Rethinking Communication in the E-health Era

Exploring online reproductive health promotion in Canada: a focus on behavioral and environmental influences from a sex and gender perspective

BACKGROUND

Reproductive health promotion can enable early mitigation of behavioral and environmental risk factors associated with adverse pregnancy outcomes, while optimizing health of women + (all genders that can gestate a fetus) and babies. Although the biological and social influences of partners on pregnancy are well established, it is unknown whether online Canadian government reproductive health promotion also targets men and partners throughout the reproductive lifespan.

METHODS

Reproductive health promotion, designed for the general public, was assessed in a multi-jurisdictional sample of Canadian government (federal, provincial/territorial, and municipal) and select non-governmental organization (NGO) websites. For each website, information related to environmental and behavioral influences on reproductive health (preconception, pregnancy, postpartum) was evaluated based on comprehensiveness, audience-specificity, and scientific quality.

RESULTS

Government and NGO websites provided sparse reproductive health promotion for partners which was generally limited to preconception behavior topics with little coverage of environmental hazard topics. For women + , environmental and behavioral influences on reproductive health were well promoted for pregnancy, with content gaps for preconception and postpartum stages.

CONCLUSION

Although it is well established that partners influence pregnancy outcomes and fetal/infant health, Canadian government website promotion of partner-specific environmental and behavioral risks was limited. Most websites across jurisdictions promoted behavioral influences on pregnancy, however gaps were apparent in the provision of health information related to environmental hazards. As all reproductive stages, including preconception and postpartum, may be susceptible to environmental and behavioral influences, online health promotion should use a sex- and gender-lens to address biological contributions to embryo, fetal and infant development, as well as contributions of partners to the physical and social environments of the home.

Healthcare providers' promotion of physical activity among child and adolescent cancer survivors: strategies and challenges

PURPOSE

This study aims to investigate how healthcare providers (HCPs) promote physical activity (PA) to child and adolescent cancer survivors.

METHODS

Semi-structured interviews were conducted with HCPs (n = 16; women n = 12; men n = 4) who provide care for cancer survivor youth (age 3 to 18). Participants represented 7 professions, including child life specialists, oncologists, nurse practitioners, physical therapists, and social workers. A reflexive thematic analysis was conducted to explore the techniques that HCPs use to promote PA for this patient population and ways PA promotion can improve.

RESULTS

HCPs use five strategies to promote PA to cancer survivor youth: (1) broadening the definition of PA, (2) tailoring PA recommendations, (3) including families, (4) connecting patients to programming, and (5) promoting patient motivation.

CONCLUSIONS

This research highlights techniques that HCPs use to promote PA to young cancer survivors and reveals the need for additional ways to support HCPs to improve PA promotion for child and adolescent cancer survivors. While HCPs emphasized the importance of PA for this patient population, they navigate barriers that limit the quality of PA discussions.

IMPLICATIONS FOR CANCER SURVIVORS

Further research should explore interventions to improve PA promotion and PA participation among child and adolescent cancer survivors. By understanding the perspectives of HCPs, patients, and their families, PA promotion strategies can be improved, and more programs that support both patients and practitioners may be developed.

A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

Negotiating scientific knowledge in the development of an eHealth MOOC

Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts-while establishing a common understanding-can lead to a unique and meaningful delivery of high pedagogical quality.

A Review on The Theories of Adoption Telemedicine in Middle Ease : Toward Building Iraqi Telemedicine

Telemedicine is the use of modern telecommunications and information technologies for the provision of clinical care to individuals at a distance, and transmission of information to provide that care. Recent advances in information technology and biomedicine increased significantly the technical feasibility, clinical feasibility and affordability enabled collaborative of telemedicine and medical service delivery. Health organizations around the world are becoming more interested in the acquisition and implementation the telemedicine technology to improve or expand existing services and patient care. The ultimate success of telemedicine in an organization requires the adoption of adequate care both technological and managerial issues. This study examined theadoption theories,the key management problem facing many health care organizations which interested in or currently evaluating telemedicine . this research models targeted the technology adoption and empirically evaluated in a study of the investigation involving more public health agencies and criticize the theories.Several research and management implications that emerged from the study results are discussed.

Using Social Media for More Engaged Users and Enhanced Health Communication in Diabetes Care

Background: Recent literature identified social media message features predictive of user engagement. Desired information from a patient perspective and use of social media information from a provider perspective in diabetes care is less clear. Purpose: Our study analyzed diabetes patients’ desired information from social media and how such information could be used in conjunction with doctor–patient communication to enhance compliance with recommended care. Methods: A survey examined diabetic patients’ interests in searching for various diabetes information on social media and assessed the potential impact of social media sourced information on doctor–patient communication. This survey was followed by a content analysis of major US diabetes organizations’ Facebook pages, which were considered for effectiveness in their communication with diabetes patients. Results: Survey participants were most interested in diabetes management recommendations. Diabetes knowledge positively correlated with interests in diabetes management recommendations but negatively correlated with prior use of social media for diabetes information. 70.9% of patients had discussed information from social media with their doctor. The content analysis showed narrative evidence and updates on diabetes-related research findings, and medical policies generated a higher level of user engagement. Conclusion: While survey participants showed greatest interests in health recommendations and tips, only 11.7% of the analyzed social media posts included such information. Posts that included diabetes-related information led to higher engagement than posts that emphasized social values. Patients in general have asked doctors about information received on social media which suggests that social media can be a useful platform for communicating diabetes care information.

Explainable depression detection with multi-aspect features using a hybrid deep learning model on social media

The ability to explain why the model produced results in such a way is an important problem, especially in the medical domain. Model explainability is important for building trust by providing insight into the model prediction. However, most existing machine learning methods provide no explainability, which is worrying. For instance, in the task of automatic depression prediction, most machine learning models lead to predictions that are obscure to humans. In this work, we propose explainable Multi-Aspect Depression Detection with Hierarchical Attention Network MDHAN, for automatic detection of depressed users on social media and explain the model prediction. We have considered user posts augmented with additional features from Twitter. Specifically, we encode user posts using two levels of attention mechanisms applied at the tweet-level and word-level, calculate each tweet and words' importance, and capture semantic sequence features from the user timelines (posts). Our hierarchical attention model is developed in such a way that it can capture patterns that leads to explainable results. Our experiments show that MDHAN outperforms several popular and robust baseline methods, demonstrating the effectiveness of combining deep learning with multi-aspect features. We also show that our model helps improve predictive performance when detecting depression in users who are posting messages publicly on social media. MDHAN achieves excellent performance and ensures adequate evidence to explain the prediction.

