Social media in adolescent health literacy education: a pilot study

Associations between GoSmart Channel, health literacy and health behaviours in adolescents: A population-based study

BACKGROUND

Health literacy is essential in the promotion of healthy lifestyle habits and chronic disease prevention.

OBJECTIVE

To assess the health literacy level among Hong Kong adolescents; to evaluate the association between access of an online health information platform (GoSmart Channel) and health literacy level; and to examine the association between health literacy level and various unhealthy behaviours.

DESIGN

This study recruited students from 10 local secondary schools in Hong Kong to assess the health literacy level among adolescents.

SETTINGS AND PARTICIPANTS

Participants were required to complete a self-administered questionnaire on health behaviours and health literacy using the Health Literacy Measure for Adolescents (HELMA). MAIN OUTCOME MEASURE: Data were analysed using descriptive statistics and multivariate regression modelling.

RESULTS

A total of 777 responses were collected. Overall, most (74.4%) of the adolescents in Hong Kong have limited health literacy (HELMA score <66). The majority (63.7%) of adolescents relied on their parents for health information, while 11.4% of the respondents sought information from the GoSmart Channel. The intervention of GoSmart Channel was significantly associated with better health literacy in almost all aspects among adolescents. Desired levels of health literacy were significantly associated with better perceived health (adjusted odds ratio: 2.04, p = .001) and negatively associated with a range of unhealthy and risky behaviours including unhealthy dietary habits, poor hygienic measures and physical inactivity.

DISCUSSION AND CONCLUSION

This study highlights the importance of improving health literacy among Hong Kong adolescents and the potential of technology-based interventions. The findings suggest the need for continued efforts to promote health literacy and healthy behaviours among adolescents, especially given the limited health literacy levels observed in the study.

PATIENT OR PUBLIC CONTRIBUTION

Members of the GoSmart.Net Built-on Project patient and public involvement and engagement group advised about survey development.

The role of online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran: Development of a conceptual model

Online social networks have been used to enhance human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevention, diagnosis, and treatment programs worldwide. This study aimed to develop a conceptual model of using online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran. This mixed-method sequential exploratory study was conducted in three phases. Firstly, a series of semi-structured interviews with a purposive sample of 29 HIV-positive patients were conducted to investigate the perceptions and experiences of HIV-positive patients about using online social networks to support health literacy and medication adherence. Thematic analysis was used to analyse qualitative interviews, extract potential components, and design a conceptual model. Then, a Delphi study with 27 HIV-positive patients was subsequently conducted to examine the consensus of patients on the proposed model. Finally, the trustworthiness and credibility of the proposed model were reviewed and evaluated by expert panel members from epidemiology and public health. Seven themes and 24 sub-themes emerged from the qualitative interviews. Five themes encompassed components of online social networks that supported communication and information-seeking behaviour of people living with HIV/AIDS. The two other themes encompassed social support and health-related outcomes including medication adherence. The credibility of the proposed conceptual model was confirmed methodologically using the expert panel and Delphi technique. Our findings highlighted that using online social networks has empowered Iranian people living with HIV/AIDS, making them more connected, safe, and able to access HIV/AIDS-related information and services. The role of online social networks in improving health literacy and medication adherence was also demonstrated in a conceptual model to understand the supportive components of online social networks in the HIV care continuum as well as customized interventions to improve the success of antiretroviral therapies.

Letramento em saúde de adolescentes na pandemia de COVID-19: revisão integrativa

RESUMO Objetivo: analisar a produção científica sobre o letramento em saúde (LS) de adolescentes durante a pandemia de COVID-19. Método: revisão integrativa, nas bases de dados MEDLINE, LILACS, CINAHL e Web of Science, entre março de 2020 e agosto de 2021. Foram incluídos artigos originais nos idiomas inglês, espanhol e português. Resultados: dos 65 estudos encontrados na busca, oito foram incluídos para análise, não havendo nenhuma publicação no Brasil, com cinco publicações no ano de 2021, predominância na língua inglesa (n=7) e todos classificados com nível de evidência VI. Dos instrumentos utilizados, eHealth literacy foi a ferramenta mais aplicada (n=2). Televisão, família e internet foram apontadas como as principais fontes de informações de saúde durante a pandemia. Considerações finais: a literatura sinalizou que o LS pode interferir na tomada de decisão dos adolescentes e que um baixo LS pode levar a decisões e ações de exposição física e mental dos adolescentes.

