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Zysset AE, Schwärzler P, Dratva J. Seeking Health in a Digital World: Exploring Immigrant Parents' Quest for Child Health Information-A Scoping Review. Int J Environ Res Public Health 2023; 20:6804. [PMID: 37835074 PMCID: PMC10572919 DOI: 10.3390/ijerph20196804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/15/2023]
Abstract
During pregnancy and early parenthood, parents' strong interest in pediatric health information presents a valuable opportunity to positively impact long-term health-seeking behavior and overall child health. In line with the increasing prevalence of digital transformation, a scoping review was conducted to explore two key aspects: (1) information seeking and use of digital health information among immigrant parents, and (2) associated reasons and factors. The literature search covered the period until July 2022, using Web of Science, MEDLINE, and CINAHL Complete databases. Out of 625 articles, 12 were included, comprising six qualitative, five quantitative studies, and one review. The majority of studies focused on immigrants in North America, primarily from Latin America and Asia. The studies varied in topics and methodologies, making it challenging to draw general conclusions. Nevertheless, while most immigrant parents rely on digital information on child health, they often prefer human sources such as family, friends, or healthcare providers. Trustworthiness and accessibility emerged as critical criteria for health resources. Two focus group discussions, derived from the results of the review, confirmed these findings for migrant mothers in Switzerland.
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Affiliation(s)
- Annina E. Zysset
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Patricia Schwärzler
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Julia Dratva
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Poot CC, Meijer E, Fokkema M, Chavannes NH, Osborne RH, Kayser L. Translation, cultural adaptation and validity assessment of the Dutch version of the eHealth Literacy Questionnaire: a mixed-method approach. BMC Public Health 2023; 23:1006. [PMID: 37254148 DOI: 10.1186/s12889-023-15869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The digitalization of healthcare requires users to have sufficient competence in using digital health technologies. In the Netherlands, as well as in other countries, there is a need for a comprehensive, person-centered assessment of eHealth literacy to understand and address eHealth literacy related needs, to improve equitable uptake and use of digital health technologies. OBJECTIVE We aimed to translate and culturally adapt the original eHealth Literacy Questionnaire (eHLQ) to Dutch and to collect initial validity evidence. METHODS The eHLQ was translated using a systematic approach with forward translation, an item intent matrix, back translation, and consensus meetings with the developer. A validity-driven and multi-study approach was used to collect validity evidence on 1) test content, 2) response processes and 3) internal structure. Cognitive interviews (n = 14) were held to assess test content and response processes (Study 1). A pre-final eHLQ version was completed by 1650 people participating in an eHealth study (Study 2). A seven-factor Confirmatory Factor Analysis (CFA) model was fitted to the data to assess the internal structure of the eHLQ. Invariance testing was performed across gender, age, education and current diagnosis. RESULTS Cognitive interviews showed some problems in wording, phrasing and resonance with individual's world views. CFA demonstrated an equivalent internal structure to the hypothesized (original) eHLQ with acceptable fit indices. All items loaded substantially on their corresponding latent factors (range 0.51-0.81). The model was partially metric invariant across all subgroups. Comparison of scores between groups showed that people who were younger, higher educated and who had a current diagnosis generally scored higher across domains, however effect sizes were small. Data from both studies were triangulated, resulting in minor refinements to eight items and recommendations on use, score interpretation and reporting. CONCLUSION The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. While ongoing collection of validity evidence is recommended, the evidence presented indicate that the eHLQ can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not left behind.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands.
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Tabas RY, Ahmadian L, Samadbeik M, Arian A, Ameri A. Determining the readiness of patients with renal failure to use health information technology. BMC Med Inform Decis Mak 2022; 22:324. [PMID: 36482469 PMCID: PMC9732994 DOI: 10.1186/s12911-022-02073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Using information technology (IT) for purposes such as patient education and disease prevention and management is effective when patients are ready to use it. The objective of this study was to determine the readiness of patients with renal failure to use health IT. METHODS This study was performed on all dialysis patients in South Khorasan province (n = 263) using a 28-item questionnaire. The questionnaire consisted of (1) demographic information of participants and (2) questions concerning eight main factors including the need for information, desire to receive information, ability to use computers and the Internet, computers and the Internet anxiety, communication with physicians, using mobile phones and concerns about security and confidentiality of information. Descriptive statistics and Mann-Whitney and Kruskal-Wallis statistical tests were used to analyze the data. RESULTS About 15% of the participants stated that they do not want to receive information from the Internet. Anxiety and concern about Internet security and confidentiality were higher in women, married people, people over 60, villagers, and illiterate people (p < 0.05). Married people and people over 60 years had a higher desire to get information (p < 0.05). The rate of computer anxiety and Internet privacy concern was higher than average (p < 0.001). Most patients (34.2%) could only send text messages using mobile phones. CONCLUSION Despite the need of most patients to online health information, they do not use this information due to a lack of skills and experience to use IT. Therefore, the ability of users should be considered when developing IT-based interventions. Due to patients' concerns about Internet privacy, it is required to teach patients how to protect their privacy while using the Internet.