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Background

“Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them.

Methods

We adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health.

Results and analysis

Overall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement.

Conclusion

Developing and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.

The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review

BACKGROUND

The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication.

OBJECTIVE

The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication?

METHODS

A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified.

RESULTS

Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change.

CONCLUSIONS

Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication.

Promoting Mental Health During the COVID-19 Pandemic: A Hybrid, Innovative Approach in Malaysia

Background: The COVID-19 pandemic has had monumental effects on the mental health of populations worldwide. Previous research indicated that programs and interventions using social networks can play a positive role in promoting mental health. Nevertheless, current evidence is largely derived from high-income regions, reflecting an urgent need for more studies in low- and middle-income settings.

Objectives: This paper aims to (a) describe the potential value of a hybrid health carnival in promoting mental health and increasing access to screening services; (b) assess the level of community engagement with the digital platform.

Methods: A mental health carnival was conducted with the theme of “Mind Your Mental Health” (Cakna Kesihatan Mental) in conjunction with the World Mental Health Day in Malaysia. This was a hybrid carnival that combined elements of face-to-face interactions and virtual learning. Free online therapy sessions were offered to high-risk groups identified during the screening process. Social media metrics were utilized to report the levels of community engagement and participants completed pre-and post-assessments to measure the program's impact on their knowledge.

Results: The carnival was attended by 515 participants (78.8% virtual participants). Social media metrics reported more than 5,585 reaches on Facebook for all the activities held throughout the event. Results from pre-and post-assessments showed significant improvement in the mean knowledge scores (p < 0.05).

Conclusion: This digital approach will continue to evolve by releasing new features and tools as a new frontier for high-risk populations and all individuals seeking mental health support and treatment.

Promoting Healthy Eating Behaviors by Incentivizing Exploration of Healthy Alternatives

Incentive-based intervention programs aimed at promoting healthy eating behaviors usually focus on incentivizing repeating the desired behavior. Unfortunately, even when effective, these interventions are often short-lived and do not lead to a lasting behavioral change. We present a new type of intervention program focused on incentivizing exploration of new healthy alternatives rather than incentivizing repeated healthy behaviors. This intervention aims to help participants find long-lasting "personal treasures" -new foods that are both healthy and tasty for them. Our field study included a final sample of 48 students with low or medium daily consumption of fresh salads. Participants in the control group received a fixed payment for completing the program, while the participants in the incentivized exploration group received a lower fixed fee for completing the task and a bonus for each new salad they tried. Results show that participants in the incentivized exploration group reported eating more salads even 1 year after the program ended compared to the participants in the control group. Though preliminary, our results paint a promising picture for the successful application of incentivizing exploration interventions to promote healthy lifestyle.

Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study

Background

Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19.

Objective

The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns.

Methods

A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance.

Results

A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza.

Conclusions

Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well.

Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model

In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.

Effects of Website Interactivity on Skin Cancer-Related Intentions and User Experience: Factorial Randomized Experiment

BACKGROUND

Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement.

OBJECTIVE

We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users' attitudes, knowledge, behavioral intentions, and experience.

METHODS

We employed a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) between-subject online experiment for which 4 websites were created. Participants (n=293) were recruited using Amazon Mechanical Turk and randomly assigned into to 1 of 4 conditions. After browsing the website, participants completed an online survey regarding their experience and cognitive perceptions. General linear models and path analysis were used to analyze the data.

RESULTS

Both modality interactivity (P=.001) and message interactivity (P<.001) had an impact on intention to use sun protection. Attitudes toward health websites and perceived knowledge mediated the effects of modality interactivity and message interactivity on sun protection use intention, individually. Participants in the high modality interactivity and high message interactivity condition felt more satisfied (P=.02). Participants in the low message interactivity condition had more interest in the experience with health websites than participants in the high message interactivity condition (P=.044).

CONCLUSIONS

Findings suggested that modality interactivity influenced intention to use sun protection directly as well as via attitudes toward the websites. Message interactivity impacted intention to use sunscreen directly and also through perceived knowledge. Implications for designing health websites and health intervention content are discussed.

Using Technology Adoption Theory and a Lifespan Approach to Develop a Theoretical Framework for eHealth Literacy: Extending UTAUT

Advancements in health information technology (HealthIT) and the electronic exchanges of health information have "revolutionized" health systems in the US. However, adopting technological developments into the healthcare system has the potential to benefit populations with more resources, further exacerbating health status disparities. Efficacious utilization of HealthIT requires eHealth literacy. Although eHealth literacy is comprised of six factors, new research indicates that the components related to technology literacy may be more impactful in eHealth literacy among certain populations (e.g., older populations who shoulder a greater illness-management burden). Recognizing the importance of technology literacy in eHealth literacy across the lifespan, we investigate generational differences in New Communication Technology (NCT) use and eHealth literacy, especially considering how NCT adoption theory might systematically inform scholars' understanding of eHealth literacy. Participants included 525 adults primarily in the Midwestern United States. We found significant differences between generational groups across all variables. We found that UTAUT determinants such as performance expectancy and effort expectancy explained 38% of the variance in eHealth literacy, controlling for age, sex, level of education, and prior online health information seeking. Finally, we engaged with early critiques of UTAUT, finding that when applying UTAUT in voluntary (vs. mandatory) contexts, scholars should reconsider variables previously dismissed, such as attitude. In doing this, we extend UTAUT in three ways: new contexts (voluntary NCT adoption), endogenous theoretical mechanisms (eHealth literacy), and exogenous variables (attitude; lifespan). These findings underscore a need for a targeted approach to improve eHealth literacy and health self-management across generations.

