Factors Associated with the e-Health Literacy Among Older Adults with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Background: The telemanagement model in chronic diseases needs older patients to have a certain level of e-Health literacy. According to Electronic Health Literacy model, factors associated with the e-Health literacy among older patients could be comprehensively investigated from individual, situational, and environmental aspects. Objectives: To investigate the e-Health literacy levels among older patients with chronic obstructive pulmonary disease (COPD) and explore associated factors. Methods: A cross-sectional study was conducted among older patients with COPD. The e-Health Literacy Scale was used to measure individuals' e-Health literacy. The multiple linear regression was applied to identify factors associated with e-Health literacy. Results: A total of 230 responses were included in the final analysis. The average score of e-Health literacy for older COPD patients was 24.66 (6.86). After adjusting the model, the results of multiple linear regression demonstrated that aging attitudes (B = 0.067, p < 0.001), technophobia (B = -0.285, p < 0.001), and self-efficacy (B = 0.431, p < 0.001) accounted for 68.3% (p < 0.001) of the total variation in e-Health literacy. Conclusion: This study identifies significant correlations of technophobia, aging attitudes, and self-efficacy, respectively, with e-Health literacy, and self-efficacy and technophobia may be constant predictive factors of e-Health literacy. In the future, intervention research on e-Health literacy should be conducted from a social psychology perspective, with particular emphasis on addressing negative aging attitudes and technophobia. That will promote the tele-management model of chronic diseases. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study

BACKGROUND

The patient's spouse, in their role as the primary caregiver, assumes responsibility for the patient's care during the recovery process and provides the most robust social support. Previous research has primarily focused on the coping experiences and thoughts of individual ICU patients or caregivers, with limited attention afforded to the relationship between patients and their spouses.

AIMS AND OBJECTIVES

This study aims to explore the dyadic coping experiences of ICU transfer patients and their spouses, with the goal of providing evidence to support the subsequent development of an individualized intervention program.

STUDY DESIGN

A qualitative study using a phenomenological research approach was undertaken. Purposive sampling was employed to select participants for face-to-face semi-structured in-depth interviews. The interviews took place at a tertiary general hospital in Nanjing from January 2023 to February 2023.Twelve ICU transfer patients and their twelve spouses were interviewed. The data were then summarized, and themes were derived using the Colaizzi 7-step analysis method.

FINDINGS

A total of four themes and eleven sub-themes emerged from the analysis. The identified themes include positive coping (actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (a lack of information, high physical and psychological stress, and significant financial burden), and needs and suggestions (strengthening transition care, fostering increased intimacy, and reducing negative emotions).

CONCLUSION

Both patients and spouses experience physical and psychological stress during the transfer from the ICU to the ward. Therefore, any intervention developed for caregivers should be designed in a dyadic manner. Increasing dyadic coping skills may represent an important area for future research and intervention.

RELEVANCE TO CLINICAL PRACTICE

This study provides valuable evidence to inform the formulation of a comprehensive dual disease management plan for ICU transfer patients and their spouses.

Assessing secondary school students' digital health literacy, information searching behaviours, and satisfaction with online COVID-19 information in Northern Ghana

Available evidence suggests that managing the complexities of health information and the behaviours associated with information search call for adequate digital health literacy (DHL). Students' ability to judge the relevance of health-related information largely affects their level of satisfaction with the information. The study assessed DHL, information searching behaviours, and the link between DHL and COVID-19 information. The cross-sectional study utilised the multi-stage sampling technique in the selection of 1392 secondary school students in the Northern Region of Ghana. A DHL questionnaire was used to survey the students. The students displayed inadequate level of DHL concerning the relevance of online information. Predictably, most of them had not searched for information in the past four weeks prior to the data collection. Search engine portals, websites of public bodies, and news portals were the predominant platforms used for information search. Majority of the participants reported not being satisfied with the information they found on the internet about coronavirus. A significant association between DHL levels and utilization of COVID-19 information platforms was identified, such that students who showed high levels of DHL used platforms which had reviewed/professional content compared to those with low levels of DHL. Advanced DHL may serve as a disincentive to the consumption of information from sources which are not credible. There is an urgent call for collaboration among the ministries/agencies responsible for education and health, telecommunication networks, and civil society organisations for interventions aimed at integrating DHL in schools..