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Affiliation(s)
- Raana Younesi Tabas
- grid.411701.20000 0004 0417 4622Health Information Management Department, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Leila Ahmadian
- grid.412105.30000 0001 2092 9755Health Information Sciences Department, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahnaz Samadbeik
- grid.508728.00000 0004 0612 1516Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Anahita Arian
- grid.411701.20000 0004 0417 4622Department of Internal Medicine, Cardiovascular Diseases Research Center Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Arefeh Ameri
- grid.412105.30000 0001 2092 9755Health Information Sciences Department, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Safdari R, Yu P, Khenarinezhad S, Ghazanfari Savadkoohi E, Javanmard Z, Yousefi A, Barzegari S. Validity and reliability of the Persian version of the Patient readiness to engage in health information technology (PRE-HIT) instrument. BMC Prim Care 2022; 23:50. [PMID: 35305567 PMCID: PMC8934158 DOI: 10.1186/s12875-022-01665-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/14/2022] [Indexed: 01/06/2023]
Abstract
Background The Patient readiness to engage in health information technology (PRE-HIT) is a conceptually and psychometrically validated questionnaire survey tool to measure willingness of patients with chronic conditions to use health information technology (HIT) resources. Objectives This study aimed to translate and validate a health information technology readiness instrument, the PRE-HIT instrument, into the Persian language. Methods A rigorous process was followed to translate the PRE-HIT instrument into the Persian language. The face and content validity was validated by impact score, content validity index (CVI) and content validity ratio (CVR). The instrument was used to measure readiness of 289 patients with chronic diseases to engage with digital health with a four point Likert scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was used to check the validity of structure. The convergent and discriminant validity, and internal reliability was expressed by average variance extracted (AVE), construct reliability (CR), maximum shared squared variance (MSV), average shared square variance (ASV), and Cronbach's alpha coefficient. Independent samples, t-test and one-way ANOVA were used respectively to compare the impact of sex, education and computer literacy on the performance of all PRE-HIT factors. Results Eight factors were extracted: health information needs, computer anxiety, computer/internet experience and expertise, preferred mode of interaction, no news is good news, relationship with doctor, cell phone expertise, and internet privacy concerns. They explained 69% of the total variance and the KMO value was 0.79; Bartlett's test of sphericity was also statistically significant (sig < 0.001). The communality of items was higher than 0.5. An acceptable model fit of the instrument was achieved (CFI = 0.943, TLI = 0.931, IFI = 0.944, GFI = 0.893, RMSEA ≤ 0.06, χ2/df = 1.625, df = 292, P-value ≤ 0.001). The Cronbach's alpha coefficient achieved a satisfactory level of 0.729. The AVE for all factors was higher than 0.50 except for PMI (0.427) and CIEE (0.463) and also the CR for all factors was higher than 0.7, therefore, the convergent validity of the instrument is adequate. The MSV and ASV values for each factor were lower than AVE values; therefore, the divergent validity was acceptable. Conclusion The Persian version of the PRE-HIT was empirically proved for its validity to assess the level of readiness of patients to engage with digital health.
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Longhini J, Rossettini G, Palese A. Digital Health Competencies Among Health Care Professionals: Systematic Review. J Med Internet Res 2022; 24:e36414. [PMID: 35980735 PMCID: PMC9437781 DOI: 10.2196/36414] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/16/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. Objective This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. Methods A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. Results A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was “Self-rated competencies,” followed by “Psychological and emotional aspects toward digital technologies,” “Use of digital technologies,” and “Knowledge about digital technologies.” In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Conclusions Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775
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Affiliation(s)
- Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | | | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
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Heath M, Appan R, Henry R. Value Alignment's Role in Mitigating Resistance to IT Use: The Case of Physicians'Resistance to Electronic Health Record Systems. Information & Management 2022. [DOI: 10.1016/j.im.2022.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liu HX, Chow BC, Hu C, Hassel H, Huang WY. eHealth usage among Chinese college students: qualitative findings. BMC Public Health 2022; 22:1088. [PMID: 35642028 PMCID: PMC9158198 DOI: 10.1186/s12889-022-13521-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The information technology has developed rapidly with the evolution of internet environment transformed from requiring computer skills for information searching to self-managing health data and applying information. Therefore, a more diverse range of eHealth skills is required and these skills are referred as eHealth literacy. However, most eHealth literacy studies focused mainly on information searching skills. Little is known about eHealth usage behaviors of college students in this day and age. OBJECTIVES This study aimed to investigate how Chinese college students engage with eHealth tools and to determine the elements of their eHealth literacy. METHODS A purposive sample of 18 Chinese college students was recruited for in-depth interviews. Interviewees included three males and three females of each city (Beijing, Wuhan and Putian) from sports, medical, and non-health-related majors. Conventional content analysis was applied for data analysis. RESULTS The eHealth usage of different-major-students were compared and profiled by three themes of Expectance, Usage pattern and Perception. In Expectances, non-health major students applied eHealth only for urgent health need, sport major students used it to monitor health while medical major students, as frequent users for searching health database. In Usage pattern, purposes of eHealth for personal, practical and theoretical were identified for non-health major, sport major and medical major groups, respectively. In Perceptions, sport students felt more curious about eHealth than the other groups who perceived either fear (non-health students) or skeptical (medical students). By compiling those themes, the whole picture of eHealth usage was emerged. Based on that, the current study identified the related skills using the trilogy of Web 1.0 to 3.0, and derived a conceptual framework for eHealth literacy in the present day. CONCLUSIONS The current study obtained a comprehensive understanding of eHealth usage and a framework of eHealth literacy required for Chinese college students. And it gives a clearer look at web 3.0 related eHealth behaviors.
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Affiliation(s)
- Hua-Xuan Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, Fujian, China.
| | - Bik-Chu Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Chun Hu
- Student Mental Health Education Center, Northwestern Polytechnical University, Xi'an, Shanxi, 710000, China
| | - Holger Hassel
- Institute of Applied Health Sciences, Coburg University of Applied Science and Arts, Coburg, Germany
| | - Wendy Yajun Huang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
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Bardach NS, Stotts JR, Fiore DM, Sarkar U, Sharma AE, Boscardin WJ, Avina L, Peralta-Neel C, Rosenbluth G. Family Input for Quality and Safety (FIQS): Using mobile technology for in-hospital reporting from families and patients. J Hosp Med 2022; 17:456-465. [PMID: 35535946 DOI: 10.1002/jhm.2777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite three decades of effort, ensuring inpatient safety remains elusive. Patients and family members are a potential source of safety observations, but systems gathering these are limited. Our goal was to test a system to gather safety observations from hospitalized patients and their family members via a real-time mobile health tool. METHODS We developed a mobile-responsive website for reporting safety observations. We piloted the tool during June 2017-April 2018 on the medical-surgical unit of a children's hospital. Participants were English-speaking family members and patients ≥13 years. We sent a daily text with a website link. We assessed: (1) face validity by comparing observations to incident reporting (IR) criteria and to hospital IRs and (2) associations between the number of safety observations/100 patient-days and participant characteristics using Poisson regression. RESULTS We enrolled 235 patients (43.8% of 537 reviewed for eligibility), resulting in 8.15 safety reports/100 patient-days, most frequently regarding medications (29% of reports) and communication (20% of reports). Fifty-one (40% of 125) met IR criteria; only one (1.1%) had been reported via the IR system. Latinx participants submitted fewer observations than White participants (3.9 vs. 10.1, p = .002); participants with more prior hospitalizations submitted more observations (p < .001). In adjusted analyses, including measures of preference in decision making, and patient activation, the difference between Latinx and White participants diminished substantially (6.4 vs. 11.3, p = .16). CONCLUSIONS We demonstrated the feasibility of real-time patient and family-member technology-enabled safety observation reporting and elicited reports not otherwise identified. Variation in reporting may potentially exacerbate disparities in safety if not addressed.