Acceptability and feasibility of the mHealth intervention 'MyDayPlan' to increase physical activity in a general adult population

Background

Electronic health (eHealth) and mobile health (mHealth) interventions have the potential to tackle the worldwide problem of physical inactivity. However, they often suffer from large attrition rates. Consequently, feasibility and acceptability of interventions have become important matters in the creation of e- and mHealth interventions. The aim of this study was to evaluate participants’ opinions regarding acceptability and feasibility of a self-regulation, app-based intervention called ‘MyDayPlan’. ‘MyDayPlan’ provides an innovative daily cycle providing several self-regulation techniques throughout the day that guide users towards an active lifestyle via various self-regulation techniques.

Methods

Semi-structured interviews were conducted with 20 adults after using the app for 2 weeks. A directed content analysis was performed using NVivo Software.

Results

‘MyDayPlan’ was well-received and seems to be feasible and acceptable with inactive adults. The straightforward lay out and ease of use of the app were appreciated. Furthermore, the incorporation of the techniques ‘action planning’, and ‘prompting review of behavioral goals’ was positively evaluated. However, the users gave some recommendations: implementation of activity trackers to self-monitor physical activity could be of added value. Furthermore, increasing intuitiveness by minimizing text input and providing more preprogrammed options could further increase the ease of use. Finally, users indicated that they would benefit from more guidance during the “coping planning” component (barrier identification/problem solving), for example by receiving more tailored examples.

Conclusions

Based on these findings, adaptations will be made to the ‘MyDayPlan’ app before evaluating its effectiveness. Furthermore, involving potential end users and evaluating acceptability and feasibility during the development of an e- and mHealth intervention is key. Also, creating interventions with a large ease of use and straightforward layout that provides tailored support during action and coping planning is key.

A web-based dietary intervention in early pregnancy and neonatal outcomes: a randomized controlled trial

BACKGROUND

Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes.

METHODS

Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women.

RESULTS

Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05).

CONCLUSIONS

We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women's engagement and modifies dietary behaviour.

NeckSense: A Multi-Sensor Necklace for Detecting Eating Activities in Free-Living Conditions

We present the design, implementation, and evaluation of a multi-sensor, low-power necklace, NeckSense, for automatically and unobtrusively capturing fine-grained information about an individual's eating activity and eating episodes, across an entire waking day in a naturalistic setting. NeckSense fuses and classifies the proximity of the necklace from the chin, the ambient light, the Lean Forward Angle, and the energy signals to determine chewing sequences, a building block of the eating activity. It then clusters the identified chewing sequences to determine eating episodes. We tested NeckSense on 11 participants with and 9 participants without obesity, across two studies, where we collected more than 470 hours of data in a naturalistic setting. Our results demonstrate that NeckSense enables reliable eating detection for individuals with diverse body mass index (BMI) profiles, across an entire waking day, even in free-living environments. Overall, our system achieves an F1-score of 81.6% in detecting eating episodes in an exploratory study. Moreover, our system can achieve an F1-score of 77.1% for episodes even in an all-day-long free-living setting. With more than 15.8 hours of battery life, NeckSense will allow researchers and dietitians to better understand natural chewing and eating behaviors. In the future, researchers and dietitians can use NeckSense to provide appropriate real-time interventions when an eating episode is detected or when problematic eating is identified.

The Role of Trust When Adolescents Search for and Appraise Online Health Information

OBJECTIVE

To assess the role of trust when adolescents search for and appraise online health information.

STUDY DESIGN

A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, and ERIC) was performed. Google Scholar and reference lists for included studies were manually searched for additional articles. Studies were included if they examined the role of trust when adolescents (in the 13- to 18-year-old age range) searched for and/or appraised online health information. Findings were synthesized using thematic analysis.

RESULTS

There were 22 studies that met the inclusion criteria. Four key themes were identified: adolescents generally distrust the Internet but use it anyway (subthemes were why adolescents distrust online health information; why adolescents still use online health information), adolescents use heuristics to appraise the trustworthiness of online health information (subthemes were different heuristics used by different adolescents, range of heuristics used by adolescents), adolescents trust websites more than social media or social networking sites, and adolescents' level of trust in online health information guides their actions and responses.

CONCLUSIONS

Adolescents often distrust health information from the Internet, but continue to use it. Adolescents are aware of the need to evaluate the trustworthiness of online health information; however, their approaches vary in sophistication. As the reach and content of the Internet expands, it is important to equip adolescents with effective eHealth literacy to assess the trustworthiness of online health information.

[Health education through digital audio-visual media: strategies of the German Federal Centre for Health Education (BZgA)]

Digitalization has revolutionized the conditions and framework of media communication, including health education and promotion. The production and consumption of audio-visual formats is constantly increasing. In this contribution, the importance of digital audio-visual elements within public health interventions via the Internet is emphasized. With recent examples from the audio-visual practice of the Federal Centre for Health Education (BZgA, Cologne) a spectrum of health education video formats on the Internet is presented, together with related objectives and message strategies. In future, further research on reception processes and outcomes should be performed as well as on whether moving image formats on the Internet can contribute to better contact with socially disadvantaged target groups.

Factors that contribute to effective online nutrition education interventions: a systematic review

CONTEXT

The use of the internet and technology as a medium for delivering online nutrition education (ONE) has increased; however, evidence-based studies exploring factors that contribute to best practices in online interventions have not emerged.

OBJECTIVE

The purpose of this systematic review was to identify factors that contributed to successful ONE interventions in relation to research studies published between 2009 and 2018.

DATA SOURCES

Following the PRISMA guidelines, relevant studies were identified through PubMed, Medline, Web of Science, Science Direct, and Education Resources Information Center (ERIC) databases.

DATA EXTRACTION

Five authors screened and determined the quality of the studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and extracted the data from the articles.

DATA ANALYSIS

Twenty-seven studies were included: 21 studies were website-based, 3 were delivered through smartphone application, 2 were delivered as online courses, and 1 used text messages. Tailored messages/feedback, interaction between participants and investigators, identification of specific behaviors, use theory, adequate duration, and alignment between stated objectives and activities were factors that contributed to successful online interventions, while comparison bias and the lack of specific details on duration and dosage, tracking system, objective outcome measurements, and follow-up were factors that may have interfered with successful ONE interventions.

