How Adolescents Trust Health Information on Social Media: A Systematic Review

'I think that we can effect change': Psychologist use of social media for social justice advocacy

INTRODUCTION

Psychologists can bring social justice into their professional presence on social media, with the public perceiving health care professionals as a reputable source of information online. This study aimed to explore practitioner psychologists' use of social media for social justice advocacy as a mental health influencer.

METHODS

Twelve UK-based practitioner psychologists were interviewed who had an Instagram account that they used as a mental health influencer. The semi-structured interview transcripts were analysed using reflexive thematic analysis.

RESULTS

Systemic issues have motivated many psychologists to begin work as a mental health influencer. There are challenges between the use of social media for social justice advocacy and for business purposes to promote private practice. Psychologists can use social media to share psychoeducation to increase mental health literacy and encourage access to therapy. The accessibility of this content is particularly valuable for people from marginalised communities and for people on long waiting lists to access mental health support. Psychologists can use social media to raise critical consciousness of social inequalities and reduce an individual's sense of self-blame.

CONCLUSION

Irrespective of working in the public sector or private practice, there are opportunities for psychologists to use social media as a resource for social justice advocacy.

Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany

BACKGROUND

Children and adolescents extensively use the internet in their daily lives, often seeking information related to health and well-being. In modern society, the volume of health information available in digital environments is constantly increasing. This includes both reliable and misleading content, making it challenging to assess trustworthiness. Digital health literacy is essential for navigating the digital information ecosystem, protecting oneself from misinformation, and making informed health decisions.

OBJECTIVE

This representative study aims to examine the digital health literacy of children and adolescents in Germany and its association with sociodemographic factors.

METHODS

A cross-sectional study design with face-to-face interviews was utilized to collect data from 1448 children and adolescents aged 9-18 years in Germany between October and November 2022. Digital health literacy was assessed using an adapted and translated version of the Digital Health Literacy Instrument (DHLI), which comprises 7 subscales: operational skills, navigation skills, information searching, self-generated content, evaluating reliability, protecting privacy, and determining relevance. Bivariate and binary logistic regression analyses were conducted to examine associations between digital health literacy subscales and sociodemographic characteristics (sex, age, migration background, school type, and perceived family affluence).

RESULTS

The study found that 419 out of 1362 (30.76%) children and adolescents had a problematic level of digital health literacy, while 63 out of 1362 (4.63%) had an inadequate level. Overall, the least difficulties were observed in operational skills and determining relevance, whereas the greatest challenges were related to protecting privacy and navigation skills. Age was significantly associated with 6 of the 7 subscales (excluding protecting privacy), with younger children (9-11 years) facing a higher risk of limited skills (operational skills: odds ratio [OR] 5.42, P=.002; navigation skills: OR 4.76, P<.001; information searching: OR 4.68, P<.001; adding self-generated content: OR 7.03, P<.001; evaluating reliability: OR 3.82, P<.001; and determining relevance: OR 4.76.42, P<.001). Migration background was associated with fewer limited digital health literacy skills, while low perceived family affluence was associated with more limited skills. In the subscales of information searching, self-generated content, and evaluating information reliability, a lower risk of limited skills was observed among those with a 2-sided migration background (information searching: OR 0.62, P=.02; adding self-generated content: OR 0.30, P=.003; and evaluating reliability: OR 0.66, P=.03). By contrast, a higher risk was found among those with low perceived family affluence, including in the subscale of determining relevance (information searching: OR 2.18, P<.001; adding self-generated content: OR 1.77, P=.01; evaluating reliability: OR 1.67, P<.001; and determining relevance: OR 1.58, P<.001). Although school type was not associated with any dimension, sex was linked to operational skills, with females having an increased risk of limited skills (OR 1.58, P=.03).

CONCLUSIONS

The results highlight a strong need for interventions to improve digital health literacy among children and adolescents, particularly in protecting privacy, navigation skills, and evaluating the reliability of health information. Effective interventions should be tailored to address the varying needs associated with age, migration background, and family affluence.

Lessons from COVID-19 for sexually transmitted infections: Listening and learning from young adults and healthcare providers on sexual health communications dynamics and decisions in four states

OBJECTIVES

To learn how the COVID-19 pandemic response could shape public health messaging for sexually transmitted infections (STIs), researchers conducted qualitative interviews with young adults in demographic groups experiencing disparate rates of STIs and healthcare providers in California, Florida, Louisiana, and Missouri.

