealth) and eHealth technologies as tools for managing chronic diseases, particularly diabetes mellitus, is on the rise. Nevertheless, individuals with diabetes frequently face a literacy gap that hinders their ability to fully leverage the benefits offered by these resources. Enhancing technology literacy to facilitate the adoption of mobile eHealth services poses a significant challenge in numerous countries. OBJECTIVE This study aims to develop an educational mobile eHealth literacy (eHL) program for patients with diabetes and to evaluate its effect on patients' outcomes. METHODS This study designed a mobile eHL education program comprising 2 modules specifically tailored for individuals with type 2 diabetes (T2D). These modules focused on guiding participants through the process of effectively navigating reliable health websites and utilizing diabetes-related apps. Using a pre- and posttest experimental design, the study featured an intervention group and a control group. Participants were recruited from 3 outpatient departments in hospitals, and assessments were conducted both before and after the intervention, along with a follow-up measure at the 3-month mark. The evaluation encompassed sociodemographic characteristics, computer and internet proficiency, mobile app usage, mobile eHL, and patient outcomes such as self-care behaviors and glycated hemoglobin (HbA1c) levels. RESULTS The analysis included a total of 132 eligible participants. Significant differences were observed in the mean scores of knowledge (P<.001) and skills (P<.001) related to computers, the web, and mobile devices at the initiation of the study and after the intervention. During the 3-month follow-up, the findings indicated a significant improvement in mobile eHL (t114=3.391, P=.001) and mHealth literacy (mHL, a subconcept of mobile eHL; t114=3.801, P<.001) within the intervention group, whereas no such improvement was observed in the control group. The chi-square values from the McNemar test underscored that individuals with uncontrolled diabetes (HbA1c≥7%) in the intervention group exhibited more improvement compared with the control group. The generalized estimating equations model unveiled a significant difference in the change of general mHL in the intervention group (β=1.91, P=.047) and self-care behavior in the control group from T0 to T2 (β=-8.21, P=.015). Despite being small, the effect sizes for mobile eHL (d=0.49) and HbA1c (d=0.33) in the intervention group were greater than those in the control group (d=0.14 and d=0.16, respectively). CONCLUSIONS The implementation of a mobile eHL education intervention demonstrates a positive influence on the familiarity of patients with T2D regarding health technology, leading to favorable glycemic outcomes. While additional studies are warranted for a more comprehensive understanding, this program emerges as a promising solution for enhancing patients' uptake of digital health technology.
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Affiliation(s)
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chun Hsing
- Department of Nursing, Hsinchu Cathay General Hospital, HsinChu, Taiwan
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Ming Chuang
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Shiu LS, Liu CY, Lin CJ, Chen YC. What are the roles of eHealth literacy and empowerment in self-management in an eHealth care context? A cross-sectional study. J Clin Nurs 2023; 32:8043-8053. [PMID: 37668267 DOI: 10.1111/jocn.16876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
AIMS To examine the relationship among eHealth literacy, empowerment and self-management and the mediating effects of empowerment in diabetic kidney disease (DKD) patients in the eHealthcare context. BACKGROUND Self-management is an essential aspect of healthcare in delaying disease progression for DKD. In the eHealthcare era, health services providing self-management are transforming. The ability and confidence of patients to use eHealth services is a critical issue that impacts the effectiveness of self-management, but little is known about the role of eHealth literacy and empowerment in self-management. DESIGN A cross-sectional study guided by the STROBE. METHODS Overall, 127 Taiwanese patients were enrolled using convenience sampling. Data collection used structured questionnaires and chart reviews. Multiple regression was used to infer self-management predictors, and SPSS PROCESS macro and bootstrapping verified the mediating effects. RESULTS Empowerment and eHealth literacy both showed significant positive correlations with self-management. Empowerment was the main predictor of self-management and had a complete mediating effect between eHealth literacy and self-management. CONCLUSION Increasing patients' eHealth literacy can