CONCLUSIONS

The findings underscore the importance of developing ONE intervention designs that utilize factors unique to online platforms for effective interventions aimed at behavior change.

An app-, web- and social support-based weight loss intervention for adults with obesity: the HelpMeDoIt! feasibility RCT

Background

Finding solutions to rising levels of obesity continues to be a major public health focus. Social support has an important role in successful weight loss, and digital interventions can reach a large proportion of the population at low cost.

Objective

To develop and assess the feasibility and acceptability of an application (app), web- and social support-based intervention in supporting adults with obesity to achieve weight loss goals.

Design

Stage 1 – intervention development phase involved three focus groups (n = 10) with users, and think-aloud interviews and field testing with another group (n = 28). Stage 2 – the intervention and evaluation methods were explored in a feasibility randomised controlled trial with economic and process evaluation.

Setting

Greater Glasgow and Clyde, UK.

Participants

Adults with a body mass index of ≥ 30kg/m2 who owned a smartphone and were interested in losing weight were randomised 2 : 1 (intervention : control) and followed up at 12 months. Recruitment took place in April–October 2016.

Interventions

The intervention group had access to HelpMeDoIt! for 12 months. This encouraged them to (1) set goals, (2) monitor progress and (3) harness social support by inviting ‘helpers’ from their existing social network. The control group received a healthy lifestyle leaflet.

Main outcome measures

Data from stage 1 informed the intervention design. Key measures in stage 2 assessed the feasibility and acceptability of the intervention and trial methods against prespecified progression criteria. Three primary outcomes were explored: body mass index, diet and physical activity. Secondary outcomes included weight, waist and hip circumference, social support, self-efficacy, motivation, mental health, health-related quality of life, NHS resource use, participant-borne costs and intervention costs. Qualitative interviews with participants (n = 26) and helpers (n = 9) explored the feasibility and acceptability of the trial methods and intervention.

Results

Stage 1 produced (1) a website that provided evidence-based information for lifestyle change and harnessing social support, and (2) an app that facilitated goal-setting, self-monitoring and supportive interaction between participants and their helper(s). Progression criteria were met, demonstrating that the intervention and trial methods were feasible and acceptable. A total of 109 participants (intervention, n = 73; control, n = 36) were recruited, with 84 participants (77%: intervention, 71%; control, 89%) followed up at 12 months. Data were successfully collected for most outcome measures (≥ 82% completion). Participants and helpers were generally positive, although helper engagement with the app was low. Of the 54 (74%) participants who downloaded the app, 48 (89%) used it twice or more, 28 helpers enrolled via the app, and 19 (36%) participants interacted with their helper(s) via the app. Interview data indicated that HelpMeDoIt! prompted support from helpers that often occurred without the helpers using the app.

Limitations

Early technical problems meant that some participants and helpers had difficulty accessing the app. Ethical constraints meant that we were unable to contact helpers directly for interview.

Conclusions

The HelpMeDoIt! study demonstrated that a weight loss intervention delivered via an app and a website is feasible and acceptable. Progression criteria were met, supporting further evaluation of the intervention.

Future work

To further explore (1) the motivation and engagement of helpers, (2) the programme theory and (3) the effectiveness and cost-effectiveness of the intervention.

Trial registration

Current Controlled Trials ISRCTN85615983.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.

Understanding Computer-Mediated Support Groups: A Revisit Using a Meta-Analytic Approach

The increasing popularity of computer-mediated support groups (CMSGs) has drawn scholarly attention in recent decades. Fifteen empirical controlled studies have been published since Rains and Young's meta-analysis, showing mixed results, with a large variation of effect sizes ranging from -.77 to 1.33 in Cohen's d. To provide a better understanding of CMSGs, the current study meta-analyzed these 15 newly published studies along with the studies included in Rains and Young's meta-analysis, and tested study design and demographic moderators that have not been examined before. In addition, the study also revisited group size as a moderator and provided updated results with a larger sample size. Theoretical and practical implications of findings are discussed.

Is internet a missed opportunity? Evaluating radon websites from a stakeholder engagement perspective

Exposure to indoor radon, a naturally occurring radioactive gas, is one of the main causes of lung cancer worldwide. Although radon tests are easily accessible in most countries, and protective actions are effective and relatively easy to apply, the levels of radon testing and subsequent home remediation remain lower than aimed for. Public engagement, particularly through internet, may contribute to addressing this value-action gap. Given their role as common interaction points between citizens and public services, this research analyzed radon websites from a stakeholder engagement perspective. The rich database assembled, of websites in eight European countries with highly radon prone areas, provides for the empirical novelty of the study. The website evaluation relied on internet communication metrics adapted for radon risk mitigation. This included availability of radon information, accessibility, stakeholder interaction, dialogue, responsiveness, content and design, and transparency and openness. Unexpectedly, results show that availability of radon information on the internet in radon prone areas is often limited and poor, as for instance only three internet pages dedicated to radon have been found. Radon websites should be improved with consistent information supported by engaging stories, provide for personalized features, support stakeholder feedback and dialogue, and include the use of social media. We conclude by consolidating the analysis into a list of recommendations for health communication practitioners, which should support radon risk mitigation, and contribute to improving public health, particularly decreasing the numbers of lung cancers. The effect of radon information available on internet pages on changing protective behaviors is suggested for future research.

