Association of eHealth Use, Literacy, Informational Social Support, and Health-Promoting Behaviors: Mediation of Health Self-Efficacy

Effectiveness of Topic-Based Chatbots on Mental Health Self-Care and Mental Well-Being: Randomized Controlled Trial

BACKGROUND

The global surge in mental health challenges has placed unprecedented strain on health care systems, highlighting the need for scalable interventions to promote mental health self-care. Chatbots have emerged as promising tools by providing accessible, evidence-based support. While chatbots have shown promise in delivering mental health interventions, most studies have only focused on clinical populations and symptom reduction, leaving a critical gap in understanding their preventive potential for self-care and mental health literacy in the general population.

OBJECTIVE

This study evaluated the effectiveness of a rule-based, topic-specific chatbot intervention in improving self-care efficacy, mental health literacy, self-care intention, self-care behaviors, and mental well-being immediately after 10 days and 1 month of its use.

METHODS

A 2-arm, assessor-blinded randomized controlled trial was conducted. A total of 285 participants were randomly assigned to the chatbot intervention group (n=140) and a waitlist control group (n=145). The chatbot intervention consisted of 10 topic-specific sessions targeting stress management, emotion regulation, and value clarification, delivered over 10 days with a 7-day free-access period. Primary outcomes included self-care self-efficacy, behavioral intentions, self-care behaviors, and mental health literacy. Secondary outcomes included depressive symptoms, anxiety symptoms, and mental well-being. Assessments were self-administered on the web at baseline, 10 days after the intervention, and at a 1-month follow-up. All outcomes were analyzed using linear mixed models with an intention-to-treat approach, and effect sizes were calculated using Cohen d.

RESULTS

Participants in the chatbot group demonstrated significantly greater improvements in behavioral intentions (F2,379.74=15.02; P<.001) and mental health literacy (F2,423.57=4.27; P=.02) compared to the control group. The chatbots were also able to bring significant improvement in self-care behaviors (Cohen d=0.36, 95% CI 0.08-0.30; P<.001), mindfulness (Cohen d=0.37, 95% CI 0.14-0.38; P<.001), depressive symptoms (Cohen d=-0.26, 95% CI -1.77 to -0.26; P=.004), overall well-being (Cohen d=0.22, 95% CI 0.02-0.42; P=.02), and positive emotions (Cohen d=0.28, 95% CI 0.08-0.54; P=.004) after 10 days. However, these improvements did not differ significantly at 1 month when compared to the waitlist control group. Adherence was higher among participants who received push notifications (t138=-4.91; P<.001).

CONCLUSIONS

This study highlights the potential of rule-based chatbots in promoting mental health literacy and fostering short-term self-care intentions. However, the lack of sustained effects points to the necessary improvements required in chatbot design, including greater personalization and interactive features to enhance self-efficacy and long-term mental health outcomes. Future research should explore hybrid approaches that combine rule-based and generative artificial intelligence systems to optimize intervention effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05694507; https://clinicaltrials.gov/ct2/show/NCT05694507.

Virtual eating disorder support group utilization is associated with lower eating disorder symptoms and multiple types of social support

Support groups are a promising resource, but eating disorder (ED) support group research is scarce. This study aimed to examine associations between support group utilization, psychosocial health, and ED symptoms to guide future research on this resource. Participants (N = 494) were sampled from virtual, clinician-moderated ED support groups. Benjamini-Hochberg-corrected partial correlations tested associations of past-month attendance and participation frequency with measures of psychosocial health and ED symptoms. Participants additionally completed descriptive questions regarding perceived support group benefits. Adjusting for past-month ED treatment, more frequent support group participation was positively related to social companionship and emotional and informational support. More frequent attendance was negatively related to body dissatisfaction, binge eating, purging, restricting, excessive exercise, and negative attitudes toward obesity, but these associations were no longer significant after adjusting for psychosocial health variables. Descriptively, one-third to one-half of participants reported various positive changes from support group utilization. Utilizing and participating in clinician-moderated ED support groups could provide a low-burden outlet for ED symptom management, which may be due to provision of social support. Prospective examination of observed associations is a critical next step to investigate outcomes directly and build a testable model of group processual factors.