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Affiliation(s)
- Naomi S Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Jim R Stotts
- Department of Patient Safety and Regulatory Affairs, University of California San Francisco, San Francisco, California, USA
| | - Darren M Fiore
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
| | - Anjana E Sharma
- Department of Medicine, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Lizette Avina
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Caroline Peralta-Neel
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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Stock S, Isselhard A, Jünger S, Peters S, Schneider G, Haarig F, Halbach S, Okan O, Fischer F, Bollweg TM, Bauer U, Schaeffer D, Vogt D, Berens EM, Ernstmann N, Bitzer EM. [DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]. Gesundheitswesen 2022; 84:e26-e41. [PMID: 35472769 PMCID: PMC9050455 DOI: 10.1055/a-1807-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Das vorliegende „DNVF Memorandum Gesundheitskompetenz (Teil 2) –
Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der
Versorgungsforschung“ des Deutschen Netzwerks Versorgungsforschung e.V.
(DNVF) stellt die Fortführung des Memorandums „DNVF Memorandum
Gesundheitskompetenz (Teil 1) – Hintergrund, Gegenstand und
Fragestellungen in der Versorgungsforschung“ dar. Neben den allgemeinen
Anforderungen an die Messung der Gesundheitskompetenz, beschäftigt sich
dieses Memorandum auch mit den speziellen Anforderungen, wie die Abgrenzung zu
verwandten Konstrukten, den Unterschieden zwischen performanzbasierten und
Selbsteinschätzungsverfahren, den Unterschieden zwischen generischen und
spezifischen Instrumenten, dem Einsatz von Screeninginstrumenten sowie der
Messung der Gesundheitskompetenz bei speziellen Personengruppen. Weiterhin
werden Besonderheiten bei der Messung der digitalen Gesundheitskompetenz,
Potenziale qualitativer und partizipativer Forschungszugänge sowie
forschungsethische Gesichtspunkte bei der Messung der Gesundheitskompetenz
erarbeitet. Ein besonderer Wert wird auf den Praxisbezug gelegt, der am Ende der
jeweiligen Abschnitte mit einem Fazit für die Versorgungsforschung
aufgegriffen wird. Abschließend wird einen Blick auf Herausforderungen
und Forschungsdesiderate im Zusammenhang mit der Messung von
Gesundheitskompetenz im Rahmen der Versorgungsforschung geworfen.
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Affiliation(s)
- Stephanie Stock
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Universitätsklinikum Köln, Cologne, Germany
| | - Anna Isselhard
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Universitätsklinikum Köln, Cologne, Germany
| | - Saskia Jünger
- Department of Community Health, Hochschule für Gesundheit, Bochum, Germany
| | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Hürth Efferen, Germany
| | - Gundolf Schneider
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Standort Berlin, Berlin, Germany
| | - Frederik Haarig
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
| | - Sarah Halbach
- Bundeszentrale für gesundheitliche Aufklärung (BzgA), Köln, Germany.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Universitätsklinikum Bonn, Bonn
| | - Orkan Okan
- Fakutät für Sport- und Gesundheitswissenschaften, Technische Universität München, München, Germany
| | - Florian Fischer
- Institut für Gerontologische Versorgungs- und Pflegeforschung, Hochschule Ravensburg-Weingarten, Weingarten, Germany
| | - Torsten Michael Bollweg
- Fakultät für Erziehungswissenschaft, AG 2 Sozialisation, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Ullrich Bauer
- Fakultät für Erziehungswissenschaft, AG 2 Sozialisation, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Doris Schaeffer
- Interdisziplinäres Zentrum für Gesundheitskompetenzforschung, Universität Bielefeld, Bielefeld, Germany
| | - Dominique Vogt
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
| | - Eva-Maria Berens
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
| | - Nicole Ernstmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Universitätsklinikum Bonn, Bonn
| | - Eva Maria Bitzer
- Public Health & Health Education, Pädagogische Hochschule Freiburg, Freiburg, Germany
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Zhang L, Li P. Problem-Based mHealth Literacy Scale (PB-mHLS): Development and Validation. JMIR Mhealth Uhealth 2022; 10:e31459. [PMID: 35394446 PMCID: PMC9034416 DOI: 10.2196/31459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/17/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Mobile devices have greatly facilitated the use of digital health resources, particularly during the COVID-19 pandemic. Mobile health (mHealth) has become a common and important way to monitor and improve health conditions for people from different social classes. The ability to utilize mHealth affects its effectiveness; therefore, the widespread application of mHealth technologies calls for an instrument that can accurately measure health literacy in the era of mobile media. Objective We aimed to (1) identify the components of mHealth literacy for ordinary users and (2) develop a systematic scale for appropriately measuring individuals’ self-perceived mHealth literacy through a problem-based framework. Methods We conducted an exploratory study involving in-depth interviews and observations (15 participants) in January 2020 and used exploratory factor analysis and confirmatory factor analysis to identify the components of mHealth literacy and develop an item pool. In February 2020, we conducted a pilot survey with 148 participants to explore the factor structures of items identified during the exploratory study. Subsequently, 2 surveys were administrated using quota sampling. The first survey (conducted in Guangdong, China) collected 552 responses during March 2020; we assessed composite reliability, convergent validity, and discriminant validity. The second survey (conducted in China nationwide) collected 433 responses during October 2021; we assessed criterion-related validity using structural equation modeling. Results We identified 78 items during the exploratory study. The final scale—the Problem-Based mHealth Literacy Scale—consists of 33 items that reflect 8 domains of mHealth literacy. The first web-based survey suggested that mHealth literacy consists of 8 factors (ie, subscales), namely, mHealth desire, mobile phone operational skills, acquiring mHealth information, acquiring mHealth services, understanding of medical terms, mobile-based patient–doctor communication, evaluating mHealth information, and mHealth decision-making. These factors were found to be reliable (composite reliability >0.7), with good convergent validity (average variance extracted >0.5) and discriminant validity (square root of average variance extracted are greater than the correlation coefficients between factors). The findings also revealed that these 8 factors should be grouped under a second-order factor model (χ2/df=2.701; comparative fit index 0.921; root mean square error of approximation 0.056; target coefficient 0.831). The second survey revealed that mHealth use had a significant impact (β=0.43, P<.001) on mHealth literacy and that mHealth literacy had a significant impact (β=0.23, P<.001) on health prevention behavior. Conclusions This study revealed the distinctiveness of mHealth literacy by placing mHealth needs, the ability to understand medical terms, and the skills in patient–doctor interactions in the foreground. The Problem-Based mHealth Literacy Scale is a useful instrument for comprehensively measuring individuals’ mHealth literacy and extends the concept of health literacy to the context of mobile communication.