METHODS

Between October 2020 and October 2021, researchers interviewed 55 young adults and 49 providers about COVID-19 and STI information sources, perceived risk, and messaging. Young adults included Black/African American gay, bisexual, or other men who have sex with men (Black MSM); Latinx MSM; Black/African American transgender women; Latinx transgender women; and Black/African American cisgender women. Providers were medical doctors, doctors of osteopathy, nurse practitioners, physician assistants, and registered nurses.

RESULTS

Half of young adults identified the Centers for Disease Control and Prevention and the news as primary trusted sources of COVID-19 information; for trusted STI information, they identified providers. Conversely, providers perceived that young adults receive sexual health information from the internet, peers, and social media. Nearly all young adults assessed their likelihood of contracting COVID-19 infection and STIs as low.

CONCLUSIONS

Communication efforts surrounding the novel coronavirus can help sexual healthcare providers improve messaging by aligning multiple, trusted sources of information to reduce message variability; increasing accountability for providers' critical role in affirming sexual health discussions; and supporting patient-driven communications to address individualized STI information needs.

PRACTICE IMPLICATIONS

STI information should be presented in a simple, consistent manner from multiple credible sources-in particular, providers. Second, providers should promote patient-driven conversations that address young people's concerns and communicate with empathy in a non-judgmental fashion. Third, we can address young people's low-risk perception by emphasizing factors both within and outside of young adults' control that can facilitate an ongoing sexually healthy life.

Parental Mediation, Digital Media Usage, and Health Literacy: An Exploration Among Chinese Elementary School Students

This study examines the relationship between parental interactions, digital media usage, and health literacy among 19,386 elementary students (ages 6-11) in Guangdong Province, China, using the framework of parental mediation theory. Path analysis revealed that increased digital media usage is associated with decreased health literacy, particularly for short video platforms, which exhibit a significant negative correlation (β = -.335). Parental interaction was found to significantly reduce the use of instant messaging apps (β = -.007) and short video platforms (β = -.008), with the influence being moderated by the student's residence status (boarding or non-boarding). The findings highlight the importance of frequent parental interaction in limiting digital media usage and enhancing health literacy among children. This study suggests that parental mediation theory should pay closer attention to environmental or living status factors, as they can significantly influence its mechanisms of action. Overall, this research contributes to the discourse on digital behavior in childhood and offers evidence-based insights for improving educational and health literacy strategies.

Social media and internet use among orthopedic patients in Germany-a multicenter survey

Background

Social media (SM) is increasingly used in the healthcare system and offers various benefits for patients such as accessible health information and communication with other patients and healthcare professionals. However, SM also poses risks, including the dissemination of medical misinformation and privacy concerns. This in turn can influence patients' health-related decision-making and the patient-physician relationship. There is limited data regarding which SM orthopedic patients use and what benefits and risks of SM they perceive.

Methods

An online survey was conducted from April to December 2023 among orthopedic and trauma patients in five German orthopedic clinics. The questionnaire with 32 variables was designed to assess internet and SM usage patterns, platform preferences, and perceived benefits and risks. Statistical analysis was performed, including subgroup analyses.

Results

A total of 267 patients participated, with 82.0% reporting regular SM use. In total 45.9% of the patients used SM for general health questions and 51.3% for orthopedic-related questions. The most used information platforms were conventional websites, YouTube, Instagram, and messenger apps. A total of 45.9% used SM infrequently for general health questions, and 51.3% for orthopedic-related queries. Only 13.7% of patients agreed that SM helped in medical decision-making, and 31.1% felt confident in assessing the credibility of SM content. Additionally, 58.6% of patients were unsure about allowing physicians to present their cases on SM, and 62.3% were uncertain about posting their medical images.

Conclusion

Among German orthopedic patients, the use of SM for health-related and gain of orthopedic information was low in the given study. While SM may offer valuable health information, their role in medical decision-making remains limited due to concerns over content credibility and privacy. Video-based content seems to achieve the best reach. Future research should explore these aspects longitudinally and across diverse populations to better understand and address the challenges and benefits of SM in healthcare.