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

Digital Health Literacy and Information-Seeking in the Era of COVID-19: Gender Differences Emerged from a Florentine University Experience

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB), which is related to Digital Health Literacy (DHL). Gender differences in OHISB have been studied in different countries with different results, but no studies have investigated gender-specific OHISB among University students during the COVID-19 pandemic. We sought to investigate any gender differences in OHISB in the period between the first and second waves of the pandemic in Italian university students. A questionnaire developed by the global COVID-HL network, including existing and adapted validated scales and self-developed scales, was administered to 2996 University students in Florence. Gender differences were tested using the χ² test or the Mann-Whitney U test. Male students reported a higher score in DHL than females (p < 0.001). However, female students seek COVID-19 information more often on different sources (for themselves and other people), on various topics, consider various aspects of information quality to be "very important'' (p < 0.05) and are more likely to be "often dissatisfied'' or "partly satisfied'' with information (p < 0.001). Our study confirmed gender as an important dimension to explain students' OHISB differences, which could help institutions promote gender-specific education programmes and provide gender-oriented health information.

Digital health literacy and subjective wellbeing in the context of COVID-19: A cross-sectional study among university students in Ecuador

Background

The COVID-19 pandemic has generated an avalanche of information, which, if not properly addressed, generates uncertainty and limits healthy decision-making. On the other hand, the pandemic has exacerbated mental health problems among young people and adolescents, causing a worsening of their wellbeing. Previous studies have found that digital health literacy has a positive impact on people's attitudes toward the disease. This study aimed to analyze the association between digital health literacy on COVID-19 with subjective wellbeing in university students.

Methods

A cross-sectional study was developed in 917 students from Ecuador. Subjective wellbeing was measured with the World Health Organization WellBeing Scale. Digital health literacy was assessed using the Spanish-translated version of the Digital Health Literacy Instrument adapted to the context of the COVID-19 pandemic. Bivariate and multivariate linear regressions were performed.

Results

Digital health literacy and subjective wellbeing proofed to be significantly higher among males and among students with higher social status. The association between digital health literacy and subjective wellbeing was significant; for each increase of one point in the digital health literacy scale, an average increase of 9.64 points could be observed on the subjective wellbeing scale (IC 95% 5.61 - 13.67, p-value <0.001). This correlation persisted after adjust by demographic and socioeconomic variables.

Conclusion

Improving digital health literacy in health would improve the subjective wellbeing of university students. It is suggested strengthen the digital health literacy through public and university policies that promote access, search skills and discernment of digital information. Socioeconomic and gender inequalities related to digital health literacy need to be further investigated.

What We Ask about When We Ask about Quarantine? Content and Sentiment Analysis on Online Help-Seeking Posts during COVID-19 on a Q&A Platform in China

The COVID-19 outbreak, a recent major public health emergency, was the first national health crisis since China entered the era of mobile social media. In this context, the public posted many quarantine-related posts for help on social media. Most previous studies of social media during the pandemic focused only on people's emotional needs, with less analysis of quarantine help-seeking content. Based on this situation, this study analyzed the relationship between the number of quarantine help-seeking posts and the number of new diagnoses at different time points in the pandemic using Zhihu, the most comprehensive topic discussion platform in China. It showed a positive correlation between the number of help-seeking posts and the pandemic's severity. Given the diversity of people's help-seeking content, this study used topic model analysis and sentiment analysis to explore the key content of people's quarantine help-seeking posts during the pandemic. In light of the framework of uses and gratifications, we found that people posted the most questions in relation to help with information related to pandemic information and quarantine information. Interestingly, the study also found that the content of people's quarantine posts during the pandemic was primarily negative in sentiment. This study can thus help the community understand the changes in people's perceptions, attitudes, and concerns through their reactions to emergencies and then formulate relevant countermeasures to address pandemic control and information regulation, which will have implications for future responses to public health emergencies. Moreover, in terms of psychological aspects, it will help implement future mental health intervention strategies and better address the public's psychological problems.

