The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study

Digital Health Literacy: A systematic review of interventions and their influence on healthcare access and sustainable development Goal-3 (SDG-3)

This study explores how interventions focused on digital health literacy (DHL) can improve access to healthcare and contribute to achieving Sustainable Development Goal-3 (SDG- 3). We scrutinized information from PubMed (MEDLINE), Scopus, and Web of Science released search articles from March 1, 2020 to January 31, 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review concentrated only on experimental studies that assessed how DHL initiatives have influenced enhancing patient health outcomes and access to healthcare. Research that did not cover DHL or the availability of healthcare, was not included. The analysis was primarily qualitative, focusing on thematic patterns and insights rather than statistical outcomes. Our results showed that DHL interventions typically result in enhanced health literacy, improved medication adherence, and higher self-confidence, particularly benefiting marginalized communities. Limitations to safe & accessible healthcare underscore the need for more focused and culturally appropriate strategies. This review shows that interventions by DHL can greatly enhance healthcare results, highlighting the need to tackle inequalities to ensure marginalized communities also benefit.

Attitudes Toward Psychotherapeutic Treatment and Health Literacy in a Large Sample of the General Population in Germany: Cross-Sectional Study

BACKGROUND

Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area.

OBJECTIVE

This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored.

METHODS

A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ≥16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales ("positive attitudes" and "non-acceptance of society"), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy.

RESULTS

More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=-0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=-0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t1260.12=-10.40, P<.001, Cohen d=-0.49; t1050.95=3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t1912.06=-5.66, P<.001, Cohen d=-0.26; t1926=4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t1992=-3.60, P<.001, Cohen d=-0.16), younger age (r=-0.11, P<.001), higher subjective social status (F2,1991=5.25, P=.005, η2=.005), and higher levels of education (F2,1983=22.27, P<.001, η2=.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t1994=5.29, P<.001, Cohen d=0.24), younger age (r=-0.08, P<.001), and lower subjective social status (F2,1993=7.71, P<.001, η2=.008) were associated with higher perceived nonacceptance of psychotherapy.

CONCLUSIONS

Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior.

Revealing schoolchildren's key situations in the use of digital media inside and outside school: A media diary study

INTRODUCTION

Digital media have become integral to schoolchildren's lives, both within educational and non-educational settings. Educators emphasize the importance of bridging the gap between school learning and children's out-of-school activities. To identify potential variations and commonalities, we investigated key situations with digital media among lower secondary schoolchildren in Germany, aiming to determine which themes are especially relevant in different settings.

METHODS

We analyzed the media usage of German schoolchildren (ages 10 to 17) in class and outside of school using a mixed-method approach with a focus on the qualitative facets of key situations. For this purpose, 49 schoolchildren from seven schools were asked to complete media diaries. Over a six-week period, they documented key situations with details on setting, emotional experiences, post-communication, social support, and self-reflection. We analyzed the key situations using content and frequency analyses.

RESULTS

The schoolchildren reported 145 key situations, from which we developed a categorization system comprising 15 distinct categories. The most reported key situations involved "playing video games", "digital learning or homework", and "online communication or content sharing". Most key situations (115) took place outside of school, while 30 occurring in class. Schoolchildren mostly reported key situations that involved feelings of happiness and low levels of arousal. They discussed key situations more often and in greater depth with family members and school friends, and less often with school staff or non-school friends. Key situations were discussed more often face-to-face than online. Notably, schoolchildren engaged in self-reflection on their key situations, including concerns about excessive media use.

DISCUSSION

Overall, the study provides comprehensive insights into the digital media behaviors of schoolchildren, highlighting individual differences and preferences. The discussion offers valuable implications for both educational practice and future research, particularly regarding the integration of digital media into formal educational settings.

Feasibility of Employing mHealth in Delivering Preventive Nutrition Interventions Targeting the First 1000 Days of Life: Experiences from a Community-Based Cluster Randomised Trial in Rural Bangladesh

BACKGROUND/OBJECTIVES

An Android platform-based customised app and web-linked system was developed to aid in implementing selected nutrition interventions by community health workers (CHWs) in a community-based cluster randomised trial (c-RCT) in rural Bangladesh.

