The Longitudinal Relationship Between eHealth Literacy, Health-Promoting Lifestyles, and Health-Related Quality of Life Among College Students: A Cross-Lagged Analysis

Associations Between Sociodemographic Characteristics, eHealth Literacy, and Health-Promoting Lifestyle Among University Students in Taipei: Cross-Sectional Validation Study of the Chinese Version of the eHealth Literacy Scale

BACKGROUND

The popularization of the internet and rapid development of mobile devices have led to an increased inclination and opportunities to obtain health-related information online. The eHealth Literacy Scale (eHEALS), widely used for measuring eHealth literacy, assesses an individual's ability to search, understand, appraise, and use eHealth information. However, the Chinese version of the eHEALS multiple-factor model remains to be validated, and the correlation between eHEALS and the health-promoting lifestyle profile (HPLP) among university students is rarely explored in Taiwan.

OBJECTIVE

This study aimed to examine the fit, validity, and reliability of the Chinese eHEALS multiple-factor model and to clarify the predictive effects of eHEALS on the HPLP among university students.

METHODS

University students in Taipei, the capital of Taiwan, were recruited, and 406 valid questionnaires including sociodemographic characteristics, eHEALS, and HPLP responses were collected. Confirmatory factor analysis was performed to validate the Chinese eHEALS. Independent sample t test, 1-way ANOVA, and multiple linear regression analyses were conducted to examine the relationship between sociodemographic variables and the HPLP. Pearson product-moment correlation and binary logistic regression analyses were performed to ascertain the predictive effects of eHEALS on the HPLP.

RESULTS

The Chinese eHEALS exhibited an optimal fit when delineated into the search, usage, and evaluation 3-factor model (comparative fit index=0.991, Tucker-Lewis index=0.984, root mean square error of approximation=0.062), and its validity and reliability were confirmed. The mean eHEALS score of university students was 3.17/4.00 (SD 0.48) points, and the score for the evaluation subscale was the lowest (mean 3.08, SD 0.56 points). Furthermore, there were significant sex, institution orientation, daily reading time, daily screen time, primary information channel, and perceived health status differences in the HPLP: male participants (t404=2.346, P=.02), participants attending general university (t404=2.564, P=.01), those reading ≥1 hour daily (F2,403=17.618, P<.001), those spending <3 hours on mobile devices or computers daily (F2,403=7.148, P<.001), those acquiring information from others (t404=3.892, P<.001), and those with a good perceived health status (F2,403=24.366, P<.001) had a significantly higher score. After adjusting for sociodemographic variables, the eHEALS score remained an independent predictor of the HPLP. Compared to students with relatively high eHEALS scores, those with relatively low eHEALS scores had a 3.37 times risk of a negative HPLP (adjusted odds ratio [OR]=3.37, 95% CI 1.49-7.61), which could explain 14.7%-24.4% of the variance (Cox-Snell R2=0.147, Nagelkerke R2=0.244, P=.004).

CONCLUSIONS

There is room for improvement in eHealth literacy among university students in Taipei. eHEALS may be used to screen students who require HPLP improvement, thereby providing appropriate eHealth literacy training programs, particularly those targeting evaluation literacy. Additionally, the 3-factor model of the Chinese eHEALS used in this study results in more definite scale content, thus increasing the practicality and applicability of this scale in health-promoting studies.

Health-Promoting Lifestyle and Its Predictors in Renal Transplant Recipients in Hunan, China: A Cross-Sectional Study

Background

Kidney transplantation is a critical treatment for end-stage renal disease (ESRD), with health-promoting lifestyle (HPL) significantly impacting patient outcomes. HPL involves behaviors like regular exercise, balanced nutrition, stress management, and habit modification. However, few studies have analyzed the HPL of renal transplant recipients, addressing a significant gap in current research.

Objective

This study aimed to determine the predictors of HPL in renal transplant recipients using the Chinese Health Promoting Lifestyle Profile (HPLP).

Methods

This cross-sectional study enrolled renal transplant recipients completing the revised Chinese HPLP at organ transplant center in a tertiary hospital in Hunan Province of China between May 2022 and July 2022.

Results

A total of 450 patients were included, comprising 256 males (56.9%), with a mean age of 44.85 ± 10.57 years. The mean score of self-actualization, health responsibility, interpersonal support, physical activity, stress management, nutrition, and overall HPLP were 15.27 ± 5.03 (possible range: 0-24), 11.41 ± 4.18 (possible range: 0-24), 11.61 ± 3.13 (possible range: 0-18), 7.53 ± 3.79 (possible range: 0-18), 12.68 ± 3.61 (possible range: 0-21), 11.17 ± 2.41 (possible range: 0-15), and 69.66 ± 16.98 (possible range: 0-120), respectively. Multivariate logistic regression analysis showed that urban residence (OR = 2.061, 95% CI: 1.350-3.148, P = 0.001), non-smoking after transplantation (OR = 2.010, 95% CI: 1.123-3.600, P = 0.019) and two post-transplant complications (OR=0.387, 95% CI: 0.218-0.689, P = 0.001).

Conclusion

Although renal transplant recipients exhibit a moderate level of HPL, targeted interventions are essential to improve these behaviors. These interventions should focus especially on individuals from rural households, post-transplant smokers, and those experiencing post-transplant complications, to enhance their quality of life and clinical outcomes.

Meta-analysis: eHealth literacy and attitudes towards internet/computer technology

OBJECTIVE

To explore the relationship between eHealth literacy and attitudes towards internet/computer (I/C) technology use in healthcare.

METHODS

Analysis of data from 16 cross-sectional studies, involving literature search from databases like PubMed, EBSCO, JMIR, up to April 2023. Studies were selected based on a quantitative cross-sectional design, with no restrictions on participant characteristics.