Association of Digital Health Literacy with Future Anxiety as Mediated by Information Satisfaction and Fear of COVID-19: A Pathway Analysis among Taiwanese Students

Digital Health Literacy (DHL) helps online users with navigating the infodemic and co-existing conspiracy beliefs to avoid mental distress and maintain well-being. We aimed to investigate the association between DHL and future anxiety (FA); and examine the potential mediation roles of information satisfaction and fear of COVID-19 (F-CoV). A web-based cross-sectional survey was carried out among 1631 Taiwanese university students aged 18 years and above from June 2021 to March 2022. Data collected were socio-demographic characteristics (sex, age, social status, university location), information satisfaction, F-CoV, DHL and FA (using Future Dark scale). The linear regression model was used to explore factors associated with FA. The pathway analysis was further used to evaluate the direct and indirect relationship between DHL and FA. A higher score of DHL (B = -0.21; 95% CI, -0.37, -0.06; p = 0.006), and information satisfaction (B = -0.16; 95% CI, -0.24, -0.08; p < 0.001) were associated with a lower FA score, whereas a higher F-CoV score was associated with a higher FA score (B = 0.43; 95% CI, 0.36, 0.50; p < 0.001). DHL showed the direct impact (B = -0.1; 95% CI, -0.17, -0.04; p = 0.002) and indirect impact on FA as mediated by information satisfaction (B = -0.04; 95% CI, -0.06, -0.01; p = 0.002) and F-CoV (B = -0.06, 95% CI, -0.08, -0.04; p < 0.001). Strategic approaches to promote DHL, information satisfaction, lower F-CoV are suggested to reduce FA among students.

Online health information seeking and digital health literacy among information and learning resources undergraduate students

Background

During the COVID-19 pandemic, students have trouble coping with the available health information regarding the coronavirus in their daily lives because of misinformation.

Objectives

The aim of this study was to evaluate online health information seeking and digital health literacy among information and learning resources undergraduate students at Taibah University during the COVID-19 pandemic.

Methods

To investigate the primary goal, this study used a simultaneous exploratory mixed methods design. Seventeen students participated in phone interviews, and 306 were invited to complete an online survey.

Analysis

The collected data was analyzed using both quantitative (SPSS) and qualitative (NVivo 10) methods.

Results

Search engines, social media, and YouTube were most often used by the respondents as sources to search for COVID-19-related information. COVID-19 symptoms, restrictions, and the current spread of COVID-19 were the most searched topics by the respondents. Significant and relevant differences emerged for the digital health literacy subscales “information search” and “adding self-generated content”. However, there were no significant differences in the digital health literacy subscale “determining relevance”.

Conclusion

Using the internet to provide health information tailored to the needs and interests of students to seek health information online and thereby improve their health literacy.

A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the 'COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context

BACKGROUND

While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5).

METHODS

We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake.

DISCUSSION

Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.

Identifying Health Equity Factors That Influence the Public's Perception of COVID-19 Health Information and Recommendations: A Scoping Review

The COVID-19 pandemic has impacted global public health and public trust in health recommendations. Trust in health information may waver in the context of health inequities. The objective of this scoping review is to map evidence on public perceptions of COVID-19 prevention information using the PROGRESS-Plus health equity framework. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, and Embase databases from January 2020 to July 2021. We identified 792 citations and 31 studies published in 15 countries that met all inclusion criteria. The majority (30/31; 96.7%) of the studies used an observational design (74.2% cross-sectional, 16.1% cohort, 6.5% case study, 3.2% experimental trials). Most studies (61.3%) reported on perception, understanding, and uptake, and 35.5% reported on engagement, compliance, and adherence to COVID-19 measures. The most frequently reported sources of COVID-related information were social media, TV, news (newspapers/news websites), and government sources. We identified five important equity factors related to public trust and uptake of recommendations: education and health literacy (19 studies; 61.3%), gender (15 studies; 48.4%), age (15 studies; 48.4%), socioeconomic status (11 studies; 35.5%), and place of residence (10 studies; 32.3%). Our review suggests that equity factors play a role in public perception of COVID-19 information and recommendations. A future systematic review could be conducted to estimate the impact of equity factors on perception and behavior outcomes.

Assessing the Quality, Reliability, and Readability of Online Information on Dry Eye Disease

PURPOSE

The purpose of this study was to assess the quality, reliability, readability, and technical quality of web sites relating to dry eye disease.

METHODS

A cross-sectional study was conducted that evaluated the first 75 web sites on a Google Search by using the keyword "dry eyes." Each web site was evaluated by 2 independent reviewers using the DISCERN, HONcode, and JAMA criteria to assess quality and reliability. Interrater reliability was also analyzed. Readability was assessed using the Flesch-Kincaid readability tests and the Gunning fog, Simple Measure of Gobbledygook, Coleman-Liau, and automated readability indices. Technical quality was determined by the presence of 10 specific features. Web sites were further categorized into institutional (academic centers, medical associations, and government institutions) and private (private practices) categories.