improve empowerment and prevent health inequality issues. Healthcare providers should consider improving patients' eHealth literacy to enhance their self-management. RELEVANCE TO CLINICAL PRACTICE Healthcare service systems need to create user-friendly eHealthcare environments, and healthcare professionals can provide multifaceted instructions that fit patients' eHealth literacy levels to enhance their motivation and confidence in disease care, thus cultivating positive self-management behaviours. IMPACT The popularity of eHealthcare services aimed at promoting self-management behaviours is increasing. However, the level of eHealth literacy is an essential factor that affects the effectiveness of self-management in the healthcare environment. In addition, empowerment is a major critical influence factor of self-management and a completely mediating variable between self-management and eHealth literacy. Consequently, healthcare providers should consider promoting patients' eHealth literacy to empower people using eHealthcare services for implementing self-management. REPORTING METHOD The Strengthening the Reporting of Observational Studies in cross-sectional studies (STROBE) checklist was used to ensure comprehensive reporting. PATIENT OR PUBLIC CONTRIBUTION Patients were diagnosed with DKD in the study hospital. Physicians and case managers transferred patients to research assistants who screened them for the inclusion criteria and invited them to participate in this study if they met the requirements. After participants signed informed consent, the research nurse encouraged participants to respond to the research questionnaire face to face.
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Affiliation(s)
- Lian-Shin Shiu
- International Priority Care Center, Taiwan Adventist Hospital, Taipei, Taiwan, ROC
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Bíró É, Vincze F, Nagy-Pénzes G, Ádány R. Investigation of the relationship of general and digital health literacy with various health-related outcomes. Front Public Health 2023; 11:1229734. [PMID: 37588120 PMCID: PMC10426797 DOI: 10.3389/fpubh.2023.1229734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
Background Despite the growing number of health literacy surveys, we know little about the combined effect of the different dimensions of health literacy on various health-related outcomes. Objective Thus, our study aimed to examine the impacts of general and digital health literacy on health behaviour, confidence in vaccination, self-perceived health, and health care utilization. Methods Our research was part of the Health Literacy Population Survey 2019-2021, which was an international, multicentre, cross-sectional study. The data were collected via computer-assisted telephone interview in December 2020 in Hungary. Multiple multinomial logistic and multivariate linear regression models were used to analyse the separately effects of general and digital health literacy on the studied outcomes. Moreover, the combined effect of general and digital health literacy was also analysed via sensitivity analyses. In the last step, the interactions between general and digital health literacy were examined using the Johnson-Neyman procedure. Results The results did not reveal any associations between health literacy and health behaviour. Health care use was only affected by digital health literacy; however, this effect was inconsistent. Both dimensions of health literacy were positively associated with self-perceived health and vaccination confidence. Conclusion Our results suggest that increasing health literacy could promote health and vaccination confidence, while the potential effect of higher digital health literacy on more conscious use of the health care system should be investigated further.
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Affiliation(s)
- Éva Bíró
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabriella Nagy-Pénzes
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- National Laboratory for Health Security, Center for Epidemiology and Surveillance, Semmelweis University, Budapest, Hungary
- Department of Public Health, Semmelweis University, Budapest, Hungary
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Sjöström AE, Hajdarevic S, Hörnsten Å, Kristjánsdóttir Ó, Castor C, Isaksson U. The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study. J Med Internet Res 2023; 25:e43267. [PMID: 37043268 PMCID: PMC10134016 DOI: 10.2196/43267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. OBJECTIVE The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. METHODS We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis). RESULTS A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. CONCLUSIONS The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.