The development of a theory-based eHealth app prototype to promote oral health during prenatal care visits

Poor maternal oral health during pregnancy is associated with adverse maternal and child outcomes, including preterm birth and early childhood caries. Subsequently, professional associations have developed prenatal oral health guidelines, but significant gaps exist in implementing guidelines into clinical practice. The purpose of this study was to develop and test the usability of an innovative, theory-driven, eHealth application ("app") to facilitate prenatal providers' (nurse practitioners and midwives) implementation of oral health promotion during prenatal care visits. App development was guided by previous research, an integrated conceptual framework, Scientific Advisory Board input, and consumer-engaged iterative processes utilizing mixed-methods (observations, surveys, in-depth interviews) among providers (n = 4) during 10 unique prenatal care visits at a federally qualified health care center. Triangulation of quantitative and qualitative data analysis produced descriptive frequencies and salient themes. Concepts and principles from the following theoretical frameworks informed intervention development and testing: Consolidated Framework for Implementation Research; Information-Motivation-Behavioral Skills Model; Health Literacy; and Brief Motivational Interviewing. Overall, providers reported the app was effective at providing the information, motivation, and behavioral skills needed to integrate oral health promotion (e.g., easy to use; provided cues to action via scripts and tailored education; and documented findings into the patient's record). Although providers reported high usability, time constraints and detailed patient counseling scripts were identified areas for improvement. Findings suggest that the eHealth app could serve as an innovative mechanism to assist providers in implementing the prenatal oral health guidelines into practice. Future research is needed to continue app development efforts and to determine efficacy and effectiveness in practice settings.

Determinants of access to eHealth services in regional Australia

BACKGROUND

Australia has a universal public healthcare system, but access to eHealth services (i.e. use of the Internet and related technologies for healthcare services) remains a remarkable challenge, particularly in regional, rural and remote communities. Similar to many other countries, Australia faces the challenges of an ageing population and chronic disease management as well as balancing the supply of and the demand for quality healthcare and advanced medical procedures. The prima facie case for inequality in accessing eHealth services across geographical settings is widely acknowledged. However, regional residents' perceptions on access to eHealth services lack empirical evidence. Therefore, this study empirically investigates the current state and predictors of eHealth service access in regional Australia.

METHODS

A cross-sectional questionnaire-based household survey was conducted within a total of 390 randomly selected adults from the Western Downs Region in Southeast Queensland, Australia. Bivariate analysis was conducted to examine the relationship between eHealth access and respondents' characteristics. A multivariate logistic regression model was also performed to identify the significant predictors of eHealth service access in regional Australia.

RESULTS

Approximately 78% of the households have access to eHealth services. However, access to eHealth services in socioeconomically disadvantaged households was lower (19%) than that of their advantaged counterparts (25%). Factors that significantly increased the likelihood of accessing eHealth services included middle age (odds ratio [OR] = 2.75, 95% confidence interval [CI]: 1.84, 8.66), household size (three to four members) (OR = 2.29, 95% CI: 1.19, 4.73), broadband Internet access (OR = 1.67, 95% CI: 1.15, 2.90) and digital literacy (OR = 2.39, 95% CI: 1.23, 4.59). Factors that negatively influenced access to eHealth services were low educational levels (OR = 0.28, 95% CI: 0.09, 0.61), low socioeconomic status (OR = 0.65, 95% CI: 0.28, 0.83) and remote locations (OR = 0.66, 95% CI: 0.23, 0.80).

CONCLUSION

Emerging universal eHealth access provides immense societal benefits in regional settings. The findings of this study could assist policy makers and healthcare practitioners in identifying factors that influence eHealth access and thereby formulate effective health policies to optimise healthcare utilisation in regional Australia.

Communication of cancer screening results by letter, telephone or in person: A mixed methods systematic review of the effect on attendee anxiety, understanding and preferences

Attending and receiving a result from screening can be an anxious process. Using an appropriate method to deliver screening results could improve communication and reduce negative outcomes for screening attendees. Screening programmes are increasingly communicating results by letter or telephone rather than in-person. We investigated the impact of communication methods on attendees. We systematically reviewed the literature on the communication methods used to deliver results in cancer screening programmes for women, focusing on screening attendee anxiety, understanding of results and preferences for results communication. We included qualitative and quantitative research. We searched MEDLINE, PsycINFO, CINAHL, Cochrane Library and Embase. Results were analysed using framework synthesis. 10,558 papers were identified with seven studies meeting the inclusion criteria. Several key ideas emerged from the synthesis including speed, accuracy of results, visual support, ability to ask questions, privacy of results location and managing expectations. Verbal communication methods (telephone and in-person) were preferred and facilitated greater understanding than written methods, although there was considerable variability in attendee preferences. Findings for anxiety were mixed, with no clear consensus on which method of communication might minimise attendee anxiety. The low number of identified studies and generally low quality evidence suggest we do not know the most appropriate communication methods in the delivery of cancer screening results. More research is needed to directly compare methods of results communication, focusing on what impact each method may have on screening attendees.

A Comparative Multimetric Assessment of English and Spanish Carpal Tunnel Syndrome Materials

BACKGROUND

Spanish-speaking Hispanics living in the United States utilize the internet as a primary means to obtain health information. Accurate, accessible information is important for English speakers; however, it could have even greater utility for Spanish speakers who have lower health literacy levels. The aim of this study was to evaluate and compare online English and Spanish carpal tunnel surgery materials provided by using a multimetric approach.

MATERIALS AND METHODS

A web search using the English term "carpal tunnel surgery" was performed. The first 10 institutional/organizational websites that provided carpal tunnel surgery information in English and Spanish were included. All relevant online materials were evaluated using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and Simplified Measure of Gobbledygook, Spanish (SOL) to assess understandability and actionability, cultural sensitivity, and readability, respectively.

RESULTS

There were no statistically significant differences in understandability or actionability scores between Spanish and English materials. Average cultural sensitivity scores for Spanish materials were significantly lower than English materials (P = 0.015). The average reading grade level of online English materials was greater than that for Spanish materials (P = 0.011). Both mean values were above the recommended sixth-grade reading level.

