Patients' Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence

Medication Non-Adherence in Inflammatory Bowel Disease: A Systematic Review Identifying Risk Factors and Opportunities for Intervention

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and qualitative studies researching IBD medication adherence between 2011 and 2023 were reviewed. In total, 36,589 participants were included in 79 studies. The associated non-adherence factors were contradictory across studies, with rates notably higher (72-79%) when measured via medication refill. Non-adherence was lower in high-quality studies using self-report measures (10.7-28.7%). The frequent modifiable non-adherence risks were a poor understanding of treatment or disease, medication accessibility and an individual's organisation and planning. Clinical variables relating to non-adherence were the treatment type, drug regime and disease activity. Depression, negative treatment beliefs/mood and anxiety increased the non-adherence likelihood. The non-modifiable factors of limited finance, younger age and female sex were also risks. Side effects were the main reason cited for IBD non-adherence in interviews. A large, contradictory set of literature exists regarding the factors underpinning IBD non-adherence, influenced by the adherence measures used. Simpler medication regimes and improved accessibility would help to improve adherence. IBD education could enhance patient knowledge and beliefs. Reminders and cues might minimise forgetting medication. Modifying risks through an adherence support intervention could improve outcomes.

Association of BMI, lipid-lowering medication, and age with prevalence of type 2 diabetes in adults with heterozygous familial hypercholesterolaemia: a worldwide cross-sectional study

BACKGROUND

Statins are the cornerstone treatment for patients with heterozygous familial hypercholesterolaemia but research suggests it could increase the risk of type 2 diabetes in the general population. A low prevalence of type 2 diabetes was reported in some familial hypercholesterolaemia cohorts, raising the question of whether these patients are protected against type 2 diabetes. Obesity is a well known risk factor for the development of type 2 diabetes. We aimed to investigate the associations of known key determinants of type 2 diabetes with its prevalence in people with heterozygous familial hypercholesterolaemia.

METHODS

This worldwide cross-sectional study used individual-level data from the EAS FHSC registry and included adults older than 18 years with a clinical or genetic diagnosis of heterozygous familial hypercholesterolaemia who had data available on age, BMI, and diabetes status. Those with known or suspected homozygous familial hypercholesterolaemia and type 1 diabetes were excluded. The main outcome was prevalence of type 2 diabetes overall and by WHO region, and in relation to obesity (BMI ≥30·0 kg/m2) and lipid-lowering medication as predictors. The study population was divided into 12 risk categories based on age (tertiles), obesity, and receiving statins, and the risk of type 2 diabetes was investigated using logistic regression.

FINDINGS

Among 46 683 adults with individual-level data in the FHSC registry, 24 784 with heterozygous familial hypercholesterolaemia were included in the analysis from 44 countries. 19 818 (80%) had a genetically confirmed diagnosis of heterozygous familial hypercholesterolaemia. Type 2 diabetes prevalence in the total population was 5·7% (1415 of 24 784), with 4·1% (817 of 19 818) in the genetically diagnosed cohort. Higher prevalence of type 2 diabetes was observed in the Eastern Mediterranean (58 [29·9%] of 194), South-East Asia and Western Pacific (214 [12·0%] of 1785), and the Americas (166 [8·5%] of 1955) than in Europe (excluding the Netherlands; 527 [8·0%] of 6579). Advancing age, a higher BMI category (obesity and overweight), and use of lipid-lowering medication were associated with a higher risk of type 2 diabetes, independent of sex and LDL cholesterol. Among the 12 risk categories, the probability of developing type 2 diabetes was higher in people in the highest risk category (aged 55-98 years, with obesity, and receiving statins; OR 74·42 [95% CI 47·04-117·73]) than in those in the lowest risk category (aged 18-38 years, without obesity, and not receiving statins). Those who did not have obesity, even if they were in the upper age tertile and receiving statins, had lower risk of type 2 diabetes (OR 24·42 [15·57-38·31]). The corresponding results in the genetically diagnosed cohort were OR 65·04 (40·67-104·02) for those with obesity in the highest risk category and OR 20·07 (12·73-31·65) for those without obesity.

INTERPRETATION

Adults with heterozygous familial hypercholesterolaemia in most WHO regions have a higher type 2 diabetes prevalence than in Europe. Obesity markedly increases the risk of diabetes associated with age and use of statins in these patients. Our results suggest that heterozygous familial hypercholesterolaemia does not protect against type 2 diabetes, hence managing obesity is essential to reduce type 2 diabetes in this patient population.

FUNDING

Pfizer, Amgen, MSD, Sanofi-Aventis, Daiichi-Sankyo, and Regeneron.