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Affiliation(s)
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | | | - Ulf Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden
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Mertens L, Dewitte H, Seuntjens L, Vanobberghen R, Aertgeerts B. The guided use of an e-health tool to strengthen health literacy. A pilot study in a multicultural diabetes population in a primary care clinic in Brussels. PEC INNOVATION 2022; 1:100056. [PMID: 37213751 PMCID: PMC10194349 DOI: 10.1016/j.pecinn.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 05/23/2023]
Abstract
Objectives We aimed to investigate whether the use of an e-health tool, guided by a healthcare provider, can improve health literacy (HL) in primary care. Methods We set up a longitudinal prospective cohort study in a primary care clinic in Brussels. Diabetes patients were invited to participate in two study consultations with a trained healthcare provider, in which an e-health tool was introduced. The Health Literacy Questionnaire (HLQ) was used to evaluate HL before (n = 59) and after intervention (n = 41). The data were analysed within SPSS, Version 26. Additionally, impressions and experiences of both patients and healthcare providers were collected throughout the different phases of the study. Results Patients feel significantly stronger in finding good health information after intervention (p = 0.041), with relatively stronger progress for the subgroup with weaker digital skills (p = 0.029). Participants also declare understanding health information better after intervention (p = 0.050). Specifically, the lower educated participants feel reinforced to correctly evaluate and assess health information and come closer to the skill level of the higher educated patients after intervention. The relationship with the healthcare provider was also more markedly enhanced within the group of the lower educated (p = 0.008; difference between higher and lower educated), which could strengthen self-management in the long run. Conclusions The guided use of an e-health tool in primary care strengthens various patient HL skills. Most particularly the skills "the ability to find good health information" and "understand health information well enough to know what to do" are reinforced. Moreover, patient populations with lower HL, such as the lower educated and lower digitally skilled, show a greater learning potential. Innovation Our results offer further proof for the learnable and flexible nature of HL, and show that even a small e-health intervention, in a very diverse patient population, can produce significant, positive effects on HL. These results need to be considered as promising, and a motivation for further investments in more widely accessible e-health tools to further improve HL at population level and to bridge health differences.
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Affiliation(s)
- Lien Mertens
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
- Corresponding author at: Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium.
| | - Harrie Dewitte
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
| | - Lieve Seuntjens
- Department of Family Medicine and Primary Care, University of Antwerp (UAntwerpen), Belgium
| | - Rita Vanobberghen
- Department of Family Medicine and Primary Care, University of Brussels (Vrije Universiteit Brussel), Belgium
| | - Bert Aertgeerts
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
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Gunasekara NP, Fernando WMN, Karunarathne E. Online health information-seeking behaviour: an empirical study of managerial-level employees in Sri Lanka. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2022. [DOI: 10.1108/ijphm-03-2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Over the past few years, the internet has expanded rapidly, and it has been considered a systematic way that consumers use to retrieve health-related information. However, the existing literature does not provide an articulated view of online health information-seeking behaviour through an in-depth understanding of users’ searching-related behaviour. The objectives of this study are to identify the factors affecting consumers’ health-related internet use and recognise the relationships between those specified and health-related internet use. Finally, the recommendations are made based on the findings.
Design/methodology/approach
An amalgamated model of technology acceptance model and health belief model was used to hypothesise health-related internet use behaviour, which is then tested using a cross-sectional survey of 287 Sri Lankan managerial-level employees. The covariance-based structural equation modelling with AMOS was used to check the study hypotheses.
Findings
Findings of this study depict five factors contributing to consumers’ health-related internet use as follows: perceived health risk towards chronic diseases consisting of perceived susceptibility and perceived severity; health consciousness; perceived usefulness of the internet; perceived ease of internet use; and attitude towards health-related internet use. As theorised, the internet’s perceived usefulness was positively and significantly related to consumers’ use of health-related internet and attitude towards health-related internet use. But as hypothesised, perceived ease of internet use did not directly affect consumers’ use of health-related internet. Further, findings reveal that health-related internet use is estimated by perceived health risk than health consciousness.
Originality/value
Findings reveal that Sri Lankan managerial-level employees have a reactive health behaviour driven by the perceived health risk and the desire to seek online health information.