Health literacy of adolescents in the COVID-19 pandemic: an integrative review

ABSTRACT Objective: to analyze the scientific production on health literacy (HL) of adolescents during the COVID-19 pandemic. Method: an integrative review, in the MEDLINE, LILACS, CINAHL and Web of Science databases, between March 2020 and August 2021. Original articles in English, Spanish and Portuguese were included. Results: of the 65 studies found in the search, eight were included for analysis, with no publication in Brazil, with five publications in 2021, predominantly in English (n=7) and all classified with level of evidence VI. Of the instruments used, eHealth literacy was the most applied instrument (n=2). Television, family and the internet were identified as the main sources of health information during the pandemic. Final considerations: the literature has indicated that HL can interfere with adolescents’ decision making and that a low HL can lead to decisions and physical and mental exposure actions of adolescents.

Effects of Media Health Literacy School-Based Interventions on Adolescents' Body Image Concerns, Eating Concerns, and Thin-Internalization Attitudes: A Systematic Review and Meta-Analysis

This systematic and meta-analytic review investigated the effects of media health literacy (MHL) interventions in school settings on adolescents' body image. Twenty one intervention-control comparisons reported in 16 studies were identified. The following attributes were extracted from each study for a systematic review: Study time-period and country location, sample composition, school atmosphere, unit of random assignment, theoretical perspective, intervention-control comparison, co-interventions, number of overall and MHL sessions, length of MHL sessions, and outcomes measured. The meta-analysis of effect sizes for three outcomes of interest related to body image showed consistent changes in the desired negative direction as expected: body image concerns (g = -0.25, k = 19); eating concerns (g = -0.18, k = 19); thin-internalization attitudes (g = -0.40, k = 12); and combined (g = -0.25, k = 21). Homogeneity analysis for the combined effect size and moderator analyses for gender composition of intervention group, number of overall intervention sessions, number of MHL specific intervention sessions within the overall intervention, and time length of MHL intervention session all showed absence of moderators. However, all study samples except one were of European origin and so caution should be exercised when generalizing to other cultures that may have different standards of female ideal body type.

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.

The role of Twitter in dental education: A systematic review

BACKGROUND

The rapid growth of social media in recent years has highlighted uses beyond their original purposes, particularly in education. Twitter is a free, open access social network with high potential to enhance interactive learning. The use of Twitter in dental education has been far less investigated; therefore, the objective of this systematic review is to explore the current uses and to examine the impact of Twitter on dental education, and to analyze and predict potential models of Twitter for future application in dental training, education, and teaching.

METHODS

Five databases (PubMed, Embase, Medline, Scopus, and Web of Science) and the gray literature using keywords related to Twitter and dental education were searched. Articles were screened for inclusion, and two researchers independently extracted the data using a standardized data collection template and analyzed the quality of the included articles using the Medical Education Research Study Quality Instrument.

RESULTS

Of the 121 articles identified from the initial search, 68 remained after duplications were removed. Article screening removed 61 articles leaving 7 eligible for inclusion and data extraction. Five studies were cross-sectional and two were cohort studies, and all involved survey-based designs with 998 respondents in total. Quality assessment gave a score range between 8 and 12.5 out of a total of 18 points.

CONCLUSIONS

Our study supports the potential for Twitter as a useful learning tool in dental education. Features, including the open access nature of Twitter as well as the low level of ads and free registration, make it appealing to students as well as a useful tool for interactive learning. However, there are significant barriers to its use, including privacy and concerns about professionalism. Higher quality and greater impact research is required.