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Affiliation(s)
- Lingmin Zhang
- School of Journalism and Communication, Guangzhou University, Guangzhou, China
| | - Pengxiang Li
- School of Media and Communication, Shenzhen University, Shenzhen, China
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Xie L, Zhang S, Xin M, Zhu M, Lu W, Mo PKH. Electronic health literacy and health-related outcomes among older adults: A systematic review. Prev Med 2022; 157:106997. [PMID: 35189203 DOI: 10.1016/j.ypmed.2022.106997] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/17/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
This review aims to identify, appraise, and synthesize research evidence of the association between electronic health (eHealth) literacy and health outcomes in older adults. English-written articles that presented the relationships between eHealth literacy and health-related outcomes in older adults were identified by searching five scientific databases (Web of Science, PubMed, Cochrane Library, APA PsycInfo, and EMBASE) hand-searching reference lists. Searches yielded 2993 studies after duplicates were removed, of which 24 publications were included in the final review. eHealth literacy was relatively low in older adults, and the eHealth Literacy Scale, developed by Norman and Skinner in 2006, was the most frequently used instrument in the included studies (21/24, 87.5%). The health-related outcomes associated with eHealth literacy were grouped into four categories: physical, behavioral, psychosocial, and cognitive. For behavioral (e.g., health-promoting behaviors, self-care, and medication adherence) and cognitive (e.g., health knowledge and health decision making) outcomes, the evidence was mostly consistent that eHealth literacy was positively associated with better outcomes. For physical (e.g., health-related quality of life) and psychosocial outcomes (e.g., anxiety and self-efficacy), the associations were less consistent, with some studies showing significant associations while others showed no associations. Most included studies were assessed as moderate quality. Overall, higher eHealth literacy is associated with more positive health behaviors and better health knowledge and attitude in older adults, however, the associations with some physical and psychosocial outcomes are less consistent. Clarifying the pathways of the relationships between eHealth literacy and some health-related outcomes is needed for further exploring their underlying mechanisms.
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Affiliation(s)
- Luyao Xie
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Shuxian Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Meiqi Xin
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Weiyi Lu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Phoenix Kit-Han Mo
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China.
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Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. Programme Grants Appl Res 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
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Zingg A, Singh T, Myneni S. Towards Digestible Digital Health Solutions: Application of a Health Literacy Inclusive Development Framework for Peripartum Depression Management. AMIA Annu Symp Proc 2022; 2021:1274-1283. [PMID: 35308913 PMCID: PMC8861658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Women of low income and education have lower levels of peripartum depression (PPD) literacy, limiting their ability to recognize symptoms and make informed healthcare decisions. Existing digital solutions and underlying development frameworks for PPD lack an integrative approach addressing health literacy and related disparities. Therefore, we develop an integrative framework for digital content engineering in PPD self-management consisting of (a) user needs analysis, (b) inclusion of eHealth literacy principles (science and health literacy), and (c) mapping user needs to the Behavioral Intervention Technology model. Results revealed that perinatal women seeking mental health care prefer information in multisensory formats, and knowledge needs were identified in areas such as medication management and coping with abnormal results. Results were mapped to eHealth literacy features of whiteboard videos covering essential PPD knowledge, and social media features where patients can articulate information needs. Initial evaluation of proposed features against existing PPD self-management solutions are discussed.
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Affiliation(s)
- Alexandra Zingg
- University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, Texas, USA
| | - Tavleen Singh
- University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, Texas, USA
| | - Sahiti Myneni
- University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, Texas, USA
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Moshood TD, Sorooshian S, Nawanir G, Okfalisa S. Efficiency of medical technology in measuring service quality in the Nigerian healthcare sector. International Journal of Africa Nursing Sciences 2022. [DOI: 10.1016/j.ijans.2022.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Liu HX, Chow BC, Liang W, Hassel H, Huang YW. Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study. J Med Internet Res 2021; 23:e31627. [PMID: 34554098 PMCID: PMC8498898 DOI: 10.2196/31627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured. OBJECTIVE This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students. METHODS In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages. RESULTS Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 (χ2244=903.076, χ2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability (α=.976, ρ=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing). CONCLUSIONS The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students.
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Affiliation(s)
- Hua-Xuan Liu
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Bik-Chu Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Wei Liang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Holger Hassel
- Institute of Applied Health Sciences, Coburg University of Applied Science and Arts, Coburg, Germany
| | - YaJun Wendy Huang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
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Neter E, Brainin E, Baron-Epel O. Group differences in health literacy are ameliorated in ehealth literacy. Health Psychol Behav Med 2021; 9:480-497. [PMID: 34104571 PMCID: PMC8158255 DOI: 10.1080/21642850.2021.1926256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Heath literacy and eHealth literacy are skills that enable individuals to seek, understand and use information in ways which promote and maintain health. The present study examined group differences (ethnicity, immigration) in both literacies and whether there exists an association between the literacies and potential outcomes/gains in health behaviors, health care utilization, perceived health and perceived outcomes of Internet search. METHODS Participants included 819 Israeli men and women who responded to a nationally representative random-digital-dial (RDD) telephone survey. Respondents were veteran Jews, immigrants from the Former Soviet Union, and Palestinian Citizens of Israel. RESULTS Significant differences between the groups were found in health literacy, especially in higher ordered skills, so that the immigrant group was the lowest, after accounting for demographic variables. No significant group differences were found in eHealth literacy. Health literacy was found to be significantly associated with healthcare utilization, perceived health and perceived outcomes of Internet search while eHealth literacy was associated with perceived health and perceived outcomes of Internet search. No interaction was found between group and literacies in the prediction of the outcomes. CONCLUSIONS Immigration hampers health literacy but differences are ameliorated in eHealth literacy. Finding on association between literacies and outcomes replicated previous ones and the absence of moderation by group attests to the robustness of the models on health literacies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Orna Baron-Epel
- Faculty of Social Welfare and Health, School of Public Health, University of Haifa, Haifa, Israel
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Shiferaw KB, Tilahun BC, Endehabtu BF, Gullslett MK, Mengiste SA. E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey. BMC Med Inform Decis Mak 2020; 20:181. [PMID: 32762745 PMCID: PMC7407428 DOI: 10.1186/s12911-020-01202-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023] Open
Abstract
Background Chronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia. Methods Institutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05. Result In total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level. Conclusion Besides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.