Conflicting and Changing Health Recommendations and Their Influence on Cancer Prevention: Social Media Use and Trust as Positive Mediators

PurposeThis study examines the mediating roles of social media use and trust in the relationship between experts' health recommendations being conflicting and changing and their intention to receive cancer screening tests using the O1-S-O2-R model.DesignCross-sectional.SettingData were extracted from the Health Information National Trends Survey (HINTS) 6.SubjectsOf 6252 individuals, 5014 were used in the final analysis. The total weighted sample size is 255,489,241.MeasuresConflicting & Changing Health Recommendations (O1): How often experts' health recommendations seem to conflict and change. Social Media Use (S): The use of social media to seek and share health information. Trust in Cancer Information (O2): Trust in cancer information from doctors, government health agencies, and scientists. Interest in Cancer Screening in the next year (R).AnalysisMultiple and logistic regressions were performed with the weighted sample. A PROCESS mediation model with a 5000 bootstrapping sample was also performed.ResultsThe perception of health recommendations from experts conflicting was a positive, marginally significant predictor of social media use for seeking and sharing health information (P = .08), which generated higher trust in cancer information from government health agencies (P < .05) and higher intention to receive cancer screening tests within the next year (P < .01).ConclusionsWith strong digital health literacy and appropriate social media algorithms, social media could reinforce cancer screening behaviors.

Perception of occupational health and safety in the manufacturing sector: a qualitative evaluation

Objectives. Earlier work found gaps with respect to legislative compliance and disparities in perceptions, attitudes and beliefs towards occupational health and safety in the Ontario manufacturing sector. The current follow-up study was undertaken to gain a more thorough understanding of the cause of these gaps and differences in perspectives. Methods. Focus group discussions were held with workers and managers separately. Key questions related to health and safety in general, health and safety training, and health and safety communication were asked of each focus group. The discussions were qualitatively analysed. Results. Overall, 12 worker focus groups (n = 76) and seven manager focus groups (n = 38) were conducted. Individuals who felt safe in their workplace indicated that it was a supportive environment, and that health and safety was a priority. Health and safety training was considered important but improvements in engagement and frequency were suggested. Conclusions. Health and safety communication might be hindered by technical terms and language barriers. Delivering this communication in multiple ways as well as the tone of communication should be taken into consideration. Overall, safety culture was lacking and manufacturing workplaces should be mindful of the gaps identified to improve health and safety performance.

'You Can't Muck Around With Transplant': Young People's Experiences of Clinical Care Following Lung Transplant

BACKGROUND

Lung transplantation improves survival and quality of life in young people with end-stage lung disease. Few studies have investigated the clinical care experiences of young people after lung transplantation.

DESIGN

This qualitative study aimed to explore the experiences of young people who underwent lung transplantation. Semi-structured interviews were conducted with 16 lung transplant recipients (< 25 years at transplant). Interviews were analysed to identify themes and categorize and describe the experience of young lung transplant recipients.

RESULTS

The themes that emerged were (1) Hope and spectre: The transplant dilemma; (2) Information delivery and comprehension; (3) Independence and navigating care; and (4) Continuity and youth-appropriate care. Findings suggest that young people have distinct care needs that consider the many parallel life transitions that occur in addition to transplantation. They value consistent and familiar teams, which nurture autonomy and independence in the context of post-transplant survivorship and highlight the importance of feeling that they can relate to the healthcare process.

CONCLUSION

The results highlight key areas where adolescent lung transplant recipients can be supported by clinicians, enabling the development of youth-friendly services that cater to this group's healthcare and psychosocial needs.

PATIENT OR PUBLIC CONTRIBUTION

Sixteen lung transplant recipients participated in the study by completing a semi-structured interview. Two additional lung transplant recipients who received lung transplants as adolescents and one parent of an adolescent lung transplant recipient participated in a Project Advisory Group (PAG) with six clinicians representing paediatric, adolescent, and adult healthcare experience. They provided advice on research design including the development and revision of the interview guide and recruitment methods. They additionally provided feedback on the preliminary findings and outline of the manuscript. A summary of results was presented to the PAG who in conjunction with the writing group developed a list of recommendations based on the themes identified and the tenets of youth-appropriate care as set out by the World Health Organization. One lung transplant recipient was an author on the manuscript contributing to its writing and review before submission. The clinicians who participated in the PAG did not have direct healthcare relationships with the study participants.

Health information orientation and health literacy as determinants of health promotion behaviors in adolescents: a cross-sectional study

Introduction

This cross-sectional study aimed to identify the impact of health information orientation and health literacy on adolescents' health-promoting behaviors.

Methods

We enrolled 149 middle school students from an urban city in South Korea through convenience sampling. The data was collected in October 2022 using a self-reported questionnaire. Health information orientation was measured using the Health Information Orientation Instrument (Cronbach's α = 0.86). Health literacy was assessed with the Korean Adolescent Health Literacy Scale (KR-20 = 0.66), and health promotion behaviors were evaluated using the Adolescent Health Promotion Scale-Short Form (Cronbach's α = 0.89). Analysis methods included independent t-tests, one-way ANOVA, and multiple regression.