Use of aspirin in cardiovascular disease prevention-the role of online information search

OBJECTIVES

This study intends to examine influences of online information search on the use of aspirin in cardiovascular diseases (CVDs) prevention among the applicable adult population in the United States.

METHODS

We used data of 2018 National Health Interview Survey (NHIS). Our study sample is limited to adults age 40 or older to be consistent with the American Heart Association/American College of Cardiology Foundation (AHA/ACCF) guidelines for aspirin use. Linear probability models were used to test the association between patient's aspirin use behaviors and the variables of interest in four separate models.

RESULTS

Our results show that the use of aspirin for CVD prevention was associated with online health information seeking in different ways. When patients received doctors' advice to use aspirin, online information seeking has a negative influence, depending on whether the individual has CVD risk factors. However, for patients without recommendations from providers, the effects of online information seeking on self-initiated aspirin use depend on the different types of preventions (primary vs. secondary) and CVD risk factors.

CONCLUSION

Overall, online health information might lead to both overuse and underuse of aspirin in CVD preventions. Findings in this study may lead to decision-making that is not consistent with advice from healthcare professionals and/or established clinical guidelines.

Pharmacy-Led Management of Atrial Fibrillation: Improving Treatment Adherence and Patient Outcomes

The world's population is ageing, with the number of those over 60 years expected to represent a fifth of the total population by 2050. Increases in chronic long-term health conditions (LTCs) associated with ageing, and requiring regular but often avoidable medical intervention, are pressurising already overloaded, health and social care systems. Atrial fibrillation (AF) is an LTC, which is most frequently diagnosed in the elderly. An often, asymptomatic condition, AF is associated with a 3- to 5-fold increased risk of severe ischemic stroke. Stroke prevention, with risk-stratified oral anticoagulants (OACs) is the standard recommended care for patients with AF. Stroke avoidance is, however, dependent on persistent adherence to OAC medication, with an adherence rate of >80% considered necessary to achieve optimal health outcomes. Suboptimal adherence to OACs is common, with a third of all AF patients not taking their medication as prescribed. This combined with the short half-life of OACs can result in poor clinical outcomes for patients. Policy makers now consider improving adherence to prescribed medicines for LTCs, a public health priority, to ensure better health outcomes for patients, whilst minimising unnecessary health system costs. Prescribing medicines to treat LTCs, such as AF, is not enough, particularly when the patient may not experience any measurable benefit to the treatment and may instead, experience medication-associated adverse events, including a risk of bleeding. Pharmacists who are experts in medicines management are ideally placed to support medication adherence, to educate, and to improve health outcomes for patients with AF. In this review, I will consider the evidence for poor medication adherence in LTCs and in particular adherence to OACs in patients with AF and highlight the role that pharmacists can play in ensuring optimal adherence and showcase pharmacist-led interventions that effectively address this problem.

Medication safety perceptions in China: Media exposure, healthcare experiences, and trusted information sources

OBJECTIVE

Amid ongoing medication safety concerns in China and limited research on public perceptions, this study investigates the correlations between media exposure, healthcare experiences, and individuals' perceptions of medication safety. It also examines individuals' reliance on information sources during safety crises.

METHODS

A multistage stratified random sampling was employed with the gross sample containing 3090 Chinese adults aged 18-60 years. Data were analyzed using multiple linear regression.

RESULTS

Social media exposure was found to negatively correlate with perceptions of current medication safety and its perceived improvement, while exposure to television and print media showed positive correlations. Positive healthcare experiences were associated with improved medication safety perceptions. Among various information sources, healthcare professionals were deemed most trustworthy during medication safety incidents.

CONCLUSIONS

Media exposure and personal healthcare experiences significantly shape individuals' perceptions of medication safety in China, with healthcare professionals playing a crucial role in this context. Practiceimplications: Effective health crisis communication in China needs to be multifaceted, integrating traditional media and social media platforms to disseminate accurate information broadly. Additionally, healthcare professionals should be actively involved in crisis communication. Their role as trusted sources can be leveraged to clarify misconceptions, and reassure the public during medication safety incidents.

Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study

Objective

Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk.

Methods

A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling.

Results

The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048).

Conclusions

Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.

Consumers' longitudinal health information needs and seeking: a scoping review

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

Reducing Health Anxiety in Patients With Inflammatory Bowel Disease Using Video Testimonials: Pilot Assessment of a Video Intervention

BACKGROUND

Health anxiety has many damaging effects on patients with chronic illness. Physicians are often unable to alleviate concerns related to living with a disease that has an impact on daily life, and unregulated websites can overrepresent extreme anxiety-inducing outcomes. Educational clinician video interventions have shown some success as an acute anxiolytic in health settings. However, little research has evaluated if peer-based video interventions would be a feasible alternative or improvement.