RESULTS

There was no significant difference in scoring observed between the 2 reviewers. The overall mean DISCERN score ± standard error (SE) was 3.2 ± 0.1, the mean HONcode score (±SE) was 9.3 ± 0.3, and the mean JAMA score (±SE) was 1.9 ± 0.1. Institutional web sites had a higher DISCERN score (3.4 ± 0.1 vs. 3.1 ± 0.1; P < 0.05) and HONcode score (10.3 ± 0.5 vs. 8.8 ± 0.4; P < 0.05) than private sites. Technical quality was higher in institutional web sites compared with private web sites ( P < 0.05). Readability was poor among all web sites, with most web sites not achieving below a ninth grade reading level.

CONCLUSIONS

Quality, reliability, and readability scores were low for most web sites. Although institutional web sites achieved higher scores than private web sites, revision is warranted to improve their overall quality of information and readability profile.

Improving Health Literacy: Analysis of the Relationship between Residents' Usage of Information Channels and Health Literacy in Shanghai, China

Background: This study aimed to examine the relationship between residents’ health literacy (HL) and their use of and trust in information channels. Methods: A community-based cross-sectional health survey utilizing a cluster sampling design was conducted in January 2022. The sample consisted of 1067 residents in Shanghai, China. Those who correctly answered over 80% of the questions were regarded as qualified. The differences in residents’ HL and the dimensions of knowledge HL, lifestyle HL, and skills HL were analyzed based on their use of and trust in traditional media, the internet, and offline activities. Logistic regression was conducted to examine the effects of the usage of these channels on all four types of HL. Results: A total of 27.65% of participants were qualified for HL. The use of traditional media (OR = 1.405, p < 0.05) and engagement in offline activities (OR = 1.951, p < 0.05) were significantly related to HL. Disbelief in traditional media was related to being qualified in knowledge HL (OR = 1.262; p < 0.05), whereas disbelief in offline activities had an adverse effect on knowledge HL and skills HL (OR = 0.700, 0.807; p < 0.05). Conclusion: Effort should be made to improve the efficiency of offline health education, and ensure the reliability and quality of health-related information from mass media and the internet to improve residents’ HL.

COVID-19 and Well-Being of Non-local Students: Implications for International Higher Education Governance

Non-local students have been one of the worst affected groups during the COVID-19 pandemic. Many of them live in foreign countries/regions with limited social and economic support. This study examines the effects of the COVID-19 pandemic and its control measures on the well-being of non-local students globally. It also examines the effectiveness of university support for the well-being of non-local students. Data were derived from a global survey on non-local students' knowledge, experiences, and well-being amidst the COVID-19 Pandemic, which was conducted in April 2020 (n = 583). A significant proportion (42.6%) of the students had low well-being. We found that being worried about COVID-19 (B = - 0.206, p = 0.048), perceived disruption of academic activities (B = - 0.155, p = 0.024), perceived disruption of social activities (B = - 0.153, p = 0.044), and feeling lonely (B = - 0.340, p = 0.000) were negatively associated with the students' well-being. However, informational support from universities was positively associated with their well-being (B = 0.225, p = 0.004). These findings are discussed in the context of higher education governance and practical changes necessary to promote non-local students' well-being during and after the pandemic.

Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia

During the COVID-19 pandemic, there is a growing interest in online information about coronavirus worldwide. This study aimed to investigate the digital health literacy (DHL) level, information-seeking behaviour, and satisfaction of information on COVID-19 among East and South-East Asia university students. This cross-sectional web-based study was conducted between April to June 2020 by recruiting students from universities in China, Malaysia, and the Philippines. University students who have Internet access were invited to participate in the study. Items on sociodemographic variables, DHL, information-seeking behaviour, and information satisfaction were included in the questionnaire. Descriptive statistics and logistic regression analysis were conducted. A total of 5302 university students responded to the survey. The overall mean score across the four DHL subscales was 2.89 (SD: 0.42). Search engines (e.g., Google, Bing, Yahoo) (92.0%) and social media (88.4%) were highly utilized by the students, whereas Websites of doctors or health insurance companies were of lower utilization (64.7%). Across the domains (i.e., adding self-generated content, determining relevance, evaluating reliability, and protecting privacy) higher DHL was positively associated with higher usage of trustworthy resources. Providing online information on COVID-19 at official university websites and conducting health talks or web-based information dissemination about the strategies for mental health challenges during pandemic could be beneficial to the students. Strengthening DHL among university students will enhance their critical thinking and evaluation of online resources, which could direct them to the quality and trustworthy information sources on COVID-19.