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Kubb C, Foran HM. Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search. JMIR Pediatr Parent 2022; 5:e29618. [PMID: 35532970 PMCID: PMC9127650 DOI: 10.2196/29618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/18/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics. OBJECTIVE This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers. METHODS In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child's (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants' search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined. RESULTS Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (rs=-0.39, P=.01), stress after the search (rs=-0.33, P=.02), and the number of search queries (rs=-0.29, P=.04) but was not significantly associated with eHealth literacy (rs=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (rs=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (rs=0.08, P=.56), number of performed search queries (rs=0.20, P=.17), or total clicks (rs=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child's symptoms. CONCLUSIONS This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public.
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Affiliation(s)
- Christian Kubb
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
| | - Heather M Foran
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
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12
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Lu X, Zhang R. Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study. J Med Internet Res 2021; 23:e14908. [PMID: 34515638 PMCID: PMC8477298 DOI: 10.2196/14908] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/31/2020] [Accepted: 01/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs. Objective This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory. Methods This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses. Results The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs. Conclusions Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.
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Affiliation(s)
- Xinyi Lu
- School of Management and E-business, Zhejiang Gongshang University, Hangzhou, China
| | - Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
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13
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Does Health Literacy Reinforce Disease Knowledge Gain? A Prospective Observational Study of Hungarian COPD Patients. J Clin Med 2021; 10:jcm10173990. [PMID: 34501438 PMCID: PMC8432554 DOI: 10.3390/jcm10173990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
We set out to measure the health literacy (HL) of COPD patients using the Short Test of Functional Health Literacy (S-TOFHLA), perception-based screening questions (BHLS), and a specific disease knowledge test (COPD-Q). Our main focus is the relationship between functional HL and patients' disease-knowledge, which contributes to the clarification of the relationship between the different kinds of HL. In two prospective observational studies, 151 COPD patients (80 males, mean age: 62 ± 9 years) completed a questionnaire containing HL measurements, psychological tests (e.g., the Self-Control and Self-Management Scale), and questions regarding subjective health status. Medical data of the patients from the MedSole system were added. The HL scores of the COPD patients were compared to a representative sample using a t-test. Furthermore, correlations of HL with demographic, psychological, and medical variables were calculated within the patient group. The relations among the different HL measurements were tested by chi-square trials. COPD patients had significantly lower HL, as measured by S-TOFHLA. Younger and higher educated patients possessed higher S-TOFHLA scores. Unlike the demographic variables, general self-management showed significant correlations with both BHLS and with COPD-Q. Out of the medical variables, objective health status was associated with BHLS and COPD-Q. Neither BHLS nor S-TOFHLA had a correlation with COPD-Q, but they correlated with each other. We found S-TOFHLA to be a better tool in the medical context. There is a clear gap between self-perceived/functional HL and the necessary disease knowledge. Rehabilitation care for patients with lower HL was more advantageous.
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Sumaedi S, Sumardjo S, Saleh A, Syukri AF. A model of digital health communication media use during the Covid-19 pandemic. HEALTH EDUCATION 2021. [DOI: 10.1108/he-03-2021-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PurposeThis research aims to develop and test a model of digital health communication media (DHCM) use for healthy food information – DHCM usage – during the Covid-19 pandemic. More specifically, this research investigated the simultaneous effects of perceived threat of Covid-19, e-health literacy, attitude toward DHCM usage, knowledge toward DHCM usage, facilitating conditions and information quality on the DHCM usage.Design/methodology/approachThe empirical data were collected through a survey. The respondents of the survey are 192 DHCM users who lived in Tangerang Regency. Structural equation modelling (SEM) analysis was performed.FindingsThe DHCM usage during the Covid-19 pandemic is significantly affected by the attitude towards the DHCM usage and the facilitating conditions. However, the DHCM usage during the Covid-19 pandemic is not significantly affected by the perceived threat of Covid-19, e-health literacy, information quality and knowledge of the DHCM usage.Research limitations/implicationsThis research was conducted only in Tangerang Regency and employed a purposive sampling technique. Future research should be conducted in other contexts to examine the stability of the research findings.Practical implicationsIn order to improve DHCM usage for healthy food information, it is important for building a positive attitude towards DHCM usage and ensuring the availability of the facilitating conditions.Originality/valueThis paper is the first that develops and tests a model of DHCM usage for healthy food information during the Covid-19 pandemic.