OBJECTIVE

This pilot study assesses the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. It investigates the degree to which patient testimonials can affect state anxiety, and whether patients are comfortable enough with the technology to share their stories.

METHODS

Patients with CD (n=51) and those with UC (n=49) were shown testimonial videos of patients with CD during their physician consultations at Kitasato University Kitasato Institute Hospital in Japan. The video testimonials were collected from Dipex Japan, the Japan branch of an international organization specializing in understanding patient experiences. Patients completed a Visual Analogue Scale for Anxiety before and after viewing the videos, a Hospital Anxiety and Depression Scale (HADS) survey before the videos, and satisfaction surveys. Patients receiving infusion therapy participated in the study while receiving treatment to minimize hospital workflow disruption.

RESULTS

Anxiety reduction, on the Visual Analog Scale for Anxiety, was significant in the entire cohort both when viewed as an ordinal variable (P=.003, t₉₈=1086.5) and as a continuous variable (P=.01, t₉₄=-2.54, 90% CI -3.47 to -0.72). Eighty percent (n=15) of patients with high HADS Anxiety (HADS-A) scores and 71% (n=24) of patients with high starting state anxiety experienced reduced anxiety after watching testimonials. Patients with high state anxiety but low HADS-A scores experienced anxiety reduction (69%, n=16). Forty-two percent (n=100) of patients responded that they would share their stories for future users. When patients with UC received testimonials from patients with CD, 71% (n=49) of patients reported that they were relevant despite differences in condition.

CONCLUSIONS

Our pilot results suggest that patient testimonial videos can reduce illness-related state anxiety for patients with CD and those with UC, especially in those with higher baseline state anxiety. The success of this study in reducing anxiety and achieving patient involvement suggests that video interventions for reducing anxiety might be a low-cost intervention that could scale to any number of hospitals, suggesting that technology can help scale up efforts to record and share patient testimonials. Future work can establish whether patient testimonials can be helpful in other contexts, such as before major surgeries or when a family member receives a difficult diagnosis.

“What are the roles and competencies of doctors in the artificial intelligence implementation society?: A qualitative analysis through physician interview” (Preprint)

BACKGROUND

Artificial intelligence (AI) is a term used to describe the use of computers and technology to emulate human intelligence mechanisms. Although AI is known to affect health services, the impact of information provided by AI on the patient-physician relationship in actual practice is unclear.

OBJECTIVE

The purpose of this study is to investigate the effect of introducing AI functions into the medical field on the role of the physician or physician-patient relationship, as well as potential concerns in the AI era.

METHODS

We conducted focus group interviews in Tokyo's suburbs with physicians recruited through snowball sampling. The interviews were conducted in accordance with the questions listed in the interview guide. A verbatim transcript recording of all interviews was qualitatively analyzed using content analysis by all authors. Similarly, extracted code was grouped into subcategories, categories, and then core categories. We continued interviewing, analyzing, and discussing until we reached data saturation. In addition, we shared the results with all interviewees and confirmed the content to ensure the credibility of the analysis results.

RESULTS

A total of 9 participants who belonged to various clinical departments in the 3 groups were interviewed. The same interviewers conducted the interview as the moderator each time. The average group interview time for the 3 groups was 102 minutes. Content saturation and theme development were achieved with the 3 groups. We identified three core categories: (1) functions expected to be replaced by AI, (2) functions still expected of human physicians, and (3) concerns about the medical field in the AI era. We also summarized the roles of physicians and patients, as well as the changes in the clinical environment in the age of AI. Some of the current functions of the physician were primarily replaced by AI functions, while others were inherited as the functions of the physician. In addition, "functions extended by AI" obtained by processing massive amounts of data will emerge, and a new role for physicians will be created to deal with them. Accordingly, the importance of physician functions, such as responsibility and commitment based on values, will increase, which will simultaneously increase the expectations of the patients that physicians will perform these functions.

CONCLUSIONS

We presented our findings on how the medical processes of physicians and patients will change as AI technology is fully implemented. Promoting interdisciplinary discussions on how to overcome the challenges is essential, referring to the discussions being conducted in other fields.

The Readability and Accountability of Online Patient Education Materials Related to Common Oculoplastics Diagnoses and Treatments

PURPOSE

To assess the readability and accountability of online patient education materials related to oculoplastic diagnoses and treatments, and to determine the source of information encountered by patients searches.