Association of Health Information Literacy and Health Outcomes Among Individuals with Type 2 Diabetes and Metabolic Syndrome

Objectives: Based on social cognitive theory, this study aims to explore the associated factors of and whether and how health information literacy was correlated to health behavior and glycemic control among individuals with type 2 diabetes and metabolic syndrome. Methods: Following convenient sampling, this cross-sectional, correlational study was conducted among 225 patients with type 2 diabetes and metabolic syndrome from an outpatient clinic in a suburban area of Beijing, China. Hierarchical multiple regression and mediation analysis were performed to explore the effect of health information literacy on self-management practice and hemoglobin A1c in this sample. The STROBE guidelines for cross-sectional studies were followed. Results: The findings showed incompetent health information literacy, inadequate self-management behavior, and suboptimal glycemic control in a sample of patients with type 2 diabetes and metabolic syndrome. Based on social cognitive theory, the results of regression analysis indicated that self-management attitude, health problem-solving, and chronic illness resources were correlated with self-management practice, and health problem-solving and health information evaluation were correlated with hemoglobin A1c. Mediation analysis revealed that self-management attitude, health problem-solving, and chronic disease resources fully mediated the effect of health information literacy on self-management practice. There was an indirect effect of health information literacy on hemoglobin A1c through health problem-solving. Conclusions: The findings demonstrated that health information literacy has significant indirect and direct effects on self-management behavior and glycemic control through self-management attitude, health problem-solving, and chronic disease resources in a sample of patients with type 2 diabetes and metabolic syndrome.

Attitudes of German General Practitioners Toward eHealth Apps for Dementia Risk Reduction: Qualitative Interview Study

BACKGROUND

eHealth interventions constitute a promising approach to disease prevention, particularly because of their ability to facilitate lifestyle changes. Although a rather recent development, eHealth interventions might be able to promote brain health and reduce dementia risk in older adults.

OBJECTIVE

This study aimed to explore the perspective of general practitioners (GPs) on the potentials and barriers of eHealth interventions for brain health. Understanding the perspective of GPs allows us to identify chances and challenges for implementing eHealth apps for dementia risk reduction.

METHODS

We conducted semistructured expert interviews with 9 GPs working in an outpatient setting in and near Leipzig, Germany. Data were fully transcribed and analyzed using a process model of qualitative content analysis with codes and categories being constructed inductively and deductively.

RESULTS

We found generally favorable but balanced views of eHealth apps for brain health. Eight themes were identified and elaborated on in the data as follows: "addressing dementia," "knowledge about dementia," "need for information," "potential for prevention," "chances for apps for prevention," "development of apps for prevention," and "barriers of apps for prevention." GPs talked mostly about how and when to address dementia and the requirements for their use of eHealth apps for dementia prevention. GPs stated that they only addressed dementia once abnormalities were already present or less frequently when a patient or relative expressed a direct wish, while individual dementia risk or standardized diagnostic during routine check-ups were mentioned much less frequently. According to GPs, knowledge about dementia in patients was low; therefore, patients expressed little need for information on dementia risk factors and prevention in GP practices. Most patients wished for quick information regarding diagnostics, treatment options, and progression of the disease. GPs mentioned a lack of overview of the available eHealth apps and their content. They also expressed a fear of inducing health anxiety when talking to patients about risk factors and prevention.

CONCLUSIONS

GPs want patients to receive relevant and individualized information. Prerequisites for the use of eHealth apps for dementia prevention were app characteristics related to design and content. GPs need to address dementia more routinely, assess relevant risk factors, and aid patients in a preventive role. Concerns were expressed over limited effectiveness, overwhelming patients, limited use in clinical practice, and only targeting patients with an already low risk of dementia.

Multi-Level Factors Influencing eHealth Literacy Among Chinese Older Adults: A Longitudinal Study

AIMS

Based on the socio-ecological model, the present study examined influencing factors of eHealth literacy among Chinese older adults at individual-level (e.g., socio-demographics, Internet use, and health status), interpersonal (e.g., informational support and instrumental support), and community-level (e.g., available public facilities).

DESIGN

A longitudinal study was conducted among 611 Chinese older adults aged 55 or over.

METHODS

From February to December 2022, older people's eHealth literacy was collected at baseline, 3-month and 6-month follow-up surveys and other variables were collected only at baseline, using online questionnaires.