METHODS

Here, we describe the architecture of the intervention delivery system, and explore feasibility of employing mHealth as CHWs' job aid, employing a mixed-method study design covering 17 visits per mother-child dyad. We analysed CHWs' real-time visit information from monitoring and documentation data, and CHWs' qualitative interviews to explore the advantages and barriers of using mHealth as a job aid.

RESULTS

Intervention coverage was high across the arms (>90%), except around the narrow perinatal period (51%) due to mothers' cultural practice of moving to their parents' homes and/or hospitals for childbirth. CHWs mentioned technical and functional advantages of the job aid including device portability, easy navigability of content, pictorial demonstration that improved communication, easy information entry, and automated daily scheduling of tasks. Technical challenges included charging tablets, especially in power cut-prone areas, deteriorated battery capacity over continuous device usage, unstable internet network in unsupportive weather conditions, and device safety. Nevertheless, onsite supervision and monitoring by expert supervisors remained important to ensure intervention quality.

CONCLUSIONS

With appropriate training and supervision, CHWs utilised the tablet-based app proficiently, attaining high coverage of long-term visits. mHealth was thus useful for designing, planning, scheduling, and delivering nutrition interventions through CHWs, and for monitoring and supervision by supervisors. Therefore, this application and job aid can be adopted or replicated into the currently developing national health systems platform for improving coverage and quality of preventive maternal and child nutrition services. In addition, continuous supportive supervision by skilled supervisors must be accompanied to ensure CHWs' task quality. Finally, future studies should rigorously assess undesirable health and environmental effects of mHealth before and after mainstreaming, effective interventions addressing device-induced health hazards should be designed and scaled up, and effective e-waste management must be ensured.

Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review

Adolescent health literacy is critical for navigating the complex landscape of modern healthcare and making informed decisions that influence long-term health outcomes. This comprehensive review synthesizes current research on integrating digital tools and interactive learning approaches to enhance health literacy among adolescents. We explore the use of digital technologies, such as mobile apps and virtual reality, which cater to the preferences of this tech-savvy generation, offering personalized and accessible health information. The effectiveness of interactive learning methodologies, including simulations and role-playing, is also examined, highlighting their potential to increase engagement and retention of health-related knowledge. We address the importance of mental health literacy and the role of social media and peer education in disseminating health information effectively. Our review identifies gaps in the current literature, particularly the need for studies that consider long-term outcomes and the impact of socioeconomic and cultural factors on health literacy initiatives. We propose a multidimensional approach to health literacy education that incorporates innovative technologies and interactive methods to meet the diverse needs of adolescents in various contexts. The findings suggest that an integrated approach, including digital and critical health literacy, is essential for developing comprehensive health education programs that are both informative and engaging for adolescents.

Get Health'e': A Pilot Test of a Digital Health Literacy Intervention for Young Adults

BACKGROUND

Young adults face a number of health concerns and are typically beginning to manage their health on their own. At the same time, this age group is more connected to digital technology than ever before, and studies show that young adults can struggle with digital health literacy skills.

OBJECTIVE

The online Get Health'e' Program consists of six modules addressing digital health literacy skills, including topics such as internet searches and social media. This study evaluates the program based on a usability and pilot study.

METHODS

Recruited participants ranged in age from 18 to 24 years and were predominantly White women. After an eligibility screening, half of the participants were randomly assigned to the program group. All 131 participants were administered two surveys, 2 weeks apart; the program group had access to the program for that week. Survey questions included demographics, the eHealth Literacy Scale (eHEALS), and six sets of five multiple-choice questions assessing digital health knowledge.

KEY RESULTS

Both groups showed an improvement of 1.0 points on the eHEALS scale, but a repeated measures analysis comparing scores for the program and control groups indicated no significant difference in score improvement between the two groups, F(1, 129) = 0.003, p = .96. The program group had an average improvement in quiz scores (from pre to post) from 1.6 to 2.3 which was better than score improvement in the control group across the six modules. The majority of participants in the program group found the program to be useful (67.2%) and informative (59.4%), and 93.8% said they would recommend it to someone they know.

CONCLUSIONS

The Get Health'e' program was well received by participants and led to an increase in digital health knowledge. Programs like this have the potential to raise awareness among youth about how to access and evaluate health information online. [HLRP: Health Literacy Research and Practice. 2024;8(4):e224-e235.].

Digital health literacy, behavior and knowledge of adolescents for hand hygiene during the COVID-19 pandemic

OBJECTIVE

to investigate factors associated with digital health literacy, hand hygiene knowledge and behavior among Brazilian adolescents during the COVID-19 pandemic.