METHODS

We conducted a Google search for 20 search terms related to common oculoplastic diagnoses and treatments and analyzed the first 10 patient education websites populated for each term. Readability was assessed using four validated measures: Gunning Fog Index, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and New Dale-Chall Readability. Accountability was assessed using 4 JAMA benchmarks on a scale of 0-4, with one point awarded for each of the following accountability criteria provided on the website: (1) including all authors and their relevant credentials (2) listing references (3) providing disclosures and (4) providing date of last update.

RESULTS

The average grade level of 200 websites analyzed was 10.89, with 29% written at less than the 6^th grade reading level recommended by the American Medical Association. The source of online information was most frequently educational institutions (36%) and private practices (34%), with fewer online patient education materials from national organizations (18%) and crowdsourced websites (12%). There were no significant differences in readability when comparing searches related to oculoplastics diagnoses versus treatments. Websites averaged 0.91 out of a maximum of 4 recommended accountability criteria, reflecting low overall accountability.

CONCLUSIONS

Online education resources encountered by patients are often written at inappropriate reading levels and demonstrate low accountability. Online patient education materials are most frequently maintained by educational institutions and private practices, with fewer articles from national organizations. Revision of online materials may be necessary to improve health literacy among oculoplastic patients.

"I'm Worth Saving": Making Sense of Medication Taking in a Care Coordination Organization

Patients and healthcare providers (HCPs) may communicatively make sense of medication taking in divergent ways. Often, HCPs prioritize medication adherence, the extent to which patients consume medications as prescribed. In contrast, patients may focus on how medications fit in with their everyday lives. Care coordination organizations (CCOs) provide cohesive, interdisciplinary, health services to chronically ill patients and may help bridge the gap between patient and HCP sensemaking. Our qualitative study asked: How do patients and HCPs involved in a CCO communicatively make sense of medication taking? Through thematic analysis, we found three themes related to patients' sensemaking. Patients (N = 9) made sense of medication taking (1) as necessary and important through embodied experiences, social discourses, and interpersonal interactions; (2) as easy when supported; and (3) through building bonds. We also found three themes related to HCPs' sensemaking: HCP participants (N = 5) made sense of medication taking (1) through dialogue with patients; (2) by interacting in patients' home spaces; and (3) through building relationships with patients. Our final theme explores how communicative sensemaking became more complicated for participants in the context of psychotropic medications. Using Mishler's Voice of the Lifeworld (VoL) and Weick's sensemaking, we advance a constitutive perspective on medication taking. We suggest that researchers and HCPs should focus on constructing shared meanings about medication taking through dialogue, rather than on increasing adherence. Our study provides evidence that, by promoting engagement with the VoL, CCOs may facilitate such dialogs.

Patient Influencers: The Next Frontier in Direct-to-Consumer Pharmaceutical Marketing

Social media influencers are becoming an increasingly popular strategic communication tactic used across industry verticals, including entertainment, fashion, and beauty, to engage directly with consumers. Pharmaceutical companies have also recently entered the social media marketing arena and—within the bounds of governmental regulations—have found ways to build relationships directly with patients using covert persuasion tactics like partnering with social media influencers. Due to consumers’ negative perceptions of pharmaceutical companies, it makes sense that new marketing tactics are being used to establish and improve relationships with consumers. Previous research well documents the ethical dilemmas of direct-to-consumer advertising, and there is recent burgeoning literature on online covert marketing tactics. The academic and medical literature, however, is behind in regard to social media influencers used in health and medicine. This paper highlights and defines terms used in industry practice, and also calls for more investigation and sets forward a research agenda. As consumers spend more time online and patients continue to consult social media for health information, it is important that this new marketing trend does not go unnoticed.

Commentary on the EMA reflection paper on the pharmaceutical development of medicines for use in the older population

Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease-related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.

The Patient Navigator: Can a systematically developed online health information tool improve patient participation and outcomes related to the consultation in older patients newly diagnosed with colorectal cancer?

BACKGROUND

Older cancer patients may search for health information online to prepare for their consultations. However, seeking information online can have negative effects, for instance increased anxiety due to finding incorrect or unclear information. In addition, existing online cancer information is not necessarily adapted to the needs of older patients, even though cancer is a disease often found in older individuals.

OBJECTIVE

The aim of this study was to systematically develop, implement and evaluate an online health information tool for older cancer patients, the Patient Navigator, providing information that complements the consultation with healthcare providers.

METHOD

For the development and evaluation of the Patient Navigator, the four phases of the MRC framework were used. In the first and second phase the Patient Navigator was developed and pilot tested based on previous research and sub-studies. During the third phase the Patient Navigator was implemented in four Dutch hospitals. In the last phase, a pilot RCT was conducted to evaluate the Patient Navigator in terms of usage (observational tracking data), user experience (self-reported satisfaction, involvement, cognitive load, active control, perceived relevance of the tool), patient participation (observational data during consultation), and patient outcomes related to the consultation (questionnaire data regarding anxiety, satisfaction, and information recall). Recently diagnosed colorectal cancer patients (N = 45) were randomly assigned to the control condition (usual care) or the experimental condition (usual care + Patient Navigator).