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Papp-Zipernovszky O, Horváth MD, Schulz PJ, Csabai M. Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary. Front Public Health 2021; 9:635943. [PMID: 34055714 PMCID: PMC8158579 DOI: 10.3389/fpubh.2021.635943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization. Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis. Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals. Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.
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Affiliation(s)
- Orsolya Papp-Zipernovszky
- Department of Personality, Clinical and Health Psychology, Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Mária Dóra Horváth
- Department of Health Economics, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Peter J Schulz
- Institute of Communication and Health, Faculty of Communication Science, University of Lugano, Lugano, Switzerland
| | - Márta Csabai
- Department of Personality, Clinical and Health Psychology, Institute of Psychology, University of Szeged, Szeged, Hungary
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16
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Li S, Cui G, Kaminga AC, Cheng S, Xu H. Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study. J Med Internet Res 2021; 23:e25600. [PMID: 33822734 PMCID: PMC8104003 DOI: 10.2196/25600] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/29/2021] [Accepted: 04/03/2021] [Indexed: 02/06/2023] Open
Abstract
Background During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors. Objective The objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy. Methods A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors. Results Of 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth literacy=.277; P<.001). Conclusions The COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students.
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Affiliation(s)
- Shaojie Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghui Cui
- School of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Atipatsa Chiwanda Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Luwinga, Malawi.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Sixiang Cheng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Guo SHM, Hsing HC, Lin JL, Lee CC. Relationships Between Mobile eHealth Literacy, Diabetes Self-care, and Glycemic Outcomes in Taiwanese Patients With Type 2 Diabetes: Cross-sectional Study. JMIR Mhealth Uhealth 2021; 9:e18404. [PMID: 33544088 PMCID: PMC7895642 DOI: 10.2196/18404] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background Understanding how people with diabetes seek online health information and use health applications is important to ensure these electronic tools are successfully supporting patient self-care. Furthermore, identifying the relationship between patient mobile eHealth literacy (mobile eHL) and diabetes outcomes can have far-reaching utility, for example, in the design of targeted interventions to address mobile eHL limitations. However, only limited studies have explored the impact of mobile eHL in a population with diabetes. Objective This study aims to present data about online information-seeking behavior and mobile health (mHealth) app usage, investigate the factors related to mobile eHL in Taiwanese patients with type 2 diabetes, and flesh out the relationship between eHealth literacy (eHL), mobile health literacy (mHL), and health outcomes. Methods Subjects were recruited from January 2017 to December 2017 in the outpatient departments of 3 hospitals in Taiwan. A total of 249 Taiwanese patients with diabetes voluntarily completed a cross-sectional survey assessing sociodemographic characteristics; diabetes status; knowledge and skills of computers, the internet, and mobile apps; mobile eHL; and patient outcomes (self-care behaviors, self-rated health, HbA1c). Structural equation modeling analyses examined the model fit of mobile eHL scores and the interrelationships between latent constructs and observable variables. Results Of the 249 patients with diabetes, 67% (164/249) reported they had searched for online diabetes information. The participants with smartphones had owned them for an average of 6.5 years and used them for an average of 4.5 (SD 3.81) hours per day. Only 1.6% (4/249) of the patients used health apps. Some demographic factors affecting mobile eHL included age, education, and duration of type 2 diabetes. Mobile eHL was related to self-care behaviors as well as knowledge and skills of computers, the internet, and mobile technology, but only had a weak, indirect effect on self-rated health. The final model had adequate goodness-of-fit indexes: chi-square (83)=149.572, P<.001; comparative fit index (CFI)=0.925; root mean square of approximation (RMSEA)=0.057 (90% CI 004-006); chi-square/df=1.082. Mobile eHL had a weak, indirect effect on self-rated health through the variables of knowledge with skills. Conclusions Our study reveals that although people with diabetes who rated their health conditions as moderate were confident in using mobile eHealth and technology, few adopted these tools in their daily lives. The study found that mobile eHL had a direct effect on self-care behavior as well as knowledge and skills of computers, the internet, and mobile technology, and had an indirect effect on health outcomes (glycemic control and self-rated health status). Information about this population's experiences and the role mobile eHL plays in them can spur necessary mobile eHealth patient education.