Results

Results indicated significant differences in health promotion behaviors based on perceived health status, economic status, primary health-related information provider, and health literacy. Health information orientation showed a strong positive correlation with health promotion behaviors. The factors that influenced health promotion behaviors were health information orientation, primary information provider, economic status, and health literacy.

Discussion

Findings suggest that school and community health promotion programs should engage adolescents and parents to enhance health literacy and proactive information-seeking behaviors for improving the health outcomes of adolescents.

"How to Make it Out Alive": A Strengths-Based Analysis of Latinas' Adolescent Sexual Health Experiences

BACKGROUND

Ample evidence demonstrates Latina adolescents' elevated risk for sexual health disparities, but knowledge of how they manage their sexual health during this critical period of sexual development is limited. Countering the overfocus on Latina adolescents as "at-risk" girls in extant research, this study uses a strengths-based perspective to explore this topic.

METHODS

This study used a narrative research design to gather and analyze the stories of 18 Latina young people who attended school in New York. We employed holistic-content and categorical-content approaches to identify themes and interpret findings through a strengths-based view of sexual health.

RESULTS

We identified three major themes across participants' narratives: (1) agency in gaining sexual health information; (2) self-protection; and (3) obtaining sexual healthcare despite barriers.

CONCLUSIONS

Findings underscore the need for more inclusive, culturally relevant sexual health education initiatives, youth-centered services, and interventions that capitalize on the strengths of Latina adolescents.

Young People's Trust in Digital Sexual Healthcare: A Narrative Review

Objectives

Trust has been identified as a key factor associated with supporting access to sexual health interventions and digital healthcare. We aimed to explore and synthesize factors that may cultivate trust for young people (10-24-year-old) when accessing digital sexual healthcare.

Methods

A total of 5950 articles were extracted from 5 databases (Scopus, PubMed, Embase, PsycINFO and CINAHL) and independently assessed for relevance by two researchers. Trust descriptions were analyzed using a narrative synthesis approach, extracted tabularly and synthesized into themes through conceptual mapping.

Results

Thirteen papers between 2011 and 2021 from the United States (n = 5), Australia (n = 3), United Kingdom (n = 2), Canada (n = 2), and Netherlands (n = 1) were reviewed. Young people (n = 462), varying in gender identity and sexuality, were aged between 14 and 29 years old. Four areas cultivating trust in digital sexual healthcare were described: (1) Esthetics, language, tone: Trusted digital sexual healthcare was easy to navigate, had limited sexually explicit content or pop-up ads, was not overly teen-friendly and used a professional tone and language, reflecting communication reportedly expected from healthcare providers. (2) Privacy, anonymity, safety: Safety features that preserved young people's anonymity were important for their trust, particularly amid fear of shame or stigma. (3) Authors' expertise, authenticity, reputation: Personal accounts online which reflected the young person's own lived experience were trusted for topics considered subjective (e.g., dating and relationships). (4) Consistency: Cross-checking personal accounts and scientific information to confirm the consistency of content helped with young people's evaluation of trust.

Conclusions

Considering the factors cultivating trust when designing digital sexual health interventions may improve access and use. However, given the nuance in lived experience and needs, young people should be meaningfully engaged in the design of digital sexual health interventions. Particularly as sexual health intervention and resources are increasingly being delivered and accessed online by young people.

Context counts: a qualitative study on how adolescents activate social resources to develop and practice health literacy

BACKGROUND

Recently, the importance of social networks and other contextual factors in shaping health literacy of adolescents has gained recognition. However, research often simply refers to context without explicitly describing it. In this qualitative study, we aimed to explore how adolescents activate their (social) resources to develop and practice health literacy within a Swiss cantonal school health service program and in their everyday lives.

METHODS

This study is based on a secondary analysis of interviews from an evaluation of the school health service in the canton of Zug, focusing on the final health screening in the 7th grade (corresponding to an average age of 14 years). Semi-structured interviews were conducted with 16 students. The data was analyzed using thematic analysis and constructivist grounded theory to identify and refine key themes.

RESULTS

Our analysis revealed that adolescents' interactions with their social networks, including family members, teachers, healthcare providers, and peers, were significant resources in their health literacy practices. Other resources included school health services, regular curricula and the internet. The activation of these resources was moderated by several factors that functioned as activators or deactivators, which we divided into three categories: relationships, health system, and pre-existing health literacy. Prominent activators in the category relationships involved good rapport and trust, whereas fear of judgment deactivated resources. In the category health system, access to resources as well as opportunities for participation in dealing with health information, challenges and services were important activators (or when missing, deactivators). Finally, participants demonstrated that pre-existing health literacy in the form of pre-existing knowledge and motivation and attitudes served as an activator of their resources to develop and practice health literacy in a 'virtuous circle'. Thus, although health literacy development and practice were dependent upon their social networks, adolescents played key roles as active agents while navigating health.