RESULTS

The Patient Navigator was well used and evaluated positively. Patients who received the Patient Navigator contributed less during the consultation by using less words than patients in the control condition and experienced less anxiety two days after the consultation than patients in the control condition.

CONCLUSION

Since the Patient Navigator was evaluated positively and decreased anxiety after the consultation, this tool is potentially a valuable addition to the consultation for patients. Usage of the Patient Navigator resulted in patients using less words during consultations, without impairing patients' satisfaction, possibly because information needs might be fulfilled by usage of the Patient Navigator. This could create the possibility to personalize communication during consultations and respond to other patient needs.

Association between online health information-seeking and medication adherence: A systematic review and meta-analysis

Background

The evidence of the impact of online health information-seeking (OHIS) on health outcomes has been conflicting. OHIS is increasingly recognised as a factor influencing health behaviour but the impact of OHIS on medication adherence remains unclear.

Objectives

We conducted a systematic review and meta-analysis to examine the associations between OHIS and medication adherence.

Methods

We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology and Behavioural Science Collection for studies published up to December 2020. The inclusion criteria were studies that reported the associations of OHIS and medication adherence, quantitative design, reported primary data only, related to any health condition where medications are used and conducted on patients either in clinical or community settings. A meta-analysis was used to examine the association between OHIS and medication adherence.

Results

A total of 17 studies involving 24,890 patients were included in this review. The study designs and results were mixed. In the meta-analysis, there was no significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS and medication adherence. In the sub-group analysis of people living with HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612, 95% CI 1.266-2.054, p < 0.001).

Conclusions

The current evidence of an association between OHIS and medication adherence is inconclusive. This review highlights methodological issues on how to measure OHIS objectively and calls for in-depth exploration of how OHIS affects health decisions and behaviour.

eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study

Background

Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students’ eHealth literacy and beliefs about medicines, as well as gender differences.

Objective

This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students.

Methods

We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses.

Results

The t test (t₄₇₃=3.73; P<.001; t₄₇₃=–2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed.

Conclusions

These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines.

Integration of personalized drug delivery systems into digital health

Personalized drug delivery systems (PDDS), implying the patient-tailored dose, dosage form, frequency of administration and drug release kinetics, and digital health platforms for diagnosis and treatment monitoring, patient adherence, and traceability of drug products, are emerging scientific areas. Both fields are advancing at a fast pace. However, despite the strong complementary nature of these disciplines, there are only a few successful examples of merging these areas. Therefore, it is important and timely to combine PDDS with an increasing number of high-end digital health solutions to create an interactive feedback loop between the actual needs of each patient and the drug products. This review provides an overview of advanced design solutions for new products such as interactive personalized treatment that would interconnect the pharmaceutical and digital worlds. Furthermore, we discuss the recent advancements in the pharmaceutical supply chain (PSC) management and related limitations of the current mass production model. We summarize the current state of the art and envision future directions and potential development areas.

Assessing the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Age-Related Macular Degeneration

IMPORTANCE

One of the top ten causes of disability in the United States is vision loss, primarily due to age-related eye diseases such as age-related macular degeneration. With an aging population, the number of people affected by this condition is expected to rise. Patients increasingly turn to the internet for health-related information, but no standard exists across published websites.

OBJECTIVE

To assess the quality, content, accountability and readability of information found online for age-related macular degeneration.

DESIGN

This cross-sectional study analyzed 12 freely available medical sites with information on age-related macular degeneration and used PubMed as a gold standard for comparison. Thirty-four questions were composed to include information most relevant to patients and each website was independently evaluated by one vitreoretinal surgeon, two vitreoretinal fellows and one ophthalmology resident. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the accountability of each site.

SETTING

Freely available online information was used in this study.

RESULTS

The average questionnaire score for all websites was 90.23 (SD 17.56, CI 95% ±9.55) out of 136 possible points. There was a significant difference between the content quality of the websites (P = .01). The mean reading grade for all websites was 11.44 (SD 1.75, CI 95% ±0.99). No significant correlation was found between content accuracy and the mean reading grade or Google rank (r = 0.392, P = .207 and r = 0.133, P = .732, respectively). Without including PubMed, only one website achieved the full 4 JAMA benchmarks. There was no correlation between the accuracy of the content of the website and JAMA benchmarks (r = 0.344, P = .273). The interobserver reproducibility was similar among 3 out of 4 observers (r = 0.747 between JS and NT, r = 0.643 between JS and NP, r = 0.686 between NP and NT, r = 0.581 between JS and NY; P ≤ 0.05).