CONCLUSIONS

Online patient-directed information regarding carpal tunnel surgery exceeded the recommended reading grade level for both English and Spanish-speaking populations. Most Spanish materials were often direct translations and were not contoured to the elevated literacy needs of this demographic. Institutions must caution their authors to tailor their web material in a way that is sensitive to their target population to optimize understanding.

eHealth for improving quality of life in breast cancer patients: A systematic review

Breast cancer patients (and survivors) use to deal with important challenges daily, such as coping with stress and depression, and adopting healthy lifestyles in order to improve treatment effectiveness; moreover, some experiential issues are quite specific of this disease, such as sexuality and fertility disfunctions after hormonal therapy, and distortions in body image after breast surgery. Recent literature highlighted the utility of eHealth or the use of new technologies to promote health management and quality of life in chronic diseases generally. The present contribution aims at (1) exploring usage and effectiveness of eHealth resources to improve breast cancer patients/survivors' quality of life, and (2) describing whether existing eHealth interventions addressed specific characteristics of breast cancer, or employed a generic approach only. A systematic literature search according to PRISMA guidelines was performed. Twenty-four studies met inclusion criteria and were included. Discussion highlights a majority of encouraging results about eHealth in breast cancer patients' health management, especially in those interventions featuring eHealth tools for improving patients' abilities (e.g., coping) and complex eHealth systems with multiple resources. However, generic use of eHealth is still predominant over disease-focused solutions. Guidelines for future eHealth research and development are listed in order to promote technology design centered on the lived experience of specific illness.

A Mobile Game for Patients With Breast Cancer for Chemotherapy Self-Management and Quality-of-Life Improvement: Randomized Controlled Trial

Background

The application of game-based learning in clinical practice has shown potential advantages in previous studies. However, there have been little efforts to use smartphone-based mobile games in the management of adult patients with cancer.

Objective

The objective of our study was to evaluate if patient education using a mobile game may increase drug compliance, decrease physical side effects of chemotherapy, and improve psychological status in breast cancer patients.

Methods

A total of 76 patients with metastatic breast cancer who were planned to receive cytotoxic chemotherapy were enrolled in this trial. Study participants were randomly assigned to a mobile game play group (game group, n=36) or a conventional education group (control group, n=40) in a ratio of 1:1. The patients were unblinded and followed prospectively for 3 weeks. Outcome measures included time spent for education, compliance to medication, physical side effects, and psychological side effects including quality of life (QoL).

Results

Overall, 72 out of 76 patients completed the study after 3 weeks (95%). The subjects in the game group showed high levels of satisfaction with the app. The time spent playing the mobile game in the game group was longer than that spent for self-education in the control group (mean 22.2, SD 6.1 vs mean 5.5, SD 4.0 minutes a day; P<.001). The mobile game group showed better drug adherence (Korean version of the Medication Adherence Rating Scale; mean 7.6, SD 0.7 vs mean 6.5, SD 0.5; P<.001). The use of the mobile game was associated with lower rates of chemotherapy-related side effects, such as nausea, fatigue, numbness of hand or foot, and hair loss, than the control group. The game group exhibited better QoL during chemotherapy (mean 74.9, SD 3.5 vs mean 72.2, SD 5.3; P=.01). However, there were no significant differences in terms of depression and anxiety scales.

Conclusions

This study suggests the feasibility and potentiality of the use of smartphone mobile games for patients with breast cancer receiving chemotherapy. Education using a mobile game led to better patient education, improved drug compliance, decreased side effects, and better QoL compared with conventional education. Mobile games can be used as easy, fun, and effective measures for patient education and have the potential to improve treatment outcomes.

Trial Registration

ClinicalTrials.gov NCT03205969; http://clinicaltrials.gov/ct2/show/NCT03205969 (Archived by WebCite at http://www.webcitation.org/71jfSBOq9).

How Users Experience and Use an eHealth Intervention Based on Self-Regulation: Mixed-Methods Study

BACKGROUND

eHealth interventions show stronger effects when informed by solid behavioral change theories; for example, self-regulation models supporting people in translating vague intentions to specific actions have shown to be effective in altering health behaviors. Although these theories inform developers about which behavioral change techniques should be included, they provide limited information about how these techniques can be engagingly implemented in Web-based interventions. Considering the high levels of attrition in eHealth, investigating users' experience about the implementation of behavior change techniques might be a fruitful avenue.

OBJECTIVE

The objective of our study was to investigate how users experience the implementation of self-regulation techniques in a Web-based intervention targeting physical activity and sedentary behavior in the general population.

METHODS

In this study, 20 adults from the general population used the intervention for 5 weeks. Users' website data were explored, and semistructured interviews with each of the users were performed. A directed content analysis was performed using NVivo Software.

RESULTS

The techniques "providing feedback on performance," "action planning," and "prompting review of behavioral goals" were appreciated by users. However, the implementation of "barrier identification/problem solving" appeared to frustrate users; this was also reflected by the users' website data-many coping plans were of poor quality. Most users were well aware of the benefits of adopting a more active way of living and stated not to have learned novel information. However, they appreciated the provided information because it reminded them about the importance of having an active lifestyle. Furthermore, prompting users to self-monitor their behavioral change was not sufficiently stimulating to make users actually monitor their behavior.

CONCLUSIONS

Iteratively involving potential end users offers guidance to optimally adapt the implementation of various behavior change techniques to the target population. We recommend creating short interventions with a straightforward layout that support users in creating and evaluating specific plans for action.

Barriers and facilitators to health care professionals discussing child weight with parents: A meta-synthesis of qualitative studies

INTRODUCTION

Childhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight-related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta-synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents.

METHODS

Searches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full-text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight-related issues with parents. An inductive thematic analysis was employed to synthesize findings.

FINDINGS

Emerging subthemes were categorized using a socio-ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional-parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels.

CONCLUSION

The findings of this review may help to inform the development of future weight-related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges. Health care professionals are in a prime position to identify child weight issues during routine consultations. However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight. This review interprets key barriers and facilitators in the context of the socio-ecological model. Supports the development of interventions matched to the appropriate level of the socio-economic model.

Sources of clinical information used in HIV care and treatment: Are providers' choices related to their demographic and practice characteristics?