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Affiliation(s)
- Kirubel Biruk Shiferaw
- Health Informatics Department, Medicine and Health science college, Debre Markos University, Debre Markos, Ethiopia.
| | - Binyam Chakilu Tilahun
- Health Informatics Department, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Health Informatics Department, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Monika Knudsen Gullslett
- Faculty of Health & Social Sciences, Science center Health & Technology, University of South-Eastern Norway, Notodden, Norway
| | - Shegaw Anagaw Mengiste
- School of Business, Institute of Business, History & Social Sciences, University of South-Eastern Norway, Notodden, Norway
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Abstract
Pregnant women get information about pregnancy andchild-birth from many sources, including the Internet. There is alack of evidence about the extent to which pregnant women usethis source. This study aimed to investigate the use of the Internetby pregnant women to search for information about pregnancyand childbirth. This study was conducted in Kerman, Iran. Threehundred eighty-five pregnant women waiting for their appointmentswith obstetricians/gynecologists participated in the survey byfilling out a questionnaire. The most common searched topicswere nutrition in pregnancy (81%), fetal development (67%), andcomplications of pregnancy (49%). The most popular sources ofinformation were physicians (61%), the Internet (51%), and printedsources (41%), respectively. More than half of the participantsdid not share the retrieved information from the Internet with theirhealth professionals. After being examined by a physician, 43% ofthe participants searched the Internet about the discussed topic.Beside physicians, the Internet is the second common source ofpregnancy and childbirth information for Iranian pregnant women.Future studies are needed to analyze the quality and accuracy ofonline pregnancy and childbirth information.
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Affiliation(s)
- Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran
| | - Sudabeh Kamali
- Department of Health Information Sciences, Kerman University of Medical Sciences , Kerman, Iran
| | - Moghaddameh Mirzaee
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences , Kerman, Iran
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Duan H, Wang Z, Ji Y, Ma L, Liu F, Chi M, Deng N, An J. Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment. JMIR Mhealth Uhealth 2020; 8:e14466. [PMID: 32130161 PMCID: PMC7064970 DOI: 10.2196/14466] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management.
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Affiliation(s)
- Huilong Duan
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Zheyu Wang
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Yumeng Ji
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Li Ma
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fang Liu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mingwei Chi
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Jiye An
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
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20
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Bittlingmayer UH, Dadaczynski K, Sahrai D, van den Broucke S, Okan O. [Digital health literacy-conceptual contextualization, measurement, and promotion]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:176-184. [PMID: 31950230 DOI: 10.1007/s00103-019-03087-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The concept of digital health literacy can be regarded as the result of the increasing social permeation of digital media and their use in everyday life. Due to increasing accessibility and ubiquity, there is an increasing need not only for searching and finding, but especially for assessing the reliability as well as selecting and applying health information for one's own health concerns. In the context of digitization, it needs to be emphasized that users are not just passive recipients, but rather actively participate in the communication process by interacting with existing content or by sharing their own health-related information.With particular focus on children and adolescents, this paper provides an overview of the current state of research on digital health literacy. In addition to its terminological and conceptual foundations and its links with media literacy, the relationship between digital health literacy and social and health inequality is discussed. Inequalities are not only generated by access to digital media but, above all, by the skills required for their use. After an overview of available instruments is provided, initial reflections on how to promote the individual and structural dimension of digital health literacy with focus on school settings is given.
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Affiliation(s)
- Uwe H Bittlingmayer
- Institut für Soziologie, Pädagogische Hochschule Freiburg, Kunzenweg 21, 79117, Freiburg, Deutschland.
| | - Kevin Dadaczynski
- Fachbereich Pflege und Gesundheit, Hochschule Fulda, Fulda, Deutschland.,Leuphana Universität Lüneburg, Zentrum für Angewandte Gesundheitswissenschaften, Lüneburg, Deutschland
| | - Diana Sahrai
- Institut Spezielle Pädagogik und Psychologie, Pädagogische Hochschule FHNW, Muttenz, Schweiz
| | - Stephan van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgien
| | - Orkan Okan
- Fakultät für Erziehungswissenschaft, Universität Bielefeld, Bielefeld, Deutschland
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21
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Misra AJ, Ong SY, Gokhale A, Khan S, Melnick ER. Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment. JAMIA Open 2020; 2:447-455. [PMID: 32025641 PMCID: PMC6993997 DOI: 10.1093/jamiaopen/ooz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions. Materials and Methods A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose. Results Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0-100 scale; 95% confidence interval [CI], 51.8-62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen's kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients' understanding). Discussion Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient's preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options. Conclusion Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician-patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care.
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Affiliation(s)
- Anjali J Misra
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,School of Public Health, University College Cork, Cork, Ireland
| | - Shawn Y Ong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arjun Gokhale
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sameer Khan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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22
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Efthymiou A, Middleton N, Charalambous A, Papastavrou E. Adapting the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) in a Sample of Greek and Cypriot Carers of People With Dementia: Reliability and Validation Study. J Med Internet Res 2019; 21:e12504. [PMID: 31778120 PMCID: PMC6908974 DOI: 10.2196/12504] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 05/28/2019] [Accepted: 08/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills. OBJECTIVE This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers. METHODS The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored. RESULTS The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2). CONCLUSIONS eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.8080.