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Affiliation(s)
| | - Hung-Chun Hsing
- Department of Nursing, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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18
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FitzPatrick MA, Hess AC, Sudbury-Riley L, Schulz PJ. A Typology of Patients Based on Decision-Making Styles: Cross-Sectional Survey Study. J Med Internet Res 2019; 21:e15332. [PMID: 31746770 PMCID: PMC6893560 DOI: 10.2196/15332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Although previous research shows broad differences in the impact of online health information on patient-practitioner decision making, specific research is required to identify and conceptualize patient decision-making styles related to the use of online health information and to differentiate segments according to the influence of online information on patient decision making and interactions with health professionals. Objective This study aimed to investigate patients’ decision making in relation to online health information and interactions with health care practitioners. We also aimed to present a typology of patients based on significant differences in their decision making. Methods We applied a large-scale cross-sectional research design using a survey. Data, generated using a questionnaire that was administered by companies specializing in providing online panels, were collected from random samples of baby boomers in the United Kingdom, the United States, and New Zealand. The total sample comprised 996 baby boomers born between 1946 and 1964, who had used the internet in the previous 6 months to search for and share health-related information. Data were analyzed using hierarchical cluster analysis and confirmatory factor analysis, as well as one-way analysis of variance, chi-square tests, and paired sample t tests. Results Analyses identified 3 key decision-making styles that served as the base for 4 unique and stable segments of patients with distinctive decision-making styles: the Collaborators (229/996, 23.0%), the Autonomous-Collaborators (385/996, 38.7%), the Assertive-Collaborators (111/996, 11.1%), and the Passives (271/996, 27.2%). Profiles were further developed for these segments according to key differences in the online health information behavior, demographics, and interactional behaviors of patients. The typology demonstrates that collaborative decision making is dominant among patients either in its pure form or in combination with autonomous or assertive decision making. In other words, most patients (725/996, 72.8%) show significant collaboration in their decision making with health care professionals. However, at times, patients in the combination Autonomous-Collaborative segment prefer to exercise individual autonomy in their decision making, and those in the combination Assertive-Collaborative segment prefer to be assertive with health professionals. Finally, this study shows that a substantial number of patients adopt a distinctly passive decision-making style (271/996, 27.2%). Conclusions The patient typology provides a framework for distinguishing practice-relevant and addressable segments with important implications for health care practitioners, including better-targeted communication programs for patients and more successful outcomes for health care services in the long term.
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Affiliation(s)
- Mary Anne FitzPatrick
- School of Management and Marketing, Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Alexandra Claudia Hess
- School of Communication, Journalism and Marketing, Massey University, Auckland, New Zealand
| | | | - Peter Johannes Schulz
- Institute of Communication and Health, Faculty of Communication Science, University of Lugano, Lugano, Switzerland
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Park BK. Factors Influencing eHealth Literacy of Middle School Students in Korea: A Descriptive Cross-Sectional Study. Healthc Inform Res 2019; 25:221-229. [PMID: 31406614 PMCID: PMC6689513 DOI: 10.4258/hir.2019.25.3.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives The aim of this study is to identify eHealth literacy level and to analyze the factors influencing eHealth literacy among middle school students in Korea. Methods This descriptive cross-sectional study involved the administration of a self-report questionnaire. The participants were 799 middle school students. Descriptive statistics were analyzed via an independent t-test, Mann-Whitney U-test, and one-way ANOVA. Pearson correlation coefficients were used to test the correlations among variables. Multiple linear regression analysis was conducted to identify the factors influencing eHealth literacy. Results eHealth literacy was substantially lower in students in their first year than in students in their third year of middle school. Participants with asthma, herniated disc, and atopic dermatitis had significantly lower eHealth literacy than those without the diseases. The major finding was that eHealth literacy of middle school students was influenced by their grade and number of diseases diagnosed. eHealth literacy was higher among students in their second and third years of middle school and among those who had fewer diagnosed diseases. Conclusions eHealth literacy among adolescents is important for better health outcomes; however, middle school students with diseases had lower eHealth literacy than healthy students. Therefore, efforts to enhance eHealth literacy should focus on adolescents with diseases; moreover, health education in schools and healthcare settings for adolescents should include critical analytical skill development for better eHealth literacy.