RESULTS

Among 611 participants, 464 (75.9%) completed both follow-up surveys. At the individual level, participants who were older, female gender, rural residents, living alone, had lower education, occupational levels and income, and had chronic conditions and long-term medication showed lower eHealth literacy. Older adults with longer Internet use history, online health information seeking, more frequent health-related Internet use, higher self-rated Internet skills and positive perceptions towards online health information exhibited higher eHealth literacy over time. In terms of interpersonal and community-level factors, perceiving informational and instrumental support when using digital health, and having access to health facilities (e.g., health education) and technological training provided by the community could predict older individuals' higher eHealth literacy over time, after adjusting for covariates.

CONCLUSION

Older people's eHealth literacy can be influenced by factors at individual, interpersonal, and community levels.

IMPLICATIONS AND IMPACT

This longitudinal study identified significant factors influencing older individuals' eHealth literacy at different levels. Understanding unmodifiable factors at the individual level can help identify the subgroups that may need targeted support and interventions for promoting eHealth literacy. Furthermore, findings can guide tailored interventions to improve eHealth literacy through modifiable factors at the technological, interpersonal and community levels.

REPORTING METHOD

Adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Prospective relationship between electronic health literacy and health-promoting lifestyle among Chinese older adults: A three-wave longitudinal study

BACKGROUND

Improving older people's health-promoting lifestyle (HPL) may slow the progression of health conditions and improve quality of life. Electronic health (eHealth) literacy is increasingly important for individuals managing health in the digital age. Previous cross-sectional studies have shown a positive association between eHealth literacy and HPL among older adults. However, no longitudinal studies have examined the association over time, their temporal relationship, and the potential underlying mechanisms.

OBJECTIVES

To examine the longitudinal association and temporal relationship between eHealth literacy and HPL among older adults, and to explore their underlying mechanisms based on the Integrated Model of eHealth Use (iMeHU).

METHODS

This longitudinal study was conducted among older adults in Jiangxi Province, China, from February to November 2022. Data were collected at baseline (T1) and 3-month (T2) and 6-month follow-up (T3), using online self-reported questionnaires. Older people's eHealth literacy and HPL were measured using the Digital Health Literacy Instrument and Health-Promoting Lifestyle Profile-II. Statistical analyses included Linear mixed model (LMM), cross-lagged panel model (CLPM), longitudinal mediation analysis, and multi-group analysis.

RESULTS

611 participants were included at T1; 464 (75.9%) completed the follow-ups at T2 and T3. The LMM results suggested that older individuals with higher eHealth literacy levels showed better HPL over time (adjusted β = 0.31, 95%CI: 0.27-0.35, p < 0.001), after adjusting for covariates. CLPMs supported that eHealth literacy could predict older people's improved HPL subsequently, but not the reverse. Attitude towards eHealth mediated the relationship from eHealth literacy to improved HPL, with a mediated proportion of 17.2%. In addition, the prospective relationships were stronger and only significant in older patients.

CONCLUSIONS

From a longitudinal perspective, this study highlighted the important roles of eHealth literacy and attitude towards eHealth in improving older people's HPL, especially for the patients. The findings provide robust evidence and practical implications to develop targeted interventions.

Electronic Health Literacy and Self-Efficacy Among Primary and Middle School Students in China: A Moderated Mediated Analysis

BACKGROUND

The Internet has become a crucial tool for learning, socializing, and entertainment for contemporary minors, and plays an increasingly prominent role in their growth. However, it has been observed that students are often unable to make good judgments about online health information and barely use the Internet to help tackle their health problems. The purpose of this study was to determine the relationship between electronic health literacy (EHL) and general self-efficacy among Chinese primary and middle school students.

METHODS

A total of 1200 questionnaires were sent out, and 1085 effective questionnaires were received with effective recovery of 90.42%. First, we conducted a confirmatory factor analysis. Second, structural equation modeling (SEM) was used to explore the mechanisms underlying the relationship between EHL and general self-efficacy.

RESULTS

The results revealed a significant positive correlation between EHL and self-efficacy. The results of the CFA showed a good fit for the data. The results of SEM showed that the relationship between self-efficacy and health information applications was partially mediated by health information acquisition (β = 0.47, [Bias-Corrected 95%CI: 0.39, 0.59], [Percentile 95%CI: 0.37, 0.58]). Household factors moderated this mediating relationship (β = 0.4, [Bias-Corrected 95%CI: 0.19, 0.61], [Percentile 95%CI: 0.19, 0.61]).