The use of internet platforms for oral health information and associated factors among adolescents from Jakarta: a cross sectional study

Background

The growth of the internet has increased its use to obtain health information including oral health information (OHI). This study assessed Indonesian adolescents’ use of different internet platforms to obtain OHI and factors associated with this use.

Methods

A cross-sectional study surveyed middle school students in five regions in Jakarta in 2019. Participants completed a questionnaire that assessed demographics, oral health practices (toothbrushing and dental visits), the presence of dental pain, using internet platform to obtain OHI and type of information searched for. Multinomial logistic regression was used to assess the association between using the internet for OHI (Google, Social Media (SM), both or none) and the independent factors: demographics, oral health practice, dental pain and whether participants search for causes, symptoms, prevention or treatment of oral diseases (ODs).

Results

Most of the 521 participants were female (55.7%) with mean age = 13.4 years. Almost all of them (93.7%) searched the internet for OHI through Google (40.7%) or Google with SM (36.1%). Searching for OHI over SM was significantly associated with toothbrushing (OR = 4.12, 95% CI = 1.43, 11.89) and less dental visits (OR = 0.16, 95% CI = 0.05, 0.60). Searching Google for OHI was significantly associated with looking for information about causes (OR = 3.69, 95% CI = 1.33, 10.26) and treatment (OR = 6.17, 95% CI = 2.23, 17.03) of ODs.

Conclusions

Most adolescents used Google to seek OHI. Oral health practices and types of OHI searched for differed by internet platform. Dental health professionals should consider using internet-based interventions to promote oral health to this age group.

Development and validity testing of the Adolescent Health Literacy Questionnaire (AHLQ): Protocol for a mixed methods study within the Irish school setting

INTRODUCTION

Health literacy research has focused predominantly on the adult population, and much less is understood about this concept from an adolescent perspective. The tools currently available to measure adolescent health literacy have been adapted from adult versions. This limits their applicability to young people because of the developmental characteristics that impact on adolescents' behaviour, including impulse control and judgement skills. This protocol describes the intended development and validity testing of a questionnaire to measure health literacy in adolescents.

METHODS AND ANALYSIS

This protocol describes this mixed methods study that has three phases: the first phase will involve grounded research with adolescents using qualitative group interviews, co-design and concept mapping workshops to understand what health and healthy behaviours mean to adolescents and to explore their health literacy needs and the potential domains for the questionnaire. The draft health literacy domains identified will be presented to the youth advisory panel, and the questionnaire will be altered based on their feedback. Cognitive pretesting of the questionnaire items will also be conducted. Phase 2 will involve piloting the questionnaire to a two-stage random sample of young people in five urban and rural schools in Ireland. Test-retest reliability will be conducted using Pearson correlation coefficient. Confirmatory factor analysis will also be conducted to analyse the psychometric properties of the questionnaire. Phase 3 will involve the questionnaire being rolled out to a nationally representative sample of adolescents (n=6052) in Ireland to assess their levels of health literacy.

ETHICS AND DISSEMINATION

Ethical approval to conduct this study has been granted from the University College Dublin Human Research Ethics Committee - Sciences (LS-20-08). Informed assent from adolescents and informed consent from parents/guardians will be sought. The findings of this research will be disseminated at national and international conferences, as well as through publication in peer-reviewed journals.

Yoga and Aerobic Dance for Pain Management in Juvenile Idiopathic Arthritis: Protocol for a Pilot Randomized Controlled Trial

Background

Juvenile idiopathic arthritis (JIA) is one of the most common types of arthritis among children. According to JIA guidelines for physical activity (PA), structured PA interventions led to improved health outcomes. However, many PA programs, such as yoga and aerobic dance, have not been studied in this population despite being popular among youth. Web-based PA programs could provide patients with accessible and affordable interventions.