CONCLUSION AND RELEVANCE

The freely available information online on age-related macular degeneration varies by source but is generally of low quality. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme we used to support the patient in making medical decisions.

The Influence of Online Health Information Seeking Before a Consultation on Anxiety, Satisfaction, and Information Recall, Mediated by Patient Participation: Field Study

BACKGROUND

Today, many cancer patients engage in online health information seeking (OHIS). However, little is known about how patients differ in their OHIS levels. In addition, OHIS might influence patient participation during a consultation with a physician, which might mediate the effects on patient outcomes.

OBJECTIVE

The aim of this study is twofold: first, to provide insight into which personal characteristics and psychosocial factors affect patients' OHIS levels and, second, to test the hypothesis that the effects of OHIS on patient outcomes are mediated by patient participation during the consultation.

METHODS

Patient participation was operationalized in terms of patients' absolute word count; the relative contribution of the patient, compared with the health care provider; and the number of questions and assertions expressed during the consultation. The patient outcomes measured were anxiety after the consultation, satisfaction with the consultation, and information recall. Participants in this study were patients recently diagnosed with colorectal cancer recruited from 6 hospitals in the Netherlands (n=90). Data were collected using questionnaires and audio-recorded consultations of patients with health care providers before their surgery.

RESULTS

The results showed that younger patients, higher educated patients, patients with a monitoring coping style, and patients who experienced more cancer-related stress engaged more in OHIS. In turn, OHIS was related to patient participation in terms of the patient's absolute word count but not to the relative contribution to the consultation or expressing questions and assertions. We did not find a relation between OHIS and anxiety and OHIS and recall mediated by patient participation. However, we found that patients' absolute word count significantly mediated the positive association between OHIS and patients' satisfaction with the consultation.

CONCLUSIONS

Results indicate positive implications of OHIS for patients' care experience and, therefore, the importance of helping patients engage in OHIS. However, the results also suggest that OHIS is only successful in increasing a single aspect of patient participation, which might explain the absence of relations with anxiety and recall. The results suggest that more beneficial effects on patient outcomes may be achieved when health care providers support patients in OHIS.

The influence of online health information on health decisions: A systematic review

OBJECTIVES

This systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.

METHODS

Eligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers' (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.

RESULTS

A total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.

CONCLUSION

Consumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.

PRACTICE IMPLICATIONS

Health care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.

Impact of an Education Programme on IBD Patients' Skills: Results of a Randomised Controlled Multicentre Study [ECIPE]

BACKGROUND

Better patient knowledge on inflammatory bowel disease [IBD] could improve outcome and quality of life. The aim of this study was to assess if an education programme improves IBD patients' skills as regards their disease.

METHODS

The GETAID group conducted a prospective multicentre randomised controlled study. IBD patients were included at diagnosis, or after a significant event in the disease course. Patients were randomised between 'educated' or control groups for 6 months. Education was performed by trained health care professionals. A psycho-pedagogic score [ECIPE] was evaluated by a 'blinded' physician at baseline and after 6 and 12 months [M6 and M12]. The primary endpoint was the increase of ECIPE score at M6 of more than 20%.

RESULTS

A total of 263 patients were included in 19 centres (male:40%; median age:30.8; Crohn's disease [CD]:73%). Of these, 133 patients were randomised into the educated group and 130 into the control group. The median relative increase in ECIPE score at M6 was higher in the educated group as compared with the control group (16.7% [0-42.1%] vs 7% [0-18.8%], respectively, p = 0.0008). The primary endpoint was met in 46% vs 24% of the patients in the educated and control groups, respectively [p = 0.0003]. A total of 92 patients met the primary endpoint. In multivariate analysis, predictors of an increase of at least 20% of the ECIPE score were randomisation in the educated group (odds ratio [OR] = 2.59) and no previous surgery [OR = 1.92].

CONCLUSIONS

These findings support the set-up of education programmes in centres involved in the management of IBD patients.

Association of COVID-19-imposed lockdown and online searches for toothache in Iran

BACKGROUND

Novel coronavirus disease-2019 (COVID-19) has impacted populations in many ways worldwide, including access to oral health services. This study aims to assess the association between lockdown due to COVID-19 and online searches for toothache in Iran using Google Trends (GT).

METHODS

We investigated GT online searches for toothache within the past five years. The time frame for data gathering was considered as the initiation and end dates of the national lockdown in Iran. We performed one-way ANOVA statistical test to compare relative search volumes (RSVs) between the year 2020 and 2016-2019 for the whole country. Then we investigated the possible association of RSVs in provinces with dentists' density, prevalence of current daily smokers, Human Development Index (HDI), Internet access, and fluoride concentration in water using linear regression.

