eHealth Literacy in People Living with HIV: Systematic Review

Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach

BACKGROUND

Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management.

PURPOSE

This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes.

METHODS

A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 ( N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples.

RESULTS

Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management.

CONCLUSION/IMPLICATIONS FOR PRACTICE

This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.

Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes: Cross-sectional survey study

OBJECTIVE

The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM).

METHODS

A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables.

RESULTS

Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed.

CONCLUSIONS

The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden.

IMPLICATIONS TO PRACTICE

This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.

Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review

BACKGROUND

COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations.

OBJECTIVE

To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic.

METHODS

A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results.

RESULTS

Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results.

CONCLUSIONS

The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses.

CLINICALTRIAL

Health literacy mediates the effects of educational attainment on online pharmacy navigation skills in older adults with HIV disease

ObjectiveThe Internet serves an increasingly critical role in health behaviors for older adults with chronic medical conditions. Guided by theories of health behaviors and literacy, this study examined whether the relationship between educational attainment and online pharmacy skills in older persons with HIV disease (PWH) is mediated by health literacy. Design: Participants included 98 PWH age 50 and older who completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate an experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). Participants also completed the Medication-Management Test-Revised (MMT-R). Results: Mediation analyses revealed a significant indirect effect of education on both online pharmacy accuracy and MMT-R, which was fully mediated by health literacy. In contrast, there was no direct or indirect effect of education on online pharmacy speed when health literacy was included as a mediator. Conclusion: Health literacy plays an important role in the relationship between years of education attained and the ability of older PWH to successfully navigate online pharmacy tasks and manage their medications. Future studies might examine whether interventions to improve electronic health literacy among older PWH who have lower educational attainment have beneficial effects on online health behaviors.

e-Health Literacy Skills in People with Chronic Diseases and What Do the Measurements Tell Us: A Scoping Review

Background: Use of electronic health (e-Health) technologies has increased in the past decade and inadequate e-Health literacy may lead to health-related social inequality. This is especially true for patients living with chronic diseases who are often involved in self-care. However, the measurement of e-Health literacy represents several challenges. Among available instruments, the e-Health Literacy Scale (eHEALS) is the only instrument with available psychometric properties. Aim: To identify studies measuring e-Health literacy in adults living with chronic disease and its relationship to health-related behaviors and other perceptions such as quality of life, self-efficacy, or specific disease biomarkers, and studies analyzing the impact of educational intervention on e-Health literacy. Methods: The authors searched MEDLINE, the Cochrane Library, and Web of Science databases to identify studies published in English language until April 2022. Results: Seventeen studies involving 4,877 participants were included. A majority of the studies were cross-sectional with a lack of appropriate controls. Five of the included studies were experimental, involving 758 participants. All of them reported positive effects of educational interventions on the improvements in self-reported e-Health literacy skills. However, most studies were at risk of bias. Conclusion: Despite these limitations, the findings of this review indicate the positive relationship between e-Health literacy and various health care processes in adults with chronic diseases and highlights a need for prospective controlled studies. Promoting e-Health literacy might give better opportunities for the active involvement of people with chronic diseases in self-care and for the implementation of online interventions into existing system of care.

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

BACKGROUND

Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population.

METHODS

A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines.

RESULTS

The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+.

CONCLUSION

PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report

OBJECTIVES

This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article.

METHODS

PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores.

RESULTS

The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms.

CONCLUSIONS

To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.

Assessing eHealth literacy among internet users in Lebanon: A cross-sectional study

Objective

Assessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics.

Methods

A cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS’ psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS.

Results

A total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information.

Conclusions

Future internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.

eHealth literacy among older adults living with cancer and their caregivers: A scoping review

INTRODUCTION

Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information.

METHODS

This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of "eHealth Literacy" and "cancer" were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature.

RESULTS

Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system.

CONCLUSION

With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted.

Trends of global health literacy research (1995-2020): Analysis of mapping knowledge domains based on citation data mining

Background

During uncertainties associated with the COVID-19 pandemic, effectively improving people’s health literacy is more important than ever. Drawing knowledge maps of health literacy research through data mining and visualized measurement technology helps systematically present the research status and development trends in global academic circles.

Methods

This paper uses CiteSpace to carry out a metric analysis of 9,492 health literacy papers included in Web of Science through mapping knowledge domains. First, based on the production theory of scientific knowledge and the data mining of citations, the main bodies (country, institution and author) that produce health literacy knowledge as well as their mutual cooperation (collaboration network) are both clarified. Additionally, based on the quantitative framework of cocitation analysis, this paper introduces the interdisciplinary features, development trends and hot topics of the field. Finally, by using burst detection technology in the literature, it further reveals the research frontiers of health literacy.

Results

The results of the BC measures of the global health literacy research collaboration network show that the United States, Australia and the United Kingdom are the major forces in the current international collaboration network on health literacy. There are still relatively very few transnational collaborations between Eastern and Western research institutions. Collaborations in public environmental occupational health, health care science services, nursing and health policy services have been active in the past five years. Research topics in health literacy research evolve over time, mental health has been the most active research field in recent years.

Conclusions

A systematic approach is needed to address the challenges of health literacy, and the network framework of cooperation on health literacy at regional, national and global levels should be strengthened to further promote the application of health literacy research. In the future, we anticipate that this research field will expand in two directions, namely, mental health literacy and eHealth literacy, both of which are closely linked to social development and issues. The results of this study provide references for future applied research in health literacy.

Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review

BACKGROUND

Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs.

OBJECTIVE

This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used.