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Affiliation(s)
- Areti Efthymiou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Department of Nursing, Faculty of Health Sciences, University of Turku, Turku, Finland
| | - Evridiki Papastavrou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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23
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Paige SR, Stellefson M, Krieger JL, Miller MD, Cheong J, Anderson-Lewis C. Transactional eHealth Literacy: Developing and Testing a Multi-Dimensional Instrument. J Health Commun 2019; 24:737-748. [PMID: 31583963 PMCID: PMC7366705 DOI: 10.1080/10810730.2019.1666940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Theoretically informed measures of eHealth literacy that consider the social affordances of eHealth are limited. This study describes the psychometric testing of a multi-dimensional instrument to measure functional, communicative, critical, and translational eHealth literacies, as informed by the Transactional Model of eHealth Literacy (TMeHL). A 3-phase rating scale construction process was conducted to engage eHealth experts and end-users. In Phase 1, Experts (N = 5) and end-users (N = 25) identified operational behaviors to measure each eHealth literacy dimension. End-users (N = 10) participated in think-aloud interviews to provide feedback on items reviewed and approved by experts. A field test was conducted with a random sample of patients recruited from a university-based research registry (N = 283). Factor analyses and Rasch procedures examined the internal structure of the scores produced by each scale. Pearson's r correlations provided evidence for external validity of scores. The instrument measures four reliable (ω = .92-.96) and correlated (r= .44-.64) factors: functional (4 items), communicative (5 items), critical (5 items), and translational (4 items). Researchers and providers can use this new instrument as a theory-driven instrument to measure four eHealth literacies that are fundamental to the social affordances of the eHealth experience.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Michael Stellefson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA
| | - Janice L Krieger
- STEM Translational Communication Center, Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - M David Miller
- School of Human Development & Organizational Studies, University of Florida, Gainesville, FL, USA
| | - Jeewon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
| | - Charkarra Anderson-Lewis
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
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24
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Ahmadian L, Khajouei R, Kamali S, Mirzaei M, Ameri A. Pregnant women readiness to use the Internet to access health information about pregnancy and childbirth: A Descriptive analytical and cross-sectional study (Preprint). JMIR Res Protoc 2019. [DOI: 10.2196/16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Hyde LL, Boyes AW, Mackenzie LJ, Leigh L, Oldmeadow C, Riveros C, Sanson-Fisher R. Electronic Health Literacy Among Magnetic Resonance Imaging and Computed Tomography Medical Imaging Outpatients: Cluster Analysis. J Med Internet Res 2019; 21:e13423. [PMID: 31464188 PMCID: PMC6737886 DOI: 10.2196/13423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Variations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. Objective The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership. Methods Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. Results Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007). Conclusions The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.
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Affiliation(s)
- Lisa Lynne Hyde
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Allison W Boyes
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Lisa J Mackenzie
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Carlos Riveros
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
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26
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Zrubka Z, Hajdu O, Rencz F, Baji P, Gulácsi L, Péntek M. Psychometric properties of the Hungarian version of the eHealth Literacy Scale. Eur J Health Econ 2019; 20:57-69. [PMID: 31098883 PMCID: PMC6544600 DOI: 10.1007/s10198-019-01062-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/15/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND We adapted the eHealth Literacy Scale (eHEALS) for Hungary and tested its psychometric properties on a large representative online sample of the general population. METHODS The Hungarian version of eHEALS was developed using forward-backward translation. For the valuation study, 1000 respondents were recruited in early 2019 from a large online panel by a survey company. We tested internal consistency, test-retest reliability and construct and criterion validity using classical test theory, as well as item characteristics using an item-response theory (IRT) graded response model (GRM). RESULTS 55% of respondents were female, and 22.1% were ≥ 65 years old. Mean eHEALS score was 29.2 (SD: 5.18). Internal consistency was good (Cronbach's α = 0.90), and test-retest reliability was moderate (intraclass correlation r = 0.64). We identified a single-factor structure by exploratory factor analysis, explaining 85% of test variance. Essential criteria for GRM analysis were met. Items 3 and 4 (search of health resources) were the least difficult, followed by items 5 and 8 (utilisation of health information), and then items 1 and 2 (awareness of health resources). Items 6 and 7 (appraisal of health resources) were most difficult. The measurement properties of eHEALS were not affected by gender, age, education or income levels. Female gender, older age, intensity of health information seeking, formal health education and visit at the electronic health-record website were associated with higher eHEALS scores, as well as best and worst self-perceived health states, BMI < 25 and participation at health screenings over the past year. CONCLUSIONS The Hungarian eHEALS is a useful and valid tool for measuring subjective eHealth literacy.
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Affiliation(s)
- Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary.
- Doctoral School of Management, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary.
| | - Ottó Hajdu
- Department of Comparative Economics, Eötvös Loránd University, Egyetem tér 1-3, 1053, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, 1051, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
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Tang Y, Yang YT, Shao YF. Acceptance of Online Medical Websites: An Empirical Study in China. Int J Environ Res Public Health 2019; 16:ijerph16060943. [PMID: 30884754 PMCID: PMC6466387 DOI: 10.3390/ijerph16060943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
As a new type of public health service product, online medical websites (OMWs) are becoming quite popular. OMWs can address patients' basic medical problems remotely and give health guidance online. Compared to traditional hospitals, OMWs are more convenient and inexpensive, they can usually provide a better service for patients with poor medical conditions (especially in rural areas), and they also contribute to the rational distribution of medical resources. Therefore, key factors that affect patients' acceptance of OMWs must be identified to contribute to public health. By integrating perceived risk (PR) and the technology acceptance model (TAM), we proposed a modified TAM and clarified how PR and other factors affect patients' behavioral intention (BI) towards OMWs. A sample of 245 research participants in China took part in this study and the structural equation model (SEM) was used to test our hypotheses. The results revealed that perceived usefulness (PU) is a positive predictor of BI but has no significant effect on attitude (ATT), while perceived ease of use (PEOU) can affect BI through PU and attitude (ATT). Moreover, trust (TRU) was identified as a mediator of PR and PU/PEOU. Also, the doctor⁻patient relationship (DPR) was shown to moderate PR and TRU. In order to increase patients' BI, OMW providers need further innovations to improve patients' TRU and reduce their PR.
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Affiliation(s)
- Yuan Tang
- The School of Management and Economics, University of Electronic Science and Technology of China, Chengdu 611731, China.
- School of Management, Sichuan University of Science & Engineering, Zigong 643000, China.
| | - Yu-Tao Yang
- School of Economics and Management, Harbin Institute of Technology, Weihai 264200, China.
| | - Yun-Fei Shao
- The School of Management and Economics, University of Electronic Science and Technology of China, Chengdu 611731, China.