Objective

The primary aims of the proposed pilot randomized controlled trial (RCT) are to examine (1) the feasibility of conducting a full-scale RCT to evaluate the effectiveness of two popular types of PA: a yoga training program and an aerobic dance training program, in female adolescents (aged 13-18 years) with JIA compared with an electronic pamphlet control group; and (2) the acceptability of these interventions.

Methods

A three-arm prospective randomized open-label study with a parallel group design will be used. A total of 25 female adolescents with JIA who have pain will be randomized in a ratio of 2:2:1 to one of the 3 groups: (1) online yoga training program (group A: n=10); (2) online aerobic dance training program (group B: n=10); and (3) electronic pamphlet control group (group C: n=5). Participants in groups A and B will complete 3 individual 1-hour sessions per week using online exercise videos, as well as a 1-hour virtual group session per week using a videoconferencing platform for 12 weeks. Participants from all groups will have access to an electronic educational pamphlet on PA for arthritis developed by the Arthritis Society. All participants will also take part in weekly online consultations with a research coordinator and discussions on Facebook with participants from their own group. Feasibility (ie, recruitment rate, self-reported adherence to the interventions, dropout rates, and percentage of missing data), acceptability, and usability of Facebook and the videoconferencing platform will be assessed at the end of the program. Pain intensity, participation in general PA, morning stiffness, functional status, fatigue, self-efficacy, patient global assessment, disease activity, and adverse events will be assessed using self-administered electronic surveys at baseline and then weekly until the end of the 12-week program.

Results

This pilot RCT has been funded by the Arthritis Health Professions Association. This protocol was approved by the Children’s Hospital of Eastern Ontario Research Ethics Board (#17/08X). As of May 11, 2020, recruitment and data collection have not started.

Conclusions

To our knowledge, this is the first study to evaluate the effectiveness of yoga and aerobic dance as pain management interventions for female adolescents with JIA. The use of online programs to disseminate these 2 PA interventions may facilitate access to alternative methods of pain management. This study can lead to a full-scale RCT.

International Registered Report Identifier (IRRID)

PRR1-10.2196/12823

Child and Youth Health Literacy: A Conceptual Analysis and Proposed Target-Group-Centred Definition

(1) Background: This article adopts an interdisciplinary perspective to analyse, examine, and reflect upon prominent health literacy (HL) understandings in childhood and youth. (2) Method: The conceptual analysis combined Rodgers’ and Jabareen’s approaches to conceptual analysis in eight phases. (3) Results: First, we present exploratory entry points for developing a child-specific HL understanding based on the six dimensions of a ‘health-literacy 6D model’. Second, we describe and reflect upon five meta-level dimensions covering the HL definitions and models for children and youth found in the conceptual analysis. Third, we integrate our findings into a target-group-centred HL definition for children and youth. (4) Discussion/Conclusion: This article raises awareness for the heterogeneity of the current conceptual HL debate. It offers a multidisciplinary approach for advancing the existing understanding of HL. Four recommendations for future actions are deduced from the following four principles, which are inherent to the proposed target-group-centred HL definition: (a) to characterize HL from an asset-based perspective, (b) to consider HL as socially embedded and distributed, (c) to recognize that HL develops both in phases and in flexible ways, and (d) to consider the multimodal nature of health-related information. Further research is necessary to test the feasibility and applicability of the proposed definition and conceptual understanding in both research and practice.

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses

BACKGROUND

Youth health issues represent a "wicked problem" - they are complex and multifaceted. Furthermore, they are likely to require novel approaches to understand their complexity and develop novel solutions.

OBJECTIVE

Given the importance of youth healthcare, and the need for novel approaches, the aim of this article was to demonstrate the innovative use of two research methods - thematic and lexical analyses - to better understand practitioner perspectives of youth healthcare. It clarifies the factors that shape practitioner ability to support young people and opportunities to improve practice.