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Affiliation(s)
- Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
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20
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Rathnayake S, Senevirathna A. Self-reported eHealth literacy skills among nursing students in Sri Lanka: A cross-sectional study. NURSE EDUCATION TODAY 2019; 78:50-56. [PMID: 31082746 DOI: 10.1016/j.nedt.2019.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/17/2019] [Accepted: 04/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND As nursing students are the future workforce in nursing, they should have the necessary skills to find, understand and apply health information available on electronic platforms into their practice. OBJECTIVES To assess eHealth literacy skills and associated factors among nursing students. DESIGN Cross-sectional survey. SETTING A Government School of Nursing, Sri Lanka. PARTICIPANTS A purposive sample of 440 nursing students. METHOD A self-administered questionnaire consisting of socio-demographic data, the questions related to the internet use and eHealth Literacy skills was used. In data analysis, descriptive statistics, the Mann-Whitney U test and Kruskal-Wallis H test were applied. RESULTS The sample consisted of 440 nursing students (420 females and 20 males). The mean eHealth literacy score was 28.02 (SD ± 4.60). Nearly half of the respondents (49.4%) reported inadequate eHealth literacy skills. The respondents reported comparatively poor skills in differentiating high-quality health resources from low-quality health resources on the internet and the ability to use information from the internet to make health decisions. The majority viewed that including information technology (IT) as a subject into the nursing curriculum was very (50.7%) or absolutely (33.6%) important. The influencing factors of eHealth literacy skills of nursing students were self-rated internet skills (P = < 0.001), perception towards using the internet in health decision making (P = 0.009) and using the internet to access health resources (P = 0.001). CONCLUSION Half of the nursing students have inadequate eHealth literacy skills, particularly skills in identifying trusted health resources and using this information in health decision making indicating the need for improving eHealth literacy skills among nursing students. A positive attitude towards the internet has a significant role in developing eHealth literacy skills. Improving competencies in eHealth literacy skills of nursing students is essential. Introducing these concepts into curricula, planning target interventions, and enhancing IT facilities within the educational environment are essential.
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Affiliation(s)
- Sarath Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
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Luo YF, Yang SC, Chen AS, Chiang CH. Associations of eHealth Literacy With Health Services Utilization Among College Students: Cross-Sectional Study. J Med Internet Res 2018; 20:e283. [PMID: 30361201 PMCID: PMC6231732 DOI: 10.2196/jmir.8897] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/19/2018] [Accepted: 07/28/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) literacy has become an important topic in health fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physicians. In addition, previous studies have revealed a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the effect of the three levels of eHealth literacy (functional, interactive, and critical levels) on the four aspects of health services utilization (type, site, purpose, and time interval). It is unclear whether the associations between these three levels of eHealth literacy and the four aspects of health services utilization among college students are positive or negative. OBJECTIVE The objective of this study was to investigate the associations among gender, eHealth literacy, and health services utilization. METHODS We used the eHealth Literacy Scale, a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy, and the Health Services Utilization Scale, which is a 10-item instrument developed to measure the four aspects of health services utilization by college students. A nationally representative sample of 489 college students in Taiwan was surveyed. We conducted multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. RESULTS The study found that being female was negatively related to the purpose aspect of health services utilization (t487=-2.85, P<.01). However, the R2 value of gender on the purpose aspect was low enough to be ignored. Critical (t484=2.98-4.23, P<.01) and interactive eHealth literacy (t484=2.43-2.89, P<.05) were related to three aspects of the health services utilization, and functional eHealth literacy was related to the purpose aspect (t484=-4.99, P<.001). CONCLUSIONS This study showed that Taiwanese college students with interactive eHealth literacy were more likely to have a higher rate of outpatient care use. Moreover, Taiwanese college students with critical eHealth literacy were more likely to make full use of health services than those with functional eHealth literacy. Finally, the educated and age-restricted sample may attenuate gender disparities in health services utilization among Taiwanese college students.