RESULTS

A significant positive correlation (0.36; 95% CI 0.37-0.38, p < 0.05) was found between eHealth literacy and positive attitudes towards I/C technology use. Age and regional differences, especially in participants over 50 and from Asian and Middle Eastern countries, were notable.

CONCLUSION

Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions.

Influence of eHealth Literacy and Health Promotion Behavior on Body Mass Index of Workers in the Public Sector

Background

Adequate eHealth literacy and health promotion behavior (HPB) are important to achieve good health-related quality of life. There is limited information on the influence of eHealth literacy and HPB on body mass index (BMI) in our setting and among public service workers.

Objectives

This study assessed the eHealth literacy, HPB, and BMI of public service workers and determined the influence of eHealth literacy and HPB on BMI.

Design

A descriptive cross-sectional design was adopted.

Methods

A simple random sampling technique was used to select 440 public service workers from civil service of redacted. A structured questionnaire was used to collect data on socio-demographics, eHealth literacy, and HPB. Weight and height were measured and BMI was calculated. Data were analyzed using frequency, percentage, mean, standard deviation, and logistic regression analysis. The significant level was set at 0.05.

Results

More than one quarter (28.2%) of respondents had low eHealth literacy, and more than one third (42.5%) had inadequate (30.0% fair and 12.5% poor) HPB. An average (50.5%) had a level of obesity that ranged from preobesity to type 2 obesity. There was a significant association between eHealth literacy and HPB with the BMI of respondents at p < .05.

Conclusion

There was inadequate eHealth literacy and HPB among public service workers. An average of the workers had a level of obesity that ranged from pre-obesity to type 2 obesity. There was a significant association between eHealth literacy and BMI and also between HPB and BMI of respondents. Community health professionals should assist public service workers to develop competencies and skills useful in evaluating health information on the Internet and applying such information to make informed decisions.

Are health promotion activities and preventive health practices predictors of adolescent eHealth literacy?

Adolescents' general health status and health behaviors have been closely monitored in recent years. It is estimated that adolescents comprise one-sixth of the world's population. This study examined whether eHealth literacy was predicted via health promotion activities and preventive health practices among Turkish adolescents. This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face-to-face questionnaire form was used, including socio-demographic characteristics, preventive health practices, eHealth literacy scale and Adolescent Health Promotion Scale. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis, and multiple regression analysis were used in the analyzes. The p < 0.05 value was considered statistically significant in the evaluations. In the study, 55.8% were female, and the mean age of the whole group was 16.09 ± 2.63 years. The mean score on the eHealth literacy scale was 29.40 ± 6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97 ± 21.87. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p < 0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy positively and significantly predicts health promotion activities (β = 0.27, t (695) = 7.54, p < 0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β = 0.13), annual blood iron measurement by more than 0.16 (β = 0.16) and annual dental examination by more than 0.11 (β = 0.11). Developing eHealth literacy interventions will be necessary for environments with a high concentration of adolescents (schools and courses). Also, primary health care services should be integrated with the school environment.

Self-efficacy and self-management mediate the association of health literacy and quality of life among patients with TB in Tibet, China: a cross-sectional study

BACKGROUND

This study aimed to analyze the relationship between health literacy and quality of life in patients with TB in Tibet and explore the mediating effects of self-efficacy and self-management in the relationship between health literacy and quality of life.

METHODS

We used a convenience sampling method to select 271 cases of patients with TB in Tibet to conduct a survey of their general information, health literacy, self-management, self-efficacy and quality of life, and to construct structural equation models.

RESULTS

The total health literacy score of patients with TB in Tibet was 84.28±18.57, while the lowest score was for information acquisition ability (55.99±25.66). Scores for quality of life were generally lower than the norm (patients with chronic diseases from other cities in China) (p<0.01). Moreover, self-efficacy and self-management mediated the relationship between health literacy and quality of life (p<0.05).

CONCLUSIONS

In Tibet, patients with TB have a low level of health literacy and an average level of quality of life. Emphasis should be placed on improving information access literacy, role-physicals and role-emotional to improve overall quality of life. The mediating roles of self-efficacy and self-management between health literacy and quality of life may provide a basis for further interventions.

The Association between Self-Rated Health and Health Self-Management Ability of Healthcare Undergraduates: The Chain Mediating Roles of eHealth Literacy and Resistance to Peer Influence

Health self-management is important for healthcare undergraduates who are at the late adolescent or early adulthood stage, and will play an important part in health promotion for the general population. Previous research has shown that perceived health status affects health self-management. However, few studies have uncovered the mechanism between self-rated health and health self-management among healthcare undergraduates. Based on social ecology theory and Pender's health promotion model, this study aimed to explore the associations between health self-management ability, self-rated health, eHealth literacy and resistance to peer influence of healthcare undergraduates, with a focus on identifying the mediating effects of eHealth literacy and resistance to peer influence. A cross-sectional study was conducted among 515 healthcare undergraduates in Eastern China between July and September 2021. Serial mediation analysis was performed using Haye's Model 6 PROCESS macro to examine the mediating effects. The study found that health self-management ability was significantly and positively correlated with eHealth literacy, resistance to peer influence and self-rated health. Self-rated health had a direct and positive predictive effect on health self-management, with a direct effect value of 0.654. eHealth literacy and resistance to peer influence played both an independent mediating and a chain-mediating role in the mechanism of self-rated health affecting health self-management among healthcare undergraduates, with indirect effect values of 0.085, 0.101, and 0.013, respectively. The results suggest that eHealth literacy and resistance to peer influence could be intervention targets in programs for improving these students' health self-management ability.