CONCLUSIONS

Our findings highlight potential (de)activators of adolescents' resources, primarily those available within their social networks, in the development and practice of health literacy. Results contribute to the literature on adolescent health literacy by shedding light on the often under-described concept of context. Explicit consideration of context provides actionable insights for educators, healthcare providers, and policymakers seeking to support adolescents in the development and practice of health literacy.

Recruitment of Adolescents to Virtual Clinical Trials: Recruitment Results From the Health4Me Randomized Controlled Trial

Background

Preventive interventions are needed to provide targeted health support to adolescents to improve health behaviors. Engaging adolescents in preventive interventions remains a challenge, highlighting the need for innovative recruitment strategies. Given adolescents' lives are intertwined with digital technologies, attention should be focused on these avenues for recruitment. The evolving nature of clinical trials, including the emergence of virtual clinical trials, requires new recruitment approaches, which must be evaluated.

Objective

This study aimed to examine the effectiveness and cost of various digital recruitment strategies for recruiting adolescents to a virtual clinical trial, evaluate the progression of participants from screening to enrollment, and explore factors associated with nonparticipation. This was conducted using data from the Health4Me Study, a preventive digital health intervention to improve physical activity and nutrition behaviors among adolescents aged 12 to 18 years.

Methods

Participants were recruited into the Health4Me Study via social media advertisements on various contemporary platforms, emails to schools, emails to contacts within known networks, and emails to relevant youth organizations. Data were collected from social media advertisements, screening, and recruitment logs. Data analysis included summary and descriptive statistics, as well as chi-square tests to explore factors associated with nonparticipation.

Results

From 2369 expressions of interest, 390 (16.4%) participants were enrolled. A total of 19 advertisements were placed on social media, and 385 promotional emails were sent to schools, contacts within known networks, and relevant youth organizations. Social media advertisements reached 408,077 unique accounts. Advertisements mostly reached those living in populous states in Australia (306,489/408,077, 75.11% of unique accounts) and those identifying as female (177,698/408,077, 43.55% of unique accounts). A total of 24.97% (101,907/408,077) of advertisements were delivered to accounts with uncategorized genders. The total cost per participant enrolled was Aus $3.89 (approximately US $2.58). Most participants (1980/2305, 85.90%) found out about this study through Instagram. Differences in screening characteristics between eligible participants who did and did not enroll were found to be statistically significant for gender (P=.02), with fewer males and more individuals reporting their gender as "other" enrolling than expected by chance alone. The recruitment method also differed (P<.001), with fewer participants enrolling through Instagram and more enrolling through other methods (eg, known networks or word of mouth) than expected by chance alone.

Conclusions

This study found that virtual clinical trial recruitment was found to be low-cost, with the potential to increase trial participation. Social media was the most effective recruitment method, reaching all states and territories, including hard-to-reach populations. Future action is needed to explore recruitment methods that are more effective for males and to build trust among adolescents regarding clinical trial recruitment via social media.

An exploration of having social media influencers deliver a first-line digital intervention to improve body image among adolescent girls: A qualitative study

Social media influencers are popular among adolescents and could offer a unique way to reach young people at scale with body image interventions. This study explored girls' and influencers' views on having influencers deliver body image interventions through vlogs (video blogs) and to gain insight into their preferred format, content, and views on factors that encourage engagement with vlogs. Twenty-one UK based participants were recruited. Three online focus groups were conducted with adolescent girls (n = 16) aged 14-18 years and one with influencers (n = 5) aged 24-33 years, who had a collective following of over 1.5 million subscribers across social media platforms. Data were analysed using reflexive thematic analysis and four themes were generated: Choosing an influencer whose messages and core values are aligned with the topic of body image; the importance of influencer authenticity and personal experience; collaborating on content creation with mental health professionals; and the need for long-form (i.e., 10-20 min) content to address serious topics. Findings suggest having influencers deliver body image interventions to young people could be a useful approach. Results highlight the need to engage with end users from the outset of intervention development to increase the likelihood of intervention effectiveness and engagement.