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Del Giudice P, Bravo G, Poletto M, De Odorico A, Conte A, Brunelli L, Arnoldo L, Brusaferro S. Correlation Between eHealth Literacy and Health Literacy Using the eHealth Literacy Scale and Real-Life Experiences in the Health Sector as a Proxy Measure of Functional Health Literacy: Cross-Sectional Web-Based Survey. J Med Internet Res 2018; 20:e281. [PMID: 30381283 PMCID: PMC6246968 DOI: 10.2196/jmir.9401] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/28/2018] [Accepted: 07/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The eHealth Literacy Scale (eHEALS) is a tool for the self-assessment of perceived comfort and skills in using the internet as a source for health-related information. Although evidence exists of the reliability and construct and structural validity of the scale, there is a lack of evidence in relation to what is proposed by Norman and Skinner in their theoretical lily model of eHealth literacy; in particular it is not clear whether having a higher level of health literacy can positively influence electronic health (eHealth) literacy as measured by the eHEALS. OBJECTIVE Our study aim was to assess whether real-life experiences from studying or working in the health field, as a proxy of higher functional health literacy, correlate with self-referred eHealth literacy as measured by the eHEALS. METHODS A Web-based survey was conducted among adults living in Northeast Italy using an Italian version of the eHEALS (IT-eHEALS). In order to be able to measure the effect of higher functional health literacy on eHealth literacy, we divided our sample into two groups, respectively characterized by studying or working experience in the health sector and by lack thereof. Mean differences between eHEALS were calculated using t test and effect size evaluated using Cohen d. To ensure the validity of the IT-eHEALS, we evaluated its psychometric properties (internal consistency and dimensionality) and construct validity (by evaluating its correlation with respondents age, gender, educational attainment, self-rated health, use of internet for health-related purposes, and working status). RESULTS A total of 868 respondents that completed the IT-eHEALS were included for analysis, of which 259 had working or studying experience in the health field. Mean (SD) eHEALS total score was 28.2 (6.2) for the whole sample, with statistically significant differences (P<.001) between the two groups, with the higher health literate group scoring significantly better (31.9 (5.9) vs 26.7 (5.6), respectively), with a standardized mean difference (Cohen d) of 0.9. Interestingly, we found a weak, yet significant, correlation between eHealth literacy and respondent characteristics for the higher health literate group only, as measured by positive Spearman correlation coefficients for age (0.11, P=.001), educational attainment (0.19, P=.002) and self-rated health (0.14, P=.024). Also, in line with current literature, correlation of eHEALS score with frequency of internet use for health-related purposes was significant for both groups (0.32, P<.001 and 0.15, P<.001 for higher and lower health literacy group, respectively). In our study we could not find any difference related to gender, while a significant difference for working status was only present when considering the sample as a whole (P=.03). CONCLUSIONS Our study demonstrates a sizeable effect of higher levels of functional health literacy on the eHEALS score, corroborating what was initially proposed by Norman and Skinner in the lily model of eHealth literacy.
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Affiliation(s)
| | - Giulia Bravo
- Department of Medicine, University of Udine, Udine, Italy
| | - Marco Poletto
- Department of Medicine, University of Udine, Udine, Italy
| | | | | | - Laura Brunelli
- Department of Medicine, University of Udine, Udine, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Udine, Italy
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Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a Transactional Model of eHealth Literacy: Concept Analysis. J Med Internet Res 2018; 20:e10175. [PMID: 30279155 PMCID: PMC6231800 DOI: 10.2196/10175] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | | | - JeeWon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Christine Stopka
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
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Paige SR, Miller MD, Krieger JL, Stellefson M, Cheong J. Electronic Health Literacy Across the Lifespan: Measurement Invariance Study. J Med Internet Res 2018; 20:e10434. [PMID: 29986848 PMCID: PMC6056742 DOI: 10.2196/10434] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan. Objective The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds). Methods Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, Δχ2=P>.05, ΔCFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001). Results Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, Δχ2=P>.05, ΔCFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001). Conclusions The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users’ awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth.
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Affiliation(s)
- Samantha R Paige
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States.,STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - M David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, Gainesville, FL, United States
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States.,Department of Advertising, University of Florida, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States
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Dou K, Yu P, Deng N, Liu F, Guan Y, Li Z, Ji Y, Du N, Lu X, Duan H. Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test. JMIR Mhealth Uhealth 2017; 5:e177. [PMID: 29212629 PMCID: PMC5738544 DOI: 10.2196/mhealth.7886] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. OBJECTIVE The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. METHODS Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. RESULTS The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. CONCLUSIONS This study developed a theoretical model to predict patients' acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients' awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community.
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Affiliation(s)
- Kaili Dou
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ping Yu
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Ning Deng
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Fang Liu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - YingPing Guan
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhenye Li
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yumeng Ji
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ningkai Du
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xudong Lu
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Efthymiou A, Middleton N, Charalambous A, Papastavrou E. The Association of Health Literacy and Electronic Health Literacy With Self-Efficacy, Coping, and Caregiving Perceptions Among Carers of People With Dementia: Research Protocol for a Descriptive Correlational Study. JMIR Res Protoc 2017; 6:e221. [PMID: 29133284 PMCID: PMC5703980 DOI: 10.2196/resprot.8080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 11/16/2022] Open
Abstract
Background In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers’ needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored. Objective The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions. Methods A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer’s associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures. Results As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017. Conclusions Carers’ eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers’ perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers’ eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research.
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Affiliation(s)
- Areti Efthymiou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Department of Nursing, Faculty of Health Sciences, University of Turku, Turku, Finland
| | - Evridiki Papastavrou
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Abstract
The concept of electronic health (eHealth) literacy evolved from the social and information sciences and describes competencies necessary to use electronic health services. As it is a rather new topic, and as there is no current overview of the state of the art in research, it is not possible to identify research gaps. Therefore, the objective of this viewpoint article is to increase knowledge on the current state of the art of research in eHealth literacy and to identify gaps in scientific research which should be focused on by the research community in the future. The article provides a current viewpoint of the concept of eHealth literacy and related research. Gaps can be found in terms of a missing "gold standard" regarding both the definition and the measurement of eHealth literacy. Furthermore, there is a need for identifying the implications on eHealth developers, which evolve from the measurement of eHealth literacy in eHealth users. Finally, a stronger inclusion of health professionals, both in the evolving concept and in the measurement of eHealth literacy, is needed in the future.
