Health information seeking of low socioeconomic status Hispanic adults using smartphones

Recommendations to advance digital health equity: a systematic review of qualitative studies

The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users' needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice.

Dark side consequences of cyberchondria: an empirical investigation

Purpose

Cyberchondria refers to the repeated and excessive search for health-related information online, associated with increased health anxiety. This paper utilizes the protection motivation theory to investigate the negative behavioral consequences of cyberchondria that pose health risks to users, such as trust in the physician, propensity to self-medicate, and therapy compliance.

Design/methodology/approach

The data for the study were collected from a sample of 317 participants in India using an online survey and form. The analysis was conducted using structural equation modeling.

Findings

Cyberchondria negatively affects the trust in physician and positively affects the propensity to self-medicate. Trust in physician negatively affects the propensity to self-medicate and positively affects therapy compliance. Furthermore, trust in physician partially mediates the relationship between cyberchondria and the propensity to self-medicate and completely mediates the relationship between cyberchondria and therapy compliance. Cyberchondria has no direct significant effect on therapy compliance.

Research limitations/implications

Researchers need to examine other behavioral or psychological factors affected by the reduced trust in physicians due to cyberchondria.

Practical implications

Physicians and health care providers should refocus on patients with cyberchondria and regain their trust through quality interactions and services. Policymakers may consider regulating online health information publication to set the standards of information quality and source. Websites and platforms publishing health information online should distinctly label verified information.

Originality/value

This study investigates the damaging effects of cyberchondria's behavioral consequences that pose health risks to users.

Can digital health technologies exacerbate the health gap? A clustering analysis of mothers' opinions toward digitizing the maternal and child health handbook

Background

The use of mobile health has increased worldwide, but along with its increased utilization comes the risk of the digital divide, inequity in access to information and communications technologies, exerting greater influence on health inequity caused by socioeconomic determinants of health. There is a growing need to investigate whether the digitization of existing health interventions has a risk of worsening the health gap.

Methods

We investigated the attitudes of mothers and pregnant women toward digitization of the Maternal and Child Health Handbook (MCHH), a popular personal health record (PHR) used by almost every pregnant woman or mother in Japan, using a cross-sectional survey. We determined sociodemographic factors associated with favorable opinions toward digitization using a multivariate regression model. We then grouped the participants using partitioning around medoids clustering, a machine-learning approach, to interpret their varying attitudes toward digitization in light of their sociodemographic characteristics as well as their affinity toward the paper MCHH.

Findings

Higher income and educational level, older age, and less reliance on the MCHH were significantly associated with favorable opinion toward digitization. Clustering analysis identified four latent clusters. The cluster with the highest socioeconomic status (SES) was the most favorable toward digitization, while two clusters with the lowest SES, one of which relied heavily on the paper MCHH, were less favorable of digitization compared to the high SES cluster. The final cluster was comprised of mothers with the experience of raising multiple children and did not rely heavily on the MCHH.

Interpretation

Our study identified a socioeconomic divide in opinions toward digitization of an existing health intervention. A hasty digitization may result in an unbalanced uptake of the digitized health intervention among different social classes.

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No study has evaluated the possible consequences of digitizing health interventions.

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Mothers with lower SES tended to have less favorable opinions toward digitization.

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Digitization of existing health intervention may exacerbate the health gap.

Colorectal Cancer Screening: A Quality Improvement Initiative Using a Bilingual Patient Navigator, Mobile Technology, and Fecal Immunochemical Testing to Engage Hispanic Adults

BACKGROUND

Fecal immunochemical tests (FITs) are an effective screening method to detect and prevent colorectal cancer (CRC) when done in appropriate intervals. The use of bilingual patient navigators (PNs) and secure short message service (SMS) has been demonstrated to increase CRC screening rates among Hispanic adults.

OBJECTIVES

The purpose of this quality improvement project is to increase CRC screening rates among Hispanic adults in a family clinic by 25% in the post-project implementation period using an unlicensed bilingual PN, secure SMS, and at-home FITs.

METHODS

A retrospective chart review was used. Spanish-translated educational videos were delivered using SMS, and instructional screening guidance was provided via telephone in Spanish by the PN. Participants were surveyed to determine satisfaction with the support received from the PN.

FINDINGS

Findings showed a 35% increase in the clinic's FIT rates. Findings also showed that having a PN's support influenced the decision to complete FIT as compared to the use of secure SMS.

Perioperative mobile application for mothers undergoing Cesarean delivery: a prospective cohort study on patient engagement

Purpose

Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care.