Could be better: adolescent access to health information and care

Many adolescents must overcome a broad range of barriers to access health information and care and are consequently reluctant to pursue assistance for their health concerns. In this review, we examine from whom and how adolescents seek help (for example, by consulting with friends and family members and by searching for health information using online platforms) and how adolescents treat symptoms without consulting with a clinician by engaging in self-medication. Next, we suggest ways to help adolescents receive accurate health information and access to healthcare through school-based health education programs and health centers. We also discuss how to improve the experience of care for adolescents by collaboratively engaging young patients with their physicians and caregivers using shared decision-making. Finally, we propose developing and posting accurate and engaging multilingual materials on popular online platforms to improve adolescent access to accurate health information and knowledge of how to engage with the healthcare system.

CONCLUSION

The purpose of this review is to examine how adolescents seek, and propose ways to help adolescents access, health information and care despite the many barriers they face.

WHAT IS KNOWN

• Adolescents encounter a broad range of barriers to access health information and care and turn to family members and friends, and search online, for health information. In addition, adolescents benefit from school-based health education programs and health centers that reduce barriers to healthcare access.

WHAT IS NEW

• Adolescents engage in self-medication, including with cannabis use, to treat self-diagnosed illness or symptoms in a potentially harmful manner. • While many adolescents distrust health information shared on social media, recent evidence suggests adolescents are receptive to, and will change some beliefs, in response to health information posted on social media platforms.

Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study

Background

Little is known about the role of exposure to e-cigarette-related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling.

Objective

The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette-related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants' e-cigarette use.

Methods

A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother's education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration.

Results

Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71-8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27-9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39-13.41), or had ≥2 family members aware of participants' e-cigarette use (AOR 6.42, 95% CI 1.29-39.49) were more likely to report increased e-cigarette use.

Conclusions

Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic.

Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review

Adolescent health literacy is critical for navigating the complex landscape of modern healthcare and making informed decisions that influence long-term health outcomes. This comprehensive review synthesizes current research on integrating digital tools and interactive learning approaches to enhance health literacy among adolescents. We explore the use of digital technologies, such as mobile apps and virtual reality, which cater to the preferences of this tech-savvy generation, offering personalized and accessible health information. The effectiveness of interactive learning methodologies, including simulations and role-playing, is also examined, highlighting their potential to increase engagement and retention of health-related knowledge. We address the importance of mental health literacy and the role of social media and peer education in disseminating health information effectively. Our review identifies gaps in the current literature, particularly the need for studies that consider long-term outcomes and the impact of socioeconomic and cultural factors on health literacy initiatives. We propose a multidimensional approach to health literacy education that incorporates innovative technologies and interactive methods to meet the diverse needs of adolescents in various contexts. The findings suggest that an integrated approach, including digital and critical health literacy, is essential for developing comprehensive health education programs that are both informative and engaging for adolescents.

Influence of Economic Connectedness on Pediatric Obstructive Sleep Apnea Severity and Adenotonsillectomy Outcomes

OBJECTIVE

To examine the influence of economic connectedness (EC), a measure of social capital, on obstructive sleep apnea (OSA) severity and adenotonsillectomy outcomes in children.

STUDY DESIGN

Retrospective study.

SETTING

Single tertiary medical center.

METHODS

The study population included 286 children who were referred for full-night polysomnography for OSA and underwent adenotonsillectomy. The primary outcome was the relationship between EC and the presence of severe OSA, and secondary outcomes included postoperative emergency room visits and residual OSA after adenotonsillectomy. Linear regression, Kruskal-Wallis test, Pearson's χ2 test, and multiple logistic regression were used for categorical and continuous data as appropriate.

RESULTS

In this population, the median age was 9.0 (interquartile range [IQR] = 6.9-11.7) and 144 (50.3%) were male. The majority were white (176, 62.0%), black (60, 21.1%), and/or of Hispanic ethnicity (173, 60.9%). The median EC of this population was 0.64 (IQR = 0.53-0.86). Higher EC was associated with decreased odds of having severe OSA (odds ratio: 0.17, 95% confidence interval = 0.05-0.61). However, EC was not associated with either postoperative emergency room visits or residual OSA.

CONCLUSION

EC was significantly associated with severe OSA (ie, apnea-hypopnea index ≥ 10) but not with postoperative emergency room visits or residual OSA after adenotonsillectomy. Further research is needed to understand the effects of various social capital measures on pediatric OSA and adenotonsillectomy outcomes.

Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology

BACKGROUND

Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners.

OBJECTIVE

This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL.

METHODS

Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development.

RESULTS

In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement.

CONCLUSIONS

Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.