HIV medical care providers need a wide range of evidence-based clinical information resources to manage their patients' health. We determined whether providers' choice of information sources for HIV care and treatment are associated with their demographic and medical practice characteristics. Data used for this study were obtained from a probability sample of HIV medical care providers in 13 outpatient HIV facilities in Houston/Harris County, Texas, surveyed between June and September 2009. The mean number of information sources used by HIV medical care providers for HIV care and treatment was 5.83 (95% confidence interval: 4.90-6.75). Antiretroviral therapy guidelines (95.6%), medical journals and textbooks (82.6%), and Internet sources (69.5%) were ranked first, second, and third as sources of clinical information. At least one of the providers' demographic or medical practice characteristics was significantly (p ⩽ 0.05) associated with six of the clinical information sources. Integration of these information resources into clinicians' workflow may enhance efficiency of HIV care and treatment and facilitate improved patients' care and health outcomes.

"Your Brain Matters": Issues of Risk and Responsibility in Online Dementia Prevention Information

The Internet has been argued to provide diverse sites for health communication and promotion, including issues that constitute major public health priorities such as the prevention of dementia. In this study, discursive psychology is used to examine how information about dementia risk prevention was presented on the websites of the most prominent English-language, nonprofit dementia organizations. We demonstrate how information about dementia risk and its prevention positions audiences as at-risk of developing dementia and constructs preventive behavior as a matter of individual responsibility. Websites represented participation in certain lifestyle practices as normative and emphasized audience members' personal responsibility for managing dementia risk. It is argued that such representations promote a moral identity in regard to brain health in which an ethic of self-responsibility is central. The implications of such identity construction in a context of increasing prevalence of dementia diagnosis are discussed.

Qualitative Focus Groups: Perceived Influences on Decision Making About Diet and Physical Activity Among Hispanic/Latino Participants

Disparities in minority health are strongly associated with reduced access to culturally familiar food and physical activity opportunities. This qualitative study explores a Midwest, urban Hispanic/Latino community, the members' experiences with their multidimensional environment and its influence on their nutrition and physical activity choices. Using the principles of community-based participatory research in collaboration with a trusted, local Hispanic/Latino community agency, we conducted five bilingual focus groups with a total of 46 self-selected participants (44 women and 2 men). We find that one's perception of the environmental factors of access, convenience, affordability, and safety influence food and physical activity decision making. Findings can be used to inform interventions to enhance culturally appropriate outreach, increase food equity, and decrease health disparities.

Educating children and adolescents about vaccines: a review of current literature

INTRODUCTION

Until recently, research on vaccine hesitancy has focused primarily on parent populations. Although adolescent knowledge and views are gaining momentum within the literature, particularly with regards to the human papillomavirus and influenza, children remain a virtually unstudied population with regards to vaccine hesitancy.

AREAS COVERED

This review focuses on the lack of literature in this area and argues for more vaccine hesitancy research involving child and adolescent populations. It also outlines special issues to consider when framing health promotion messages for children and adolescents. Finally, we explore the use of new and existing technologies as delivery mechanisms for education on vaccines and immunizations in populations of children and adolescents.

EXPERT COMMENTARY

Children undergo cognitive development and experiences with vaccines (e.g. pain or education) have the potential to create future attitudes toward vaccines. This can influence future vaccine behaviour, including their participation in decision-making around adolescent vaccines, their decisions to vaccinate themselves when they are adults, and their decisions to vaccinate their own children. Interventions aimed at children, such as education, can create positive attitudes toward vaccines. These can also potentially influence parental attitudes toward vaccines as children convey this knowledge to them. Both of these impacts require further study.

Using the technology acceptance model to predict patient attitude toward personal health records in regional communities

Purpose

The purpose of this paper is to statistically measure (quantify) how a sample of Canadians perceives the usability of electronic personal health records (PHRs) and, in the process, to increase Canadian patients’ awareness of PHRs and improve physicians’ confidence in their patients’ ability to manage their own health information through PHRs.

Design/methodology/approach

The authors surveyed 325 Canadian patients living in Northern Ontario to assess a research model consisting of seven perceptions of PHR systems used to manage personal health information electronically, and to assess their perceived ability to use PHR systems. The survey questions were adapted from the 2014 National Physician Survey in Canada. The authors compared the patients’ results with physicians’ own perceptions of their patients’ ability to use PHR systems.

Findings

First, there was a positive relationship between surveyed patients’ prior experiences, needs, values, and their attitude toward adopting the PHR system. Second, how patients saw a PHR system’s user-friendliness was the strongest predictor of how useful they considered it would be. Finally, of the 243 physician respondents, 90.3 percent believed their patients would not be able to manage their own e-health information via a PHR system, but 54.8 percent of the 325 patient respondents indicated they would be able to do so.

Originality/value

This study is unique in that the authors know of no other Canadian study that purports to predict, using the technology acceptance model factors, people’s attitudes toward adopting a PHR system. As well, this is the first Canadian study to compare the perspectives of healthcare providers and their patients on e-health applications.

Health literacy in a complex digital media landscape: Pediatric obesity patients’ experiences with online weight, food, and health information

This study aimed to explore experiences with online information regarding food, weight management, and health in a group of adolescents in treatment for obesity. Individual semi-structured interviews with 20 adolescents were conducted. Participants used a screen-recorded laptop to demonstrate their search procedures and online information sources. The transcribed interviews were categorized using qualitative content analysis. The adolescents described both encouraging and discouraging experiences. On one hand, they said that online forums could provide nutritious meal ideas and inspiration as well as social support for behavior change. On the other hand, they mentioned that there was a confusing amount of misleading commercial content online and also experiences of peer-facilitated food marketing in online networks. An overarching theme was generated: social media might be a resource for health inspiration, health information, and social support, but requires awareness and competencies. Implications for clinical practice are discussed in light of these findings.

Informing the development of online weight management interventions: a qualitative investigation of primary care patient perceptions

Background

The internet is a potentially promising medium for delivering weight loss interventions. The current study sought to explore factors that might influence primary care patients’ initial uptake and continued use (up to four-weeks) of such programmes to help inform the development of novel, or refinement of existing, weight management interventions.

Methods

Semi-structured interviews were conducted with 20 patients purposively sampled based on age, gender and BMI from a single rural general practice. The interviews were conducted 4 weeks after recruitment at the general practice and focused on experiences with using one of three freely available weight loss websites. Thematic Analysis was used to analyse the data.