RESULTS

When comparing 2020 with the previous four years, there was a rise of 2020 RSVs versus all previous years combined and each year (P < 0.001 for all of them). In the linear model for the year 2020, HDI (B = - 3.29, 95% CI: (- 5.80, - 0.78), P = 0.012) had a strong negative relationship with provincial RSVs. HDI mostly had strong positive relationship with provincial RSVs in prior years. Fluoride concentration (B = - 0.13, 95% CI: (- 0.24, - 0.03), P = 0.017) and dentists' density (B = - 0.04, 95% CI: (- 0.25, 0.17), P = 0.669) were also negatively associated with RSVs in 2020. These associations were mostly negative in the previous years as well. Internet access (B = 0.36, 95% CI: (- 0.38, 1.09), P = 0.325) and prevalence of daily smokers (B = 0.33, 95% CI: (0.13, 0.53), P = 0.002) were positively associated with RSVs.

CONCLUSION

The RSVs for toothache in 2020 have increased due to COVID-19-imposed lockdown compared with the same period in the past four years. This increase was related to socioeconomic factors.

Beliefs about Medicines among a Sample of Iraqi patients with Psoriasis

OBJECTIVES

This study aimed to evaluate beliefs about use of medications for a sample of Iraqi psoriasis patients, and to examine the association between these beliefs and selected patient's related factors.

METHODS

This cross-sectional study included 300 patients with diagnosed psoriasis. Participants were recruited at the center of Dermatology and Venereology, Medical City in Baghdad, the capital city of Iraq. Patients' mean age was 35.15years (±10.54). Beliefs about medicines were measured by the Arabic version of Beliefs about Medicines Questionnaire.

RESULTS

Most the patients (76.7%) had strong beliefs in the need (acceptance beliefs) for their psoriasis medicines (specific-necessity score higher than specific-concern), whereas 15.0% of patients had specific-concern score higher than specific-necessity and 8.3% of patients had specific-necessity score equal to specific-concern. At the same time, 74.4% of the patients believed that the medicines disrupt their lives and (35.6%) of them had concerns about the possibility of becoming addicted on these medicines. Many other patients were worried about the long-term consequences of the medicines (58.7%). In addition, 31.0% of the participants believe that all medicines are poisoning, and that they do more harm than good. Finally, many of the participants believed that physicians prescribe too many medicines (46.7%), and they can minimize the number of prescribed medicines by spending more time with their patients (32.6%).

CONCLUSIONS

Female gender and longer disease duration have direct association with specific necessity, while psoriasis severity has a direct association with specific concern. In conclusion, Beliefs about medications and habit strength are important modifiable drivers to enhance adherence and clinical outcomes in the control of psoriasis.

Patient literacy and awareness of medicine safety

Objective

To assess public understanding of medicine safety, approach to risks and preferences in accessing safety information.

Methods

Qualitative data were obtained from an online survey (n = 1079) covering four major themes around side effects and risks of medicines: willingness to accept side effects of medications, information seeking, sufficiency of information and understanding pharmacovigilance process. Comparisons were made for age, gender and social/financial status.

Key findings

Most respondents acknowledged medications were associated with side effects. If side effects were experienced, most (73%) would seek advice from their doctor or pharmacist. Four in 10 respondents felt doctors and pharmacists do not provide sufficient information about medications, even though many (47%) relied on their doctor to provide this. Although 51% felt that pharmaceutical companies were already providing enough information to patients, 95% responded that extra effort could still be made. Two-thirds of the respondents felt it was the companies’ responsibility to educate doctors and pharmacists so they could pass the information on, even though younger respondents preferred direct communication to patients compared to older respondents (&lt;24 years, 36% versus &gt;65 years, 10%; P &lt; 0.001). Men were more willing to accept risks, while women were more likely to seek information about their medicines. Understanding of the role of pharmaceutical companies and government in maintaining the safety of medicines was generally poor.

Conclusions

There is an ongoing need for consumer education regarding medicine safety. Doctors and pharmacists remain the more trusted source of information. Pharmaceutical companies play an important role in ensuring such information is both accessible and accurate.

The costs outweigh the benefits: seeing side-effects online may decrease adherence to statins

Background

The prevalence of medical misinformation on the Internet has received much attention among researchers concerned that exposure to such information may inhibit patient adherence to prescriptions. Yet, little is known about information people see when they search for medical information and the extent to which exposure is directly related to their decisions to follow physician recommendations. These issues were examined using statin prescriptions as a case study.