CONCLUSIONS

Information acquisition was found to play a mediating role between self-efficacy and information application. Household factors moderated the indirect relationship between self-efficacy and information applications through information acquisition.

The level of electronic health literacy among older adults: a systematic review and meta-analysis

BACKGROUND

In the context of deeper integration of the internet and healthcare services, eHealth literacy levels have become an important predictor of public health outcomes and health-promoting behaviors. However, there is a lack of comprehensive understanding of eHealth literacy levels among older adults.

OBJECTIVE

To systematically assess the level of eHealth literacy among older adults.

METHODS

We conducted searches in MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (Sinomed) to collect survey studies on the eHealth literacy levels of the older adults, with a search timeframe from the establishment of the database to May 2024. The quality of the included literature was assessed using the Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS). Additionally, subgroup analysis and meta-regression were conducted to detect sources of heterogeneity. Funnel plots and Egger's test were used to assess publication bias.

RESULTS

A total of 48 relevant studies were included, including 45 cross-sectional, 2 cohort studies and 1 longitudinal study, comprising 33,919 older adults. The quality of the studies was all above moderate, with 10 high-quality publications. Meta-integration results showed that the eHealth literacy score of older adults was 21.45 (95% CI:19.81-23.08). Subgroup analysis showed that among the elderly population, females had lower eHealth literacy at 19.13 (95% CI:15.83-22.42), those aged 80 years and older had lower eHealth literacy at 16.55 (95% CI:11.73-21.38), and elderly individuals without a spouse and living alone had even lower eHealth literacy at 18.88 (95% CI:15.71-22.04) and 16.03 (95% CI:16.51-21.79). Based on region, eHealth literacy was lower among older adults in developing countries at 20.71 (95% CI:18.95-22.48). Meta-regression results indicate that sample size and region can significantly impact heterogeneity.

CONCLUSION

Our results found that the average eHealth literacy score of the elderly was 21.45, which was much lower than the passing level (≥ 32), suggesting that more attention should be paid to the eHealth literacy aspect of the elderly. Meanwhile, due to the limitation of the literature sources, the global representativeness of the results of this study still needs to be supported by more research data from other countries.

The effect of electronic health (eHealth) interventions for promoting physical activity self-efficacy in children: A systematic review and meta-analysis

Background/objective

Physical activity (PA) self-efficacy plays a crucial role in maintaining and enhancing PA behaviors in children. However, the effectiveness of eHealth interventions in boosting PA self-efficacy among children remains uncertain. Furthermore, which behavior change techniques (BCTs) used in eHealth interventions can positively influence children's PA self-efficacy needs further exploration for designing tailored eHealth interventions. Therefore, this systematic review and meta-analysis aimed to identify the effectiveness of eHealth interventions and BCTs in promoting children's PA self-efficacy.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across six databases (PubMed, Web of Science, EBSCOhost, Ovid, SPORTDiscus, PsycINFO) up to January 8, 2024. Inclusion criteria included randomized controlled trials (RCT), quasi-experimental, and two-group experiments that examined the effect of eHealth interventions on PA self-efficacy among healthy children aged 0-18 years. The Physiotherapy Evidence Database (PEDro) scale was utilized to assess the risk of bias. Random effects meta-analysis was performed to determine the effectiveness of eHealth interventions and BCTs in selected studies.

Results

Sixteen studies were screened, including 6020 participants with an average age of 11.58 years (SD = 2.87). The result showed small but significant intervention effects with high heterogeneity (I2 = 92.34 %) for postintervention PA self-efficacy (Hedges' g = 0.315; 95 % CI = 0.069, 0.562, p = .012). Two BCTs were significantly associated with enhanced PA self-efficacy: instruction on performing the behavior (p = .003) and behavior demonstration (p = .036). Additionally, studies that adopted social support (unspecified) a nd prompt/cues were significantly less effective than studies that did not use these BCTs (p = .001).

Conclusions

The findings showed that eHealth interventions positively affect children's PA self-efficacy. This review is the pioneer in focusing on BCTs in eHealth interventions for children. The insights gained provide valuable knowledge about tailored BCTs incorporated into eHealth interventions that promote children's PA self-efficacy.

Trial registration

International Prospective Register of Systematic Review (PROSPERO): CRD42024512058.

Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data

BACKGROUND

Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic.

OBJECTIVE

This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points.

METHODS

Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age.