Digital Health Literacy Related to COVID-19: Validation and Implementation of a Questionnaire in Hispanic University Students

Digital health literacy influences decision-making in health. There are no validated instruments to evaluate the digital literacy about COVID-19 in Spanish-speaking countries. This study aimed to validate the Digital Health Literacy Instrument (DHLI) about COVID-19 adapted to Spanish (COVID-DHLI-Spanish) in university students and to describe its most important results. A cross-sectional study was developed with 2318 university students from Spain, Puerto Rico, and Ecuador. Internal consistency was measured with Cronbach’s alpha and principal component analysis. Construct validity was analyzed using Spearman’s correlations and the Kruskal−Wallis test. The internal consistency of the questionnaire was good for the global scale (Cronbach’s alpha 0.69, 95% CI 0.67) as well as for its dimensions. A total of 51.1% (n = 946) of students had sufficient digital literacy, 40.1% (n = 742) had problematic digital literacy, and 8.8% (n = 162) had inadequate digital literacy. The DHLI was directly and significantly correlated with age, subjective social perception, sense of coherence, and well-being (p < 0.001). The average digital literacy was higher in men than in women, in students older than 22 years, and in those with greater satisfaction with online information (p < 0.001). The COVID-DHLI-Spanish is useful for measuring the digital literacy about COVID-19 in Spanish-speaking countries. This study suggests gaps by gender and socioeconomic perception.

Validating the Digital Health Literacy Instrument in Relation to COVID-19 Information (COVID-DHL-K) among South Korean Undergraduates

Digital health literacy is crucial in accessing and applying health information in the COVID-19 pandemic period. Young college students are exposed daily to digital technologies, and they have further increased the use of digital information during the COVID-19 period. This study aimed to adapt DHLI into Korean and to assess the psychometric properties, during the COVID-19 pandemic period. A cross-sectional, nationwide, and web-based survey was conducted among 604 Korean undergraduates from 23 December 2020 to 8 January 2021. On the basis of the Digital Health Literacy Instrument (DHLI) by the Global COVID HL Network, the Korean questionnaire was developed by group translation, expert reviews, and forward-backward translation for validation. The scale reliability and validity were examined using Cronbach's alpha and confirmatory factor analysis. Results support the theoretical and empirical four-factor structure (search, express, evaluate, use) in the coronavirus-related DHL among Korean University students. Internal reliability of the overall scale was high (Cronbach's α = 0.908). The four-factor model was supported by confirmatory factor analysis (GFI = 0.972, CFI = 0.984, TLI = 0.978, RMSEA = 0.045). This study revealed that the COVID-DHL-K is a valid and reliable measure with appropriate psychometric characteristics.

Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.

Digital Transformation in Medical Affairs Sparked by the Pandemic: Insights and Learnings from COVID-19 Era and Beyond

A number of developments, including increasing regulatory and compliance scrutiny, increased transparency expectations, an increasingly vocal patient, patient centricity and greater requirements for real-world evidence, have driven the growth and importance of medical affairs as a trusted, science-driven partner over the past decade. The healthcare environment is shifting towards a digital, data-driven and payor-focused model. Likewise, medical affairs as a function within the pharmaceutical industry has become more "patient-centric" with strategic engagements embracing payers and patients apart from clinicians. The pandemic has impacted the healthcare industry as well as the function of medical affairs in numerous ways and has brought new challenges and demands to tackle. There is indeed a silver lining due to intense digital transformation within this crisis. The emerging digital innovation and new technologies in healthcare, medical education and virtual communications are likely to stay and advance further. In this review, we discuss how the digital transformation sparked by the pandemic has impacted the medical affairs function in pharmaceuticals and provide further insights and learnings from the COVID-19 era and beyond. Based on the learning and insights, digital innovation in three key strategic imperatives of medical affairs-HCP engagement, external partnerships and data generation will enable medical affairs to become future-fit as a strategic leadership function.