DESIGN AND SETTING

Focus groups and interviews were conducted with 37 youth health practitioners. They represented government and non-government services; hospital and community services; and metropolitan and regional services.

RESULTS

Thematic analysis highlighted the complexity of participants' work and the judgements made as they negotiated relationships with young people and ancillary services. Lexical analysis revealed two hitherto neglected dimensions of the complexity of youth healthcare - uncertainty and corporeality.

DISCUSSION

In addition to affirming the complexities of youth healthcare, this study revealed how practitioners (can) negotiate these complexities. These findings were only possible because of the innovative use of the two research methods.

CONCLUSIONS

This study has important theoretical, methodological and practical implications. Theoretically, it is the first to view the complexities of youth healthcare through the wicked problem lens. Methodologically, it highlights the complementary value of thematic and lexical analyses. Practically, it reinforces the importance of policy support and professional development to enable practitioners to grasp the complexities of their work.

YouTube videos as health decision aids for the public: An integrative review

OBJECTIVE

To determine the potential value of YouTube videos as health decision aids for the public.

METHODS

An integrative review was performed to explore 3 questions: 1) What is the validity of health-related YouTube videos created for the public? 2) Are YouTube videos an effective tool for supporting the public in decision making regarding the treatment, prevention, and diagnosis of disease? 3) How can health professionals ensure their videos will be readily accessible to those searching online for health-related information? Systematic searches of PubMed, CINAHL, and Web of Science were conducted. The returns were screened using inclusion and exclusion criteria and studies found were critically appraised.

RESULTS

Fifty-eight studies assessed the validity of videos on given topics and 9 studies examined the effectiveness of videos in supporting decision making. These studies demonstrated that the majority of health-related YouTube videos lack validity. However, evidence-based videos do exist and have the potential to be an effective instrument in supporting the public in making health decisions. Ten studies examined ways to increase the accessibility of such videos to the public.

DISCUSSION

Creators of evidence-based videos must take into consideration content and content-agnostic factors to improve the accessibility of their videos to searchers. Recommendations to support creators in making their evidence-based health videos readily accessible to the public are provided.

CONCLUSIONS

By exploiting appropriate content and content-agnostic factors, video creators can ensure that valid health information is readily accessible to information seekers.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Scoliosis and the Social Media: Facebook as a Means of Information Exchange

BACKGROUND CONTEXT

Over the last decade, the emergence of social networking websites such as Facebook have revolutionized information dissemination and broadened opportunities to engage in discussions. In particular, having been widely adopted in the younger generation, the use of this medium has become more prevalent in health disorders such as scoliosis in the adolescent population. However, the quality of information on Facebook is unregulated and variable, which may mislead patients in their decision making.

PURPOSE

To document the various types of information available and assess the quality of information on Facebook discussion boards using recognized scoring systems.

STUDY DESIGN

To evaluate the quality of information on the social network.

PATIENT SAMPLE

A search for the keyword "scoliosis" on Facebook was performed and the first 100 pages generated were reviewed.

OUTCOMES MEASURED

SCSS and DISCERN score.

METHODS

Content analysis was performed on discussion boards and personal blogs. Two independent examiners evaluated each site according to scoliosis-specific content score (SCSS) and the DISCERN criteria, both previously used instruments to judge the quality of information on the Internet pertaining to scoliosis. The SCSS range from 0 to 32 (higher score better) and the DISCERN 16 to 80 (higher score better).

RESULTS

Of the 100 sites reviewed, 33 were discussion boards and personal blogs. Of these, the overall average SCSS was 5.7 (SD 5.8, range 0-20) and the DISCERN was 22.5 (SD 7.6, range 16-45), indicating that using general scoring systems the quality of information provided was overall poor.

CONCLUSION

Using recognized scoring systems to analyze Facebook pages used as discussion forums or blogs, we showed that the quality in general was poor. For modern practices to adapt to an era of information exchange via the social network, the orthopedic community should develop ways to incorporate the social media in future patient education.