RESULTS

For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking.

CONCLUSIONS

Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women.

Health Literacy and Self-Care in Patients with Chronic Illness: A Systematic Review and Meta-Analysis Protocol

Self-care plays a critical role in symptom recognition, management, and risk factor modification for patients with chronic illnesses. Despite its significance, self-care levels in this population are generally poor. Health literacy (HL) is pivotal for promoting effective self-care, yet the association across specific chronic illnesses remains fragmented and conflicting. Therefore, a systematic review and meta-analysis will be conducted. Inclusion criteria encompass quantitative studies involving adult patients with at least one chronic illness reporting on the association between a measure of HL and one or more elements of self-care behaviors as outcomes. Databases to be searched include PubMed, CINAHL, APA PsycINFO, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The studies will undergo risk of bias and certainty of evidence assessment using ROBINS-E and GRADE. Extracted data will include authors, publication date, aim(s), study location, design, sample characteristics, chronic illness type, study length, HL, and self-care measures. Understanding the link between HL and self-care can aid healthcare providers in implementing strategies to enhance health-promoting behaviors, contributing valuable insights to the scientific community and fostering nuanced discussions. This protocol ensures methodological transparency, stimulates discourse, and paves the way for informed interventions to improve overall health outcomes.

Understanding mHealth Adoption and Lifestyle Improvement: An Empirical Test of the Antecedents and Mediating Mechanisms

The potential of using mobile phones for health care service delivery has been well acknowledged. Despite that mobile health (mHealth) related research has proliferated in the past decade, mHealth is still in the fledgling stage with a low adoption rate. There is a research gap in understanding factors influencing mHealth adoption and examining the effects of mHealth use on health outcomes. The purpose of this study was thus to explore influential factors of mHealth use, and test mediation pathways through which mHealth use impacts healthy lifestyle behaviors (e.g. sleep, exercise, and social participation). Survey results from 432 online participants illustrate that performance expectancy, social influence, support conditions, and perceived reliability were significantly associated with mHealth use. However, the impact of effort expectancy on mHealth use was statistically nonsignificant. Moreover, the results indicate that mHealth use can not only contribute to the improvement of healthy lifestyle behaviors directly but also exert an impact through the mediating effect of health competence. Knowing what factors motivate people's mHealth use and how mHealth use contributes to lifestyle improvement can help trigger interventions to boost mHealth adoption and improve public health. Implications and limitations are discussed.

Pathways of Media Contact to Health Literacy in Middle-Aged and Older People: The Chain Mediation Effect of Perceived Social Support and Self-Efficacy

Objective

To understand the status of media exposure, social support, self-efficacy, and health literacy among middle-aged and older adults in China, and explore the impact path of media exposure on the health literacy of this population, providing a reference for promoting their physical and mental health.

Methods

From July to November 2022, a multi-stage random sampling method was employed to survey 16,938 Chinese middle-aged and older adults aged 46 and above. Structural equation modeling and statistical analysis were conducted using LISREL 8.8 and Mplus 8.3 software.

Results

The average score for media exposure among Chinese middle-aged and older adults was (18.55±5.36), perceived social support was (60.68±12.51), self-efficacy was (28.76±5.40), and health literacy was (35.49±6.05). Statistical results revealed that media exposure has a positive impact on the health literacy of middle-aged and older adults, with a direct effect of 0.091 (p < 0.001). Mediation analysis showed that media exposure can affect the health literacy of this population through the independent mediating effects of perceived social support (β = 0.013, p < 0.001) and self-efficacy (β = 0.029, p < 0.001), as well as through a chain mediation effect involving perceived social support and self-efficacy (β = 0.015, p < 0.001).

Conclusion

As a pathway for health information dissemination, media exposure plays a crucial role in the intervention of health literacy among middle-aged and older adults. Perceived social support and self-efficacy not only have independent mediating effects but also significant chain mediating effects in the relationship between media exposure and health literacy among this population. Therefore, improving the health literacy of middle-aged and older people can be popularized through media and improved in a multi-path, all-round, and precise way with the help of related technologies and social forces from which media literacy can be improved.