COVID-19 infodemic and digital health literacy in vulnerable populations: A scoping review

Background

People from lower and middle socioeconomic classes and vulnerable populations are among the worst affected by the COVID-19 pandemic, thus exacerbating disparities and the digital divide.

Objective

To draw a portrait of e-services as a digital approach to support digital health literacy in vulnerable populations amid the COVID-19 infodemic, and identify the barriers and facilitators for their implementation.

Methods

A scoping review was performed to gather published literature with a broad range of study designs and grey literature without exclusions based on country of publication. A search was created in Medline (Ovid) in March 2021 and translated to Medline, PsycINFO, Scopus and CINAHL with Full Text (EBSCOhost). The combined literature search generated 819 manuscripts. To be included, manuscripts had to be written in English, and present information on digital intervention(s) (e.g. social media) used to enable or increase digital health literacy among vulnerable populations during the COVID-19 pandemic (e.g. older adults, Indigenous people living on reserve).

Results

Five articles were included in the study. Various digital health literacy-enabling e-services have been implemented in different vulnerable populations. Identified e-services aimed to increase disease knowledge, digital health literacy and social media usage, help in coping with changes in routines and practices, decrease fear and anxiety, increase digital knowledge and skills, decrease health literacy barriers and increase technology acceptance in specific groups. Many facilitators of digital health literacy-enabling e-services implementation were identified in expectant mothers and their families, older adults and people with low-income. Barriers such as low literacy limited to no knowledge about the viruses, medium of contamination, treatment options played an important role in distracting and believing in misinformation and disinformation. Poor health literacy was the only barrier found, which may hinder the understanding of individual health needs, illness processes and treatments for people with HIV/AIDS.

Conclusions

The literature on the topic is scarce, sparse and immature. We did not find any literature on digital health literacy in Indigenous people, though we targeted this vulnerable population. Although only a few papers were included, two types of health conditions were covered by the literature on digital health literacy-enabling e-services, namely chronic conditions and conditions that are new to the patients. Digital health literacy can help improve prevention and adherence to a healthy lifestyle, improve capacity building and enable users to take the best advantage of the options available, thus strengthening the patient’s involvement in health decisions and empowerment, and finally improving health outcomes. Therefore, there is an urgent need to pursue research on digital health literacy and develop digital platforms to help solve current and future COVID-19-related health needs.

Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam

Introduction: Digital health literacy (DHL) has recently been proposed as a means of enabling healthy decisions for protective behavior, preventive measures, and adherence with COVID-19 policies and recommendations especially in the era of the “infodemic”. This study aimed to (1) identify COVID-19 related DHL and its association with online information seeking; (2) to elucidate COVID-19 related DHL as a mediator predictor between the importance of online information search and its association with subjective well-being among Vietnamese university students.

Methods: A cross-sectional web-based survey was used to elicit the responses of Vietnamese students over 2 consecutive weeks (from April 25 to May 9, 2020, n = 1,003, 70.1% female students, mean age 21.4 ± 3.1). The online survey questionnaire collected data on the sociodemographic characteristics of participants, DHL about COVID-19, information seeking behavior, and subjective well-being. Mediation analysis was conducted using the importance of searching COVID-19 related information as independent variables, subjective well-being as a dependent variable, and DHL as a mediator variable.

Results: Among 1,003 students, the mean (SD) of DHL related to COVID-19 was 2.87 ± 0.32. In the survey, 87.2% of the students reported sufficient well-being, while almost 13% reported low or very low well-being. The findings also indicated that search engines were the most popular platform for information seeking by Vietnamese students (95.3%) and 92.8% of participants had searched for information related to the current spread of COVID-19. Not searching for hygiene regulation as part of infection control and an average level of information satisfaction were associated with limited DHL (p < 0.05). The importance of online information searching related to COVID-19 increased the subjective well-being of students significantly and limited DHL (p < 0.05). DHL was found to mediate the relationship between the importance of online information searching and the subjective well-being of students.

Conclusion: The finding provides insight into DHL about COVID-19 among university students, and their ability to find, understand, appraise, and use online health related information during lockdown throughout the first COVID-19 pandemic wave. DHL should be highlighted as a mediating factor that enhances the positive effect of the importance of information seeking on psychological well-being. However, further studies are needed to better define the mediating role of DHL across other factors.