Assessing Women's Knowledge and Awareness of Sexually Transmitted Infections in Saudi Arabia: A Comprehensive Study

This study aimed to comprehensively assess the knowledge, awareness, and misconceptions regarding sexually transmitted infections (STIs) among women in Saudi Arabia. A cross-sectional survey was conducted with 600 women aged 18-55 from various regions across the country. The findings revealed moderate overall STI knowledge, with gaps in understanding transmission routes (31.7%), recognizing symptoms (40.8%), and awareness of prevention methods (35.2%). Prevalent misconceptions included the belief that STIs can spread through casual contact (38%), only individuals with multiple partners are at risk (30%), and STIs are always symptomatic (32%). Demographic factors such as age, education level, and marital status significantly influenced STI knowledge, while residential area did not. Higher education, particularly bachelor's degrees and above, was strongly associated with better awareness. Digital platforms like the internet and social media emerged as significant sources of STI information. Undergoing STI testing, discussing STIs with partners, using protection, and receiving the HPV vaccine were linked to higher knowledge levels. This study highlights the need for targeted educational interventions, integration of sexual health education into curricula, training healthcare providers, community engagement, and leveraging digital platforms to enhance STI awareness and prevention efforts among Saudi women.

Associations between digital literacy, health literacy, and digital health behaviors among rural residents: evidence from Zhejiang, China

OBJECTIVE

Within the digital society, the limited proficiency in digital health behaviors among rural residents has emerged as a significant factor intensifying health disparities between urban and rural areas. Addressing this issue, enhancing the digital literacy and health literacy of rural residents stands out as a crucial strategy. This study aims to investigate the relationship between digital literacy, health literacy, and the digital health behaviors of rural residents.

METHODS

Initially, we developed measurement instruments aimed at assessing the levels of digital literacy and health literacy among rural residents. Subsequently, leveraging micro survey data, we conducted assessments on the digital literacy and health literacy of 968 residents in five administrative villages in Zhejiang Province, China. Building upon this foundation, we employed Probit and Poisson models to empirically scrutinize the influence of digital literacy, health literacy, and their interaction on the manifestation of digital health behaviors within the rural population. This analysis was conducted from a dual perspective, evaluating the participation of digital health behaviors among rural residents and the diversity to which they participate in such behaviors.

RESULTS

Digital literacy exhibited a notably positive influence on both the participation and diversity of digital health behaviors among rural residents. While health literacy did not emerge as a predictor for the occurrence of digital health behavior, it exerted a substantial positive impact on the diversity of digital health behaviors in the rural population. There were significant interaction effects between digital literacy and health literacy concerning the participation and diversity of digital health behaviors among rural residents. These findings remained robust even after implementing the instrumental variable method to address endogeneity issues. Furthermore, the outcomes of robust analysis and heterogeneity analysis further fortify the steadfastness of the aforementioned conclusions.

CONCLUSION

The findings suggest that policymakers should implement targeted measures aimed at enhancing digital literacy and health literacy among rural residents. This approach is crucial for improving rural residents' access to digital health services, thereby mitigating urban-rural health inequality.

Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland

Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.

Navigating online health information: Insights into consumer influence and decision-making strategies-An overview of reviews

Objective

Communities' use of technology and the internet for online health information (OHI) is increasing exponentially. An understanding of how and why individuals access OHI, and how this information influences decisions on health, medicines and self-care practices is critical. This review aims to: (1) identify the factors influencing OHI-seeking behaviour; (2) evaluate the evidence of OHI on self-care practices; and (3) outline strategies to improve online informed decision-making and assess the impact of these strategies on consumer outcomes.

Methods

A review of systematic reviews was conducted in November of 2023, following the Cochrane Handbook and PRISMA guidelines, and using PubMed, Scopus, Web of Science and EBSCOhost databases. The methodological quality of retrieved reviews was appraised using the AMSTAR 2 tool.

Results

The search retrieved 1725 records. Of these, 943 were screened, and 33 were included in the final analysis. The most frequently identified reasons for seeking OHI were to retrieve diagnostic and treatment information, and well-being and emotional support. Level of education and socio-economic status influenced OHI-seeking. OHI directly influenced self-care decision-making by individuals and their relationships and communication with healthcare providers. Overall, OHI-seeking (and interventions to promote the use of OHI) enhanced individuals' confidence, skills and knowledge.

Conclusions

The findings highlight the benefits of OHI-seeking and its potential influence on self-care decisions. Future research should focus on strategies that would promote the pursuit of high-quality, up-to-date OHI and on the development of interventions for healthcare professionals to improve patients' use of OHI in self-care and self-efficacy.