Method

We conducted a prospective cohort study of patients ≥ 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1–5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care.

Results

Thirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31–36] yr. Each participant visited the application a median of 15 [9–31] times over 30 days and completed a median of 3 [2–4] out of five self-monitoring questionnaires. Each participant viewed a median of 4 [2–7] out of eight education topics, with the most viewed patient education topics being “Controlling Pain” and “The First Few Days”. Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2–10).

Conclusion

Most participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs.

Trial registration

www.ClinicalTrials.gov (NCT03746678); registered 5 November 2018.

Supplementary Information

The online version of this article (10.1007/s12630-020-01907-x) contains supplementary material, which is available to authorized users.

Predictors of Smartphone Uses for Health Information Seeking in the Korean Elderly

The purpose of this research is to examine the predictors of smartphone uses for health information-seeking (SHIS) in the Korean elderly. This research applies the comprehensive model of information seeking as a theoretical framework. Data reported in this study are from the 2016 Dementia Literacy Survey, and 235 elderly smartphone users were included in logistic regression model. SHIS was significantly predicted by younger age, higher education levels, having a regular exercise, higher medical expenditures, and health literacy. The findings of this study can help social workers understand the specific features of health information seeking in the Korean elderly.

Health literacy in the eHealth era: A systematic review of the literature

OBJECTIVES

This study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.

METHODS

To identify the relevant literature published since 2010, we performed four rounds of selection-database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications.

RESULTS

The themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior.

CONCLUSION

Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy.

PRACTICE IMPLICATIONS

Efforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.

Exploring the adoption of mobile internet services by socioeconomically disadvantaged people

Purpose

The purpose of this paper is to identify enablers and inhibitors to the adoption of mobile internet services by socioeconomically disadvantaged people: an understudied population adversely affected by digital inequality.

Design/methodology/approach

A qualitative study combining a questionnaire and semi-structured interviews. In total, 32 socioeconomically disadvantaged people explored mobile lottery services and subsequently were asked a series of semi-structured questions about their perceptions of the technology.

Findings

Users’ attitudes toward mobile internet services were ambivalent. They experienced some advantages of smartphones (including escaping spatiotemporal constrains, fashionableness, privacy, and cost-effectiveness) and conceived of mobile internet services in terms of social advantages (including their ubiquitous nature, fitting in socially and fear of being “left behind”). However, they also experienced barriers and concerns, such as limited mobile data packages, external barriers from mobile services (including security concerns, complex online help tutorials, irrelevant pop-ups, and a lack of personalized services) and internal psychological barriers (including technophobia, self-concept, and habitus).

Research limitations/implications

The findings are of limited generalizability due to the small size of the sample. However, the study has implications for understanding the acceptance of technology among socioeconomically disadvantaged people.

Social implications

The study has social implications for bridging digital inequality in terms of socioeconomic status.

Originality/value

While previous studies have primarily focused on enablers of adopting mobile internet services by active users, this study reveals both the promise of and the barriers to the use of such services by inactive users who comprise an under-served population.

Hispanics and public libraries

Purpose

The fastest-growing and the largest minority group in the USA, Hispanics are known to have low health literacy because of their limited English proficiency (LEP) and other socio-economic and cultural factors. This paper aims to examine the health information-seeking behaviors of Hispanics in the e-health environment and their use of public libraries as a health information source/service.

Design/methodology/approach

An interviewer-administered survey was conducted using a semi-structured instrument. The questionnaires inquired about Hispanics’ health information needs, source use and source preference; use of the library for health information needs; and their perceptions and satisfaction about the library’s consumer health information services. A total of 26 Hispanics were recruited from a Hispanic community organization, a public library and an ethnic grocery store in North Carolina.

Findings

The majority of the participants are foreign born (92.3 per cent) and non-English speakers (84.6 per cent). The internet was the most frequently used source, followed by friends/family, doctors and TV. Eighty-one per cent of the participants were internet users, and most of them (71 per cent) used the internet at home. Only 23 per cent visited a public library to search the internet for health information. Some barriers to using a public library mentioned by the participants include lack of time to visit a library, lack of skills in using the library materials, transportation, LEP, lack of eligibility for a library card, etc.

Social implications

The findings will be useful for libraries and state/federal health services to evaluate and develop library services suitable for the Hispanics’ consumer health information needs.

Originality/value

This study is one of a few studies that use an empirical study of a low health literacy ethnic population to examine the possible roles of public libraries in enhancing health literacy.