METHODS

We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain.

RESULTS

We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy.

CONCLUSIONS

Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective.

Nurses' ehealth literacy and associations with the nursing practice environment

AIM

To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment.

BACKGROUND

Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health.

INTRODUCTION

High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses.

METHODS

The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed.

FINDINGS

In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information.

DISCUSSION

Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care.

CONCLUSION

This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study

Background

The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior.

Objective

The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior.

Methods

We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics.

Results

Better health literacy (β=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; β=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (β=.28, SE 0.07), female gender (β=.15, SE 0.05), poor health (β=.22, SE 0.06), participation in social groups (β=.13, SE 0.05), and having an annual health exam (β=.35, SE 0.12) were all associated with online health-related information-seeking.

Conclusions

Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy.

Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study

BACKGROUND

Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them.

OBJECTIVE

This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education.

METHODS

Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months.

RESULTS

Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking.

CONCLUSIONS

Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey

BACKGROUND

Providing HIV/STD testing and prevention education, medical and nonmedical case management, housing assistance, transportation services, and patient navigation are just a few examples of how community-based HIV/AIDS service organizations will help the United States realize the goals of the updated National HIV/AIDS Strategy.

OBJECTIVE

In this study, the aim was to assess electronic data security confidence level, electronic communication behaviors, and interest in using eHealth communication tools with clients of staff at community-based HIV/AIDS service organizations.

METHODS

Staff were recruited from 7 community-based HIV/AIDS service organizations in the southern United States (3 in South Carolina and 4 in Texas). The principal investigator used state department of health websites to identify community-based HIV/AIDS service organizations. Staff were included if they provided HIV/STD prevention education to clients. A recruitment letter was sent to community-based HIV/AIDS service organization leaders who then used snowball sampling to recruit eligible staff. Chi-square tests were used.

RESULTS

Among staff (n=59) who participated in the study, 66% (39/59) were very or completely confident that safeguards are in place to keep electronically shared information from being seen by other people; 68% (40/59) used email, 58% (34/59) used text messages, 25% (15/59) used social media, 15% (9/59) used a mobile app, 8% (5/59) used web-enabled videoconferencing, and 3% (2/59) used other tools (eg, electronic medical record, healthnavigator.com website) to communicate electronically with their clients. More than half were very interested in using eHealth communication tools in the future for sharing appointment reminders (67%, 38/59) and general health tips (61%, 34/59) with their clients. Half were very interested in using eHealth communication tools in the future to share HIV medication reminders with their clients (50%, 29/59). Forty percent (23/59) were very interested in using eHealth communication tools to share vaccination reminders with their clients.

CONCLUSIONS

Community-based HIV/AIDS service organization staff had some level of confidence that safeguards were in place to keep electronically shared information from being seen by other people. This is critically important given the sensitivity of the information shared between community-based HIV/AIDS service organization staff and their clients, and because many staff were very interested in using eHealth communication tools with their clients in the future. It is very likely that eHealth communication tools can be used in community settings to improve health outcomes across the HIV care continuum; in the interim, more research is needed to better understand factors that may facilitate or impede community-based HIV/AIDS service organization staff use and client acceptability.

Qualitative and Quantitative Analysis of Definitions of e-Health and m-Health

Objectives

Skills to employ nursing informatics to promote the health of individuals is of such importance that it is considered a core competence. Although investments are made to increase the use of e-health, there is no full understanding of the usability of e-health for healthcare. This paper presents a current picture of how e-health and m-health are defined and used as well as the effects their usage may have on the intended target group.

Methods

Peer-reviewed open-access papers and grey literature that define e-health and m-health from PubMed, SpringerLink, and Google.com were randomized. A mixed method design with an inductive approach was employed. Open-source software were used for analysis.

Results

The overview includes 30 definitions of e-health and m-health, respectively. The definitions were thematised into 14 narrative themes. The results of the study, and primarily a three-level model, provide an understanding of how different types of e-health and m-health can be put into practice, and the effects or consequences of using them, which may be either positive or negative.

Conclusions

Mobility and flexibility is important for both m-health and e-health. Five keywords that characterize the definitions of e-health and m-health are "health", "mobile", "use", "information", and "technology". E-health or m-health cannot replace human actors because e-health and m-health consist of social and material interactions. Using e-health and m-health is, thus, about developing healthcare without compromising native relics.

Lower Neurocognitive Functioning Disrupts the Effective Use of Internet-Based Health Resources in HIV Disease: The Mediating Effects of General Health Literacy Capacity

HIV-associated neurocognitive impairment is an independent predictor of low general health literacy, which can be associated with poor disease outcomes (e.g., viremia). Given the increasing frequency with which health behaviors occur in an online environment (e.g., health information seeking, provider interactions), there is a specific need to understand the predictors of electronic health (eHealth) literacy of persons living with HIV disease. In this study, 90 HIV+ persons completed the eHealth Literacy Scale (eHEALS), which measures one's awareness, skills and evaluation of online health resources. Participants also completed a comprehensive battery of clinical neurocognitive tests and well-validated performance-based measures of general health literacy capacity (e.g., knowledge, numeracy). Results showed that, independent of education, lower neurocognitive function was moderately related to lower eHEALS scores, particularly in the domains of learning and motor skills. Of particular note, general health literacy capacity emerged as a significant mediator of the relationship between neurocognition and eHealth literacy. Thus, the adverse effects of neurocognition on health literacy capacity carries a downstream adverse influence on HIV+ persons' awareness, skills, and evaluation of health-related resources in the online environment.