Factors associated with medication adherence among older adults with multimorbidity: A culture perspective

Multimorbidity is a healthcare concern. To manage diseases, older adults with multimorbidity are expected to practice health behaviors, particularly medication adherence. Studies have examined adherence issues in older patients with multiple diseases, but it remains unclear which factors affect medication adherence. Therefore, this study aimed to identify the factors affecting medication adherence among older adults with multimorbidity. The participants were recruited from the outpatient departments of two hospitals in the Republic of Korea using convenience sampling. Data were collected using structured questionnaires and analyzed using multiple regression analysis. The results showed that those with a lower education level, no side effects, better health literacy, higher medication self-efficacy, and more social support exhibited better medication adherence. In addition, beliefs about medication were not related to medication adherence. These results suggest that providing individualized education, strengthening social support, and decreasing harmful side effects can improve medication adherence.

The role of self-efficacy and self-care agency as mediating factors in the link between health literacy and health-promoting lifestyle among older adults post covid 19 era: A multiple mediator model

Health-promoting lifestyle is poor in older adults during COVID-19 pandemic. Elucidate the underlying mechanisms between health literacy and health-promoting lifestyle is important. Therefore, we investigated the mediating effect of self-efficacy and self-care agency in relation between health literacy and health-promoting lifestyle among older adults post covid 19 era. A cross-sectional descriptive survey on 200 older adults with the mean age of 68.3 were recruited from Lecai urban community in China, through convenience sampling. Information was assessed using Health literacy Assessment Scale for Infectious Diseases of Chinese Residents, the General Self Efficacy Scale, Chinese version of the Elderly Self-care Ability Scale, and the Health-Promoting Lifestyle Profile-Chinese Elderly. A serial multiple mediation modeling was tested using the PROCESS macro for SPSS to validate the pathways. Results indicated that positive correlations were found between health literacy, self-efficacy, self-care agency and health-promoting lifestyle in older adults. Meanwhile, health literacy was linked to enhanced health-promoting lifestyle through two pathways: (1) self-efficacy; (2) chain combination of self-efficacy and self-care agency. Self-efficacy and self-care agency mediated the relationship between health literacy and health-promoting lifestyle in older adults. Therefore, attention to improving self-efficacy, self-care agency and health literacy should be considered crucial for improving health-promoting lifestyle.

Personal Agency and Social Supports to Manage Health Among Non-Hispanic Black and Hispanic Men With Diabetes

The prevalence of type 2 diabetes (T2D) is increasing among non-Hispanic Black and Hispanic communities, especially among men who develop this chronic condition at earlier ages. Personal agency and social support are vital aspects to diabetes management. However, less is known about the relationship between these variables among men living with diabetes. The purposes of this study were to identify (1) levels of personal agency to manage health, (2) sources of social supports to manage health based on personal agency levels, and (3) factors associated with lower personal agency to manage health. Cross-sectional data from non-Hispanic Black (n = 381) and Hispanic (n = 292) men aged 40 years or older with T2D were collected using an internet-delivered questionnaire. Three binary logistic regression models were fitted to assess sociodemographics, health indicators, and support sources associated with weaker personal agency to manage health. About 68% of participants reported having the strongest personal agency relative to 32.1% reporting weaker personal agency. Men who relied more on their spouse/partner (odds ratio [OR] = 1.22, p = .025), coworkers (OR = 1.59, p = .008), or faith-based organizations (OR = 1.29, p = .029) for ongoing help/support to improve their health and manage health problems were more likely to have weaker personal agency. Conversely, men who relied more on their health care providers for ongoing help/support to improve their health and manage health problems were less likely to have weaker personal agency to manage health (OR = 0.74, p < .001). Findings suggest personal agency may influence men's support needs to manage T2D, which may also be influenced by cultural, socioeconomics, and the composition of social networks.

Effects of social support and self-efficacy on eHealth literacy in Korean women undergoing breast cancer treatment: A secondary analysis

Objective

Patients with breast cancer need to seek out and understand relevant health information to make informed decisions about long-term and complicated illnesses. With the increased use of interventions using online health information, research on eHealth literacy should be expanded. However, existing studies on the factors affecting eHealth literacy in patients with breast cancer are currently lacking. This study, therefore, conducts a secondary analysis of a previous study that surveyed the quality of life of patients with breast cancer. The primary study found a significant correlation between eHealth literacy, social support, and self-efficacy. In this secondary analysis study, we specifically examine eHealth literacy among patients with breast cancer undergoing treatment, and how patient demographic characteristics, breast cancer-specific self-efficacy, and social support contribute to their eHealth literacy.