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Affiliation(s)
- Yi Fang Luo
- Institute of Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shu Ching Yang
- Institute of Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - An-Sing Chen
- Department of Finance, National Chung Cheng University, Chiayi, Taiwan
| | - Chia-Hsun Chiang
- Institute of Education, National Sun Yat-sen University, Kaohsiung, Taiwan
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22
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Gerges M, Smith AB, Durcinoska I, Yan H, Girgis A. Exploring levels and correlates of health literacy in Arabic and Vietnamese immigrant patients with cancer and their English-speaking counterparts in Australia: a cross-sectional study protocol. BMJ Open 2018; 8:e021666. [PMID: 30068616 PMCID: PMC6074627 DOI: 10.1136/bmjopen-2018-021666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For immigrants diagnosed with cancer, the stress of a cancer diagnosis and treatment can be amplified by unfamiliarity with the health system, lack of culturally and linguistically appropriate information, and inability to communicate efficiently and accurately with the treating team. Lower levels of health literacy may be one factor underlying poorer outcomes among immigrant patients with cancer, but there have been few studies exploring this issue to date. This study aims to investigate the levels and correlates of health literacy in two immigrant populations affected by cancer and their English-speaking counterparts. METHODS AND ANALYSIS Levels and correlates of health and eHealth literacy will be evaluated using a cross-sectional self-report questionnaire. Eligible, English, Arabic and Vietnamese patients with cancer and survivors (n=50 of each language group) will be invited to complete a questionnaire in their preferred language containing the Health Literacy Questionnaire, the eHealth Literacy Scale and study-specific questions assessing potential correlates of poor health literacy, including gender, age, education level, acculturation into Australian society and number of chronic illnesses.Multivariable logistic regression will be used to identify potential approaches to support effective communication with healthcare providers and preferred methods for assessing patient-reported outcomes (PROs) to support culturally appropriate cancer care.The outcomes of this study will be used to better meet the needs of immigrant populations, including the tailoring of interventions appropriate to different health literacy levels. Outcomes will also inform strategies for PRO assessment to inform unmet needs and to address Australian healthcare system challenges to meet the needs of immigrant populations. ETHICS AND DISSEMINATION The study was reviewed and approved by the Human Research Ethics Committee of South Western Sydney Local Health District (approval number: HREC/16/LPOOL/650). Results from the study will aim to be published at international conferences and in peer-reviewed journals.
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Affiliation(s)
- Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT) Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| | - Allan Ben Smith
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT) Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| | - Ivana Durcinoska
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT) Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Henry Yan
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT) Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT) Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
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23
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Matusima M, Masumura Y, Kimura T, Sato K, Takahashi H. [A case of generalized infection with low virulent tubercle bacilli indistinguishable from BCG, showing proliferation of histiocytes with numerous bacilli but without epithelioid granuloma (author's transl)]. J Med Internet Res 1978; 53:573-88. [PMID: 370432 PMCID: PMC10134016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 12/14/2022] Open
Abstract
Background With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers’ digital competencies—their “eHealth literacy.” The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. Objective The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. Methods We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori–defined factor structure (confirmatory factor analysis). Results A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. Conclusions The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.
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