Results

Findings suggested that patients were initially motivated to engage with internet-based weight loss programmes by their accessibility and novelty. However, continued use was influenced by substantial facilitators and barriers, such as time and effort involved, reaction to prompts/reminders, and usefulness of information. Facilitation by face-to-face consultations with the GP was reported to be helpful in supporting change.

Conclusions

Although primary care patients may not be ready yet to solely depend on online interventions for weight loss, their willingness to use them shows potential for use alongside face–to-face weight management advice or intervention. Recommendations to minimise barriers to engagement are provided.

Electronic supplementary material

The online version of this article (10.1186/s40608-018-0184-6) contains supplementary material, which is available to authorized users.

Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study

Background

Technology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work.

Objective

The objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges.

Methods

A qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion.

Results

First, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care.

Conclusions

This study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients.

Justificatory Information Forefending in Digital Age: Self-Sealing Informational Conviction of Risky Health Behavior

This study proposes the idea of justificatory information forefending, a cognitive process by which individuals accept information that confirms their preexisting health beliefs, and reject information that is dissonant with their attitudes. In light of the sheer volume of often contradictory information related to health that is frequently highlighted by the traditional media, this study sought to identify antecedents and outcomes of this justificatory information forefending. Results indicate that individuals who are exposed to contradictory health information, currently engage in risky health behavior, are comfortable using the Internet to search for information, and are currently taking steps to maintain their health are likely to actively select health information that confirms their preexisting notions about their health, and to reject information that is contradictory to their beliefs. Additionally, individuals who engage in justificatory information forefending were also found to continue to engage in risky health behavior. Implications for theory and practice are discussed.

Best practices for online Canadian prenatal health promotion: A public health approach

BACKGROUND

Prenatal health promotion provides information regarding pregnancy risks, protective behaviours and clinical and community resources. Typically, women obtain prenatal health information from health care providers, prenatal classes, peers/family, media and increasingly, Internet sites and mobile apps. Barriers to prenatal health promotion and related services include language, rural/remote location, citizenship and disability. Online public health platforms represent the capacity to reach underserved women and can be customised to address the needs of a heterogeneous population of pregnant women.

AIM

Canadian government-hosted websites and online prenatal e-classes were evaluated to determine if accessible, inclusive, comprehensive and evidence-based prenatal health promotion was provided.

METHODS

Using a multijurisdictional approach, federal, provincial/territorial, municipal and public health region-hosted websites, along with affiliated prenatal e-classes, were evaluated based on four criteria: comprehensiveness, evidence-based information, accessibility and inclusivity.

FINDINGS

Online prenatal e-classes, federal, provincial/territorial and public health-hosted websites generally provided comprehensive and evidence-based promotion of essential prenatal topics, in contrast to municipal-hosted websites which provided very limited prenatal health information. Gaps in online prenatal health promotion were identified as lack of French and multilingual content, targeted information and representations of Indigenous peoples, immigrants and women with disabilities.

CONCLUSION

Canadian online prenatal health promotion is broadly comprehensive and evidence-based, but fails to address the needs of non-Anglophones and represent the diverse population of Canadian pregnant women. It is recommended that agencies enhance the organisation of website pregnancy portals/pages and collaborate with other jurisdictions and community groups to ensure linguistically accessible, culturally-competent and inclusive prenatal online resources.

Educated but anxious: How emotional states and education levels combine to influence online health information seeking

This study combined conceptual frameworks from health information seeking, appraisal theory of emotions, and social determinants of health literatures to examine how emotional states and education predict online health information seeking. Nationally representative data from the Health Information National Trends Survey (HINTS 4, Cycle 3) were used to test the roles of education, anxiety, anger, sadness, hope, happiness, and an education by anxiety interaction in predicting online health information seeking. Results suggest that women, tablet owners, smartphone owners, the college educated, those who are sad some or all of the time, and those who are anxious most of the time were significantly more likely to seek online health information. Conversely, being angry all of the time decreased the likelihood of seeking. Furthermore, two significant interactions emerged between anxiety and education levels. Discrete psychological states and demographic factors (gender and education) individually and jointly impact information seeking tendencies.

A Culture-Centered Approach to Improving Healthy Trans-Patient-Practitioner Communication: Recommendations for Practitioners Communicating withTrans Individuals

The following manuscript explores trans individuals' lived experiences with practitioners and the types of advice they suggested be provided to practitioners treating trans patients to improve the trans-patient-practitioner relationship. Thirteen semi-structured qualitative interviews were conducted with individuals who self-identified as trans. Interviews were analyzed using thematic analysis (Braun & Clarke, 2006; Owen, 1984). Data analysis revealed that changes in practitioner's communication behavior during office visits as well as modifications to office logistics and e-health particulars would contribute to a healthy communication environment. Interviewees explained that these variations may potentially improve trans-patient-practitioner communication. We conclude by offering practical and theoretical implications as well as areas of future research for trans health communication.

Understanding where and why Senegalese adolescents and young adults access health information: A mixed methods study examining contextual and personal influences on health information seeking

Background

Adolescent and young adult years are critical to the development of behaviors that influence health across the life course. To reveal which health communication channels should be used to effectively reach and influence younger populations in Senegal, we used a mixed methods approach to identify and interpret the multifaceted influences surrounding where and why this population accesses health information.

Methods

We conducted 16 focus group discussions among adolescents and young adults in Senegal in September 2012. We then collected survey data from a larger, more diverse sample of Senegalese youth in October-November 2014.

Results

Our results demonstrate that information sources vary by health topic, differential access, age, and other demographics. While there is a greater perception of credibility and usefulness in information received from health professionals, stigma remains a barrier for obtaining information about HIV/AIDS from health centers. Older youth are also less likely to seek health information from adults, which may be influenced by preferred use of information technologies, especially for information about taboo health topics.

Conclusions

Our findings support multi-pronged, targeted approaches to health communication efforts. We recommend that doctors continue to provide actionable information about preventing or treating specific diseases, whereas teachers should educate youth about general health topics and health promotion behaviors. The results suggest that traditional mass media, such as radio and television, are the best communication channels for information about HIV and sexual/reproductive health, especially for older adolescents and young adults.