Methods

A total of 143 women receiving outpatient treatment or were hospitalized for breast cancer at a cancer hospital in South Korea participated in the study from January to November 2022. The eHealth Literacy Scale (eHEALS), Multidimensional Social Support Scale, and Breast Cancer Survivors Scale were utilized in the analysis. The data were analyzed using a multiple regression analysis.

Results

Full-time employment (β ​= ​0.19, P ​= ​0.006), a monthly family income of over 4 million won (3600 USD) (β ​= ​0.14, P ​= ​0.042), completing a high school education (β ​= ​0.52, P ​< ​0.001), completing college level or higher education (β ​= ​0.54, P ​< ​0.001), age (β ​= ​-0.23, P ​= ​0.003), and social support (β ​= ​0.21, P ​= ​0.002) were predictors of eHealth literacy, explaining 40.2% of the total variance (F ​= ​14.63, P ​< ​0.001).

Conclusions

Social support was identified as a new factor influencing eHealth literacy among patients with breast cancer undergoing treatment. Therefore, nursing interventions to strengthen social support should be developed to improve eHealth literacy.

Associations between media use, self-efficacy, and health literacy among Chinese rural and urban elderly: A moderated mediation model

Objectives

The influence of media use on health literacy among urban and rural elderly has been unknown in China. This study aims to examine the association between media use and health literacy and to explore the mediating role of self-efficacy and the moderating role of urban-rural residency.

Methods

Based on the cross-sectional study of the Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022, a total of 4,070 Chinese old people aged 60 years and above were included. We adopted the simplified New General Self-Efficacy Scale (NGSES) and the simplified Health Literacy Scale-Short Form (HLS-SF) to measure self-efficacy and health literacy. Media use was measured using a self-administrated questionnaire.

Results

Results showed that Chinese urban elderly had a higher frequency of media use than rural ones in the aspects of social activities, self-presentation, social action, leisure and entertainment, information acquisition, and business transactions through media (P < 0.001). Among all participants, self-presentation (B = 0.217, 95% CI: 0.040, 0.394), leisure and entertainment (B = 0.345, 95% CI: 0.189, 0.502), and information acquisition (B = 0.918, 95% CI: 0.761, 1.076) were significantly associated with health literacy. Self-efficacy partially mediated the effect of media use on health literacy (Bindirect = 0.045, 95% CI: 0.032, 0.058), accounting for 18.37% of the total effect. Urban-rural residency (B = 0.049, 95% CI: 0.024, 0.075) moderated the relationship between media use and self-efficacy significantly.

Conclusion

The urban-rural gap in health literacy requires more attention. The promotion of media use and self-efficacy may play a role in eliminating health disparities.

Limitations

As a cross-sectional study, it could not establish cause-effect relationships.

The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis

BACKGROUND

With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors.

OBJECTIVE

To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis.

METHODS

The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale.

RESULTS

Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors.

CONCLUSIONS

Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.

Relationships among patient activation, social support and online health information seeking of community-dwelling older adults living with coronary heart disease

AIMS

To explore the relationship between patient activation (subjective initiative of patients to participate in disease management in self-health care), social support, self-efficacy and online health information seeking among older patients with coronary heart disease.

DESIGN

A cross-sectional and survey-based design.

METHODS

A total of 451 older patients with coronary heart disease were recruited from July to November 2021 from four communities in Qingdao, China. We collected data using the Patient Activation Measure, Social Support Rating Scale, Self-Efficacy Scale and Online Health Information Seeking Scale. We performed structural equation modelling to analyse the data.

RESULTS

The final model showed good model fit. Patient activation influenced online health information seeking directly (β  = .39, p  < .05) and indirectly through self-efficacy (β  = .17, p  < .05). Social support influenced online health information seeking directly (β  = .23, p  < .05) and indirectly through self-efficacy (β  = .03, p  < .05). Self-efficacy directly influenced online health information seeking (β  = .26, p  < .05).

CONCLUSIONS

We identified the interrelationships of patient activation, social support and self-efficacy and their influence on the online health information seeking of older patients with coronary heart disease. Our findings provide a theoretical basis for developing and evaluating interventions to enhance online health information seeking for older patients with coronary heart disease.

IMPACT

These findings add a better understanding of the relationship between patient activation, social support, self-efficacy and online health information seeking in older patients with coronary heart disease, and help community health workers to intervene in the early stage of disease diagnosis.