METHOD

cross-sectional study with 473 adolescents aged 15 to 19. Data were collected virtually between June and August 2021 through a questionnaire on sociodemographic characteristics, digital health literacy, knowledge and behavior regarding hand hygiene. Variables were adjusted using multiple linear regression models with normal response.

RESULTS

the average digital health literacy score was 29.89 ±5.30; for hand hygiene knowledge and behavior was 13.1 ±1.5 and 11.1±2.7, respectively. Higher knowledge and behavior scores for hand hygiene were associated with having completed high school, compared to those attending college, among those who attend health courses, seek information about the pandemic and in scientific articles. Higher digital health literacy scores in adolescents who did not wear masks when playing sports (p= 0.017). There was an association between digital health literacy and knowledge (p = 0.000) and behavior (p = 0.000) regarding hand hygiene.

CONCLUSION

there is an association between higher digital health literacy scores and hand hygiene knowledge and behavior.

Teaching methods for critical thinking in health education of children up to high school: A scoping review

According to the World Health Organization, the improvement of people's health literacy is one of the fundamental public health challenges in the 21st century. The key issue in teaching health literacy is to develop critical thinking skills. As health literacy and critical thinking should be developed at school age, we reviewed teaching methods or educational interventions used in empirical studies focused on the development of critical thinking regarding health and implemented by teachers in preschools, primary schools, or secondary schools. We searched seven databases (Medline, Embase, Web of Science, ERIC, ProqQuest, PsycArticles, and CINAHL) from inception to 20 September 2023 for any type of empirical studies. Due to the heterogeneity in interventions and inadequate reporting of results, a descriptive synthesis of studies was performed in addition to quantitative analysis. Of the 15919 initial records, 115 studies were included in the review. Most of the educational interventions focused on lifestyle-related health issues such as substance use, sexual and reproductive health, and nutrition. The popularity of health issues changed over time and depended on the geographical context. Six dimensions that differentiated the teaching methods were identified: central teaching component, central educator, pupils' activity level, teaching context, educational materials, and significance of critical thinking. Many educational interventions did not address the development of critical thinking skills in a comprehensive manner, and the significance of critical thinking varied greatly. Interventions in which critical thinking had high and very high significance applied mainly problem-solving methods and involved pupils' activity. The evidence on the effectiveness of the teaching methods that develop critical thinking is limited because most articles failed to provide detailed information on the teaching methods or did not examine their effects. We recommend that a checklist is developed to facilitate a detailed description of health educational interventions and thus promoting their replicability. Study registration: The protocol of the review was registered in the OSF Registries on 13 January 2022 (doi: https://doi.org/10.17605/OSF.IO/46TEZ).

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study

BACKGROUND

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm.

OBJECTIVE

This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions.

METHODS

Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions.

RESULTS

Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition).

CONCLUSIONS

Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Psychometric evaluation of the Chinese version of the media Health Literacy Questionnaire: A validation study

Background

The media play an important role in health promotion and disease prevention, while at the same time, a variety of mixed health messages in the media are beginning to pose new challenges to them. However, there is a lack of media health literacy (MHL) assessment tools in China. Therefore, the purpose of this study was to translate the Media Health Literacy (MeHLit) questionnaire into Chinese and to assess its psychometric properties.

Methods

This cross-sectional study was conducted from October to December 2022, and a methodological study of the translation and validation of the MeHLit questionnaire was conducted.

Results

As a result of an extensive translation and cultural adaptation process, the final MeHLit questionnaire was developed, which includes five dimensions and 21 items. Cronbach's α value of the questionnaire was 0.859, and Cronbach's α value of the dimensions ranged from 0.776 to 0.911, which is fairly good. As a result, the test-retest reliability coefficient and the split-half reliability coefficient of the questionnaire are both equal to 0.907. Its content validity index was 0.946, suggesting a reasonable level of content validity. Through exploratory factor analysis, a five-factor structure was identified based on the eigenvalues, total variance explained, and scree plot. As a result of the validation factor analysis, all recommended fit indicators were appropriate.

Conclusion

The Chinese version of the MeHLit questionnaire has been successfully introduced in China. It has shown good psychometric properties among the Chinese public and can be used as a tool to evaluate MHL in health screening.