Methods

We developed and used a tool to rank the quality of statin-related web pages based on the presence of information about side effects, clinical benefits, management of side effects, and misinformation. We then conducted an experiment in which students were presented with a hypothetical scenario in which an older relative was prescribed a statin but was unsure whether to take the medication. Participants were asked to search the web for information about statins and make a recommendation to this relative. Their search activity was logged using a web-browser add-on. Websites each participant visited were scored for quality using our tool, quality scores were aggregated for each participant and were subsequently used to predict their recommendation.

Results

Exposure to statin-related benefits and management of side effects during the search was significantly associated with a higher probability of recommending that an older relative adhere to their physician’s recommendation. Exposure to misinformation and side effects were not associated, nor were any other participant characteristics. Bigram analyses of the top reasons participants gave for their recommendation mirrored the statistical findings, except that among participants who did not recommend following the prescription order, myriad side effects were mentioned.

Conclusions

Our findings suggest that units of information people see on health-related websites are not treated equally. Our methods offer new understanding at a granular level about the impact of Internet searches on health decisions regarding evidence-based recommended medications. Our findings may be useful to physicians considering ways to address non-adherence. Preventive care should include actively engaging patients in discussions about health information they may find on the web. The effectiveness of this strategy should be examined in future studies.

Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information

OBJECTIVE

This study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking.

METHODS

We analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy.

RESULTS

Half of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients' online health information-seeking seriously or affirming patients' beliefs.

CONCLUSION

This exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients' online health information-seeking.

PRACTICE IMPLICATIONS

Results of this study could guide interventions to train providers in talking about patients' online health information-seeking.

A qualitative study of living with the burden from heart failure treatment: Exploring the patient capacity for self-care

Aim

To explore how patients with heart failure perceive their capacity to manage treatment and self-care.

Design

A qualitative descriptive study.

Methods

Patients (N = 17) were recruited from a nurse-led heart failure outpatient clinic from May-August 2017. Data were collected through individual semi-structured interviews and analysed using systematic text condensation.

Results

Three main themes were identified as follows: "Personal characteristics," "Coping strategies" and "Emotional and informative support." The first main theme contained the subthemes "inherent strength" and "maintenance of a positive attitude." The second main theme included the subthemes "selective denial," "ability to adapt by setting new goals" and "careful selection of information." The third main theme contained the subthemes "support from health professionals enhancing patient capacity," "support from next of kin in patients' self-care" and "practical support and hope from peers."

Health-related Internet use and treatment adherence: A transdiagnostic comparison of outpatients with major depressive disorder and schizophrenia

Treatment adherence is relevant for clinical and economic outcome in affective disorders as well as psychosis. Knowledge concerning the disease and its treatment might influence patients' willingness to follow the health-care providers' recommendations and mutual decision-making. In the current study, we investigated how Internet surfing for health-related issues and attitude toward the relevance of the online information impact treatment adherence in major depressive disorder (MDD) and schizophrenia (SZ). A total of 83 outpatients (59 MDD, 24 SZ) participated in a survey. A multiple linear regression model with "exposure," "attitude," "diagnosis," and their interaction as regressors was significant predictive of medication-adherence rating scores, R² = .179; 95% CI [0.00, 0.32]. In the MDD group only, more extended exposure to Internet surfing for health-related issues and attribution of higher personal relevance were associated with poorer medication adherence at a statistical trend level, p = .060 and p = .077, respectively. In both groups, being female as well as higher age and intelligence were associated with favorable adherence, p = .003, p = .044, and p = .039, respectively. Considering the limitations (e.g., small sample size), our findings add to previously published data contributing to a better understanding of how Internet use may impact treatment adherence in MDD and schizophrenia.

A Mixed Method Study Investigating the Impact of Talking about Patients' Internet Use on Patient-Reported Outcomes

This study aims to propose and test a model that provides a more comprehensive understanding of the impact of discussing online health information on patient outcomes. By combining survey data (N = 160) and qualitative analysis of video recordings of consultations (N = 165) with structural equation modeling, this study explores: (1) whether patients and health-care providers talk about online medical information and (2) the impact of talking about online medical information on patient outcomes (patient satisfaction, recall of medical information, and medication adherence). Results show that more than half of the patients searched online prior to their consultation. In about half of these consultations (46.81%), the online information was discussed. Patients were more satisfied with the consultation if the online information was discussed during the consultation. Moreover, patient satisfaction was positively related to recall of medical information, but only in patients with whom the online information was discussed. There was no effect found on medication adherence. Results of this study demonstrate the importance of talking about online information during a consultation for improving patient outcomes. Implications for research are discussed.