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Affiliation(s)
- Lena Griebel
- a Chair of Medical Informatics , Friedrich-Alexander University Erlangen-Nürnberg , Erlangen, Germany
| | - Heidi Enwald
- b Information Studies , University of Oulu , Oulu, Finland.,c Information Studies , Åbo Akademi University , Turku, Finland
| | - Heidi Gilstad
- d Health Informatics Research Group, Faculty of Medicine , NTNU The Norwegian University of Science and Technology , Trondheim, Norway
| | - Anna-Lena Pohl
- e Institute for eHealth and Management in HealthCare , Flensburg University of Applied Sciences , Flensburg, Germany
| | - Julia Moreland
- f Social Sciences , University of the Highlands and Islands, Moray College UHI , Elgin, Scotland
| | - Martin Sedlmayr
- a Chair of Medical Informatics , Friedrich-Alexander University Erlangen-Nürnberg , Erlangen, Germany
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Clarke MA, Moore JL, Steege LM, Koopman RJ, Belden JL, Canfield SM, Kim MS. Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients' information needs. Inform Health Soc Care 2017; 43:248-263. [PMID: 28398094 DOI: 10.1080/17538157.2017.1297305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS). METHOD We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. RESULTS Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. DISCUSSION This study was able to identify primary care patients' information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. PRACTICE IMPLICATIONS The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.
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Affiliation(s)
- Martina A Clarke
- a Department of Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Joi L Moore
- b School of Information Science and Learning Technologies, University of Missouri , Columbia , MO , USA.,f Informatics Institute, University of Missouri , Columbia , MO , USA
| | - Linsey M Steege
- c School of Nursing, University of Wisconsin , Madison , WI , USA
| | - Richelle J Koopman
- d Department of Family and Community Medicine , University of Missouri , Columbia , MO , USA
| | - Jeffery L Belden
- d Department of Family and Community Medicine , University of Missouri , Columbia , MO , USA.,f Informatics Institute, University of Missouri , Columbia , MO , USA
| | - Shannon M Canfield
- d Department of Family and Community Medicine , University of Missouri , Columbia , MO , USA
| | - Min S Kim
- e Department of Health Management and Informatics , University of Missouri , Columbia , MO , USA.,f Informatics Institute, University of Missouri , Columbia , MO , USA
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Lennon MR, Bouamrane MM, Devlin AM, O'Connor S, O'Donnell C, Chetty U, Agbakoba R, Bikker A, Grieve E, Finch T, Watson N, Wyke S, Mair FS. Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom. J Med Internet Res 2017; 19:e42. [PMID: 28209558 PMCID: PMC5334516 DOI: 10.2196/jmir.6900] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/08/2016] [Accepted: 01/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale.
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Affiliation(s)
- Marilyn R Lennon
- Digital Health and Wellness Group, Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matt-Mouley Bouamrane
- Digital Health and Wellness Group, Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Alison M Devlin
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Siobhan O'Connor
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Catherine O'Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ula Chetty
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Agbakoba
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Annemieke Bikker
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK, United Kingdom
| | - Tracy Finch
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne NE2 4AX, United Kingdom
| | - Nicholas Watson
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sally Wyke
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Seçkin G, Yeatts D, Hughes S, Hudson C, Bell V. Being an Informed Consumer of Health Information and Assessment of Electronic Health Literacy in a National Sample of Internet Users: Validity and Reliability of the e-HLS Instrument. J Med Internet Res 2016; 18:e161. [PMID: 27400726 PMCID: PMC4960406 DOI: 10.2196/jmir.5496] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/01/2016] [Accepted: 05/05/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The Internet, with its capacity to provide information that transcends time and space barriers, continues to transform how people find and apply information to their own lives. With the current explosion in electronic sources of health information, including thousands of websites and hundreds of mobile phone health apps, electronic health literacy is gaining an increasing prominence in health and medical research. An important dimension of electronic health literacy is the ability to appraise the quality of information that will facilitate everyday health care decisions. Health information seekers explore their care options by gathering information from health websites, blogs, Web-based forums, social networking websites, and advertisements, despite the fact that information quality on the Internet varies greatly. Nonetheless, research has lagged behind in establishing multidimensional instruments, in part due to the evolving construct of health literacy itself. OBJECTIVE The purpose of this study was to examine psychometric properties of a new electronic health literacy (ehealth literacy) measure in a national sample of Internet users with specific attention to older users. Our paper is motivated by the fact that ehealth literacy is an underinvestigated area of inquiry. METHODS Our sample was drawn from a panel of more than 55,000 participants maintained by Knowledge Networks, the largest national probability-based research panel for Web-based surveys. We examined the factor structure of a 19-item electronic Health Literacy Scale (e-HLS) through exploratory factor analysis (EFA) and confirmatory factor analysis, internal consistency reliability, and construct validity on sample of adults (n=710) and a subsample of older adults (n=194). The AMOS graphics program 21.0 was used to construct a measurement model, linking latent factors obtained from EFA with 19 indicators to determine whether this factor structure achieved a good fit with our entire sample and the subsample (age ≥ 60 years). Linear regression analyses were performed in separate models to examine: (1) the construct validity of the e-HLS and (2) its association with respondents' demographic characteristics and health variables. RESULTS The EFA produced a 3-factor solution: communication (2 items), trust (4 items), and action (13 items). The 3-factor structure of the e-HLS was found to be invariant for the subsample. Fit indices obtained were as follows: full sample: χ(2) (710)=698.547, df=131, P<.001, comparative fit index (CFI)=0.94, normed fit index (NFI)=0.92, root mean squared error of approximation (RMSEA)=0.08; and for the older subsample (age ≥ 60 years): χ(2) (194)=275.744, df=131, P<.001, CFI=0.95, NFI=0.90, RMSEA=0.08. CONCLUSIONS The analyses supported the e-HLS validity and internal reliability for the full sample and subsample. The overwhelming majority of our respondents reported a great deal of confidence in their ability to appraise the quality of information obtained from the Internet, yet less than half reported performing quality checks contained on the e-HLS.
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Affiliation(s)
- Gül Seçkin
- University of North Texas, Denton, TX, United States.
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