Is information evaluated subjectively? Social media has changed the way users search for medical information

Objective

In recent years, social media platforms, such as TikTok and RedBook, have emerged as important channels through which users access and share medical information. Additionally, an increasing number of healthcare professionals have created social media accounts through which to disseminate medical knowledge. This paper explores why users obtain their medical information from social media and how the signals transmitted by social platforms affect use behaviours.

Methods

We combined the elaboration likelihood model and signal theories to construct a comprehensive model for this study. We used simple random sampling to investigate users' behaviours related to social media usage. A total of 351 valid questionnaires were completed by people in Mainland China. The participants were enthusiastic about social media platforms and had searched for health-related information on social media in the past three months. We analysed the data using partial least squares structural equation modelling to investigate the influence of two pathways and two signals (objective and subjective judgement pathways and positive and negative signals) on social media use behaviours.

Results

When seeking medical information on social media, users tend to rely on subjective judgment rather than objective judgment, although both are influential. Furthermore, in the current era, in which marketing methods involving big data algorithms and artificial intelligence prevail, negative signals, such as information overload, have a more pronounced impact than positive signals.

Conclusions

This study demonstrates that the subjective judgment path has a greater impact on users than the objective judgment path. Platforms are encouraged to focus more on users' emotional needs. The paper also discusses the negative impact of information overload on users, sounding an alarm for enterprises to control their use of homogeneous information resulting from the excessive use of big data algorithms.

Perception of Internet Use in Relation to Health Decision-Making among Nursing Students

Internet use has increased worldwide during the COVID-19 pandemic, to the point where it has inadvertently integrated into our lives. University students use the Internet daily for different purposes: seeking information, entertaining, as a teaching and learning tool, they consider social networks as a means of connection and social interaction, and to seek information to make health decisions. Because of this, the Internet and social networks have gained popularity among this group, to the point of developing an abusive use that is not perceived as an addictive risk. A descriptive analysis was performed through the adaptation of a survey about Internet use, social networks and health perception; this survey was given to nursing students of the Gimbernat School during the academic year 2021-2022. Students completed the ad hoc questionnaire (N = 486; 83.5% female, 16.3% male; only 1 declared to be non-binary gender). Our hypothesis had to do with whether the population of nursing students at Gimbernat School had increased, after the pandemic, its use of the Internet and social networks to make decisions about health problems. The objective of the study was to analyse differences in students' habits of use of the Internet and social networks as they look for health information, their decision-making when they find the information and their perception of health as nursing students from a gender perspective. The results showed a clear positive relationship between the variables studied. Of nursing students, 60.4% spend between 20 and more than 40 h a week using the Internet, and 43.6% of these hours are spent on social networks. Of students, 31.1% make health decisions by searching for information on the Internet and consider it useful and relevant. The use of the Internet and social media in relation to health decisions is clearly affected. To try to reduce the incidence of the problem, interventions are needed regarding the prevention and/or consequences of Internet abuse and health education of student nurses as future health assets.

Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study

BACKGROUND

Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes.

OBJECTIVE

This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience.

METHODS

In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use.

RESULTS

Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback.

CONCLUSIONS

Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research.

Associations between health literacy, digital skill, and eHealth literacy among older Chinese adults: A cross-sectional study

Objective

Digital divide in health-related technology use is a prominent issue for older adults. Improving eHealth literacy may be an important solution to this problem. This study aimed to explore the associations between health literacy, digital skills, and eHealth literacy among older Chinese adults.

Methods

A total of 2,144 older adults (mean age, 72.01  ±  6.96 years) from Jinan City, China participated in this study. The eHealth Literacy Scale was used to measure eHealth literacy in older adults. A linear regression model was used to analyze the associations among health literacy, digital skills, and eHealth literacy in older Chinese adults.

Results

The mean eHealth literacy score of the older adults was 17.56  ±  9.61. After adjusting for sociodemographic characteristics and experience of Internet usage, the results of the linear regression showed that health literacy (B  =  0.258, 95% confidence interval (CI)  =  0.215-0.302, P< 0.001) and digital skills (B  =  0.654, 95% CI  =  0.587-0.720, P < 0.001) were positively associated with eHealth literacy. Sensitivity analyses revealed that this association remained robust.

Conclusions

The level of eHealth literacy in older Chinese adults is low. Health literacy and digital skills are associated with eHealth literacy in older adults. In the future, eHealth literacy intervention research should be considered from the perspective of health literacy and digital skills.