Understanding online health information seeking behavior of older adults: A social cognitive perspective

Introduction

Online health information seeking has been verified to play a crucial role in improving public health and has received close scholarly attention. However, the seeking behavior of older adults, especially the underlying mechanism through which they are motivated to seek health information online, remains unclear. This study addresses the issue by proposing a theoretical model leveraging social cognitive theory.

Methods

IT self-efficacy and IT innovativeness were identified as personal factors and professional support and social support were identified as environmental factors. We conducted a survey that included 347 older people in China and examined the research hypotheses with a structural equation model.

Results

IT self-efficacy and IT innovativeness facilitate older adults to seek health information online by increasing their perceived benefit of using the internet. Additionally, professional support and social support enhanced older adults' online seeking behavior by promoting their health awareness. We also found that perceived benefit displayed a stronger impact than health awareness on older adults' behavior related to searching for health information online.

Conclusion

This study reveals that IT self-efficacy, IT innovativeness, professional support, and social support will promote older adults to seek health information online by enhancing their health awareness and perceived benefit. The findings of this study provide significant theoretical and practical implications.

Association of social capital with self-perceived eHealth literacy among community-dwelling older people: Age and gender differences

Background

Studies have confirmed that social factors, including social capital and eHealth literacy, are important in later life. Currently, few studies are available for determining the relationship between social capital and eHealth literacy, and whether such a relationship exists among older people and there are age and gender differences in the relationship remain unclear. Consequently, this study aimed to investigate the association between social capital and eHealth literacy, specifically examing its variations in age and gender.

Methods

A cross-sectional study of 4,257 residents aged ≥ 60 years and dwelling in the community was conducted across four cities in China. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social capital, and eHealth literacy. Generalized linear models were employed to assess these associations.

Results

There were 4,218 respondents (age 71.9 ± 7.2 years; 64.8% women). Overall, social participation, social connection, trust, cohesion, and reciprocity were all statistically associated with eHealth literacy (p < 0.05), while such an association was not observed for social support (p > 0.05). Specifically, a higher level of social participation was associated with better eHealth literacy scores among participants aged 70-79 years (p < 0.001), and a higher level of social connection was associated with better eHealth literacy scores for those aged 60-69 and 70-79 years (p < 0.001). Meanwhile, no gender differences in the associations were found.

Conclusion

There is an association between social capital and eHealth literacy in older men and women. The association varis with age. The findings provide a reference for developing targeted measures to improve self-perceived eHealth literacy among older people. It is essential for achieving active and healthy aging and developing the knowledge and understanding of relevant theories, concepts, and evidence within the field of health and social capital.

Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review

Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.

Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis

BACKGROUND

Chronic non-communicable diseases (CNCDs) are an urgent public health issue in China, especially among older adults. Hence, self-management is crucial for disease progression and treatment. Electronic health (e-health) literacy and self-efficacy positively correlate with self-management. However, we know little about their underlying mechanisms in older adults with CNCDs.

OBJECTIVE

To explore the factors that influence chronic disease self-management (CDSM) and verify self-efficacy as the mediator between e-health literacy and self-management behavior in older patients with CNCDs.

METHODS

This cross-sectional study included 289 older patients with CNCDs from Hunan province, China, between July and November 2021. E-health literacy, self-efficacy, social support, and CDSM data were collected through questionnaires. The influence of each factor on CDSM was explored with multiple linear regression analysis. Intermediary effects were computed via a structural equation model.

RESULTS

The total CDSM score in the patients was 29.39 ± 9.60 and only 46 (15.92%) patients used smart healthcare devices. The regression analysis showed e-health literacy, self-efficacy, and social support were the factors that affected CDSM. Furthermore, the structural equation model revealed that self-efficacy directly affected CDSM (β = 0.45, P < 0.01), whereas e-health literacy affected it directly (β = 0.42, P < 0.01) and indirectly (β = 0.429, P < 0.01) through self-efficacy.

CONCLUSIONS

This study revealed that self-management among older patients with CNCDs is at a low level, and few of them use smart healthcare devices. Self-efficacy plays a partial intermediary role between e-health literacy and self-management in older patients with CNCDs. Thus, efforts to improve their CDSM by targeting e-health literacy may be more effective when considering self-efficacy.

The Association between Self-Rated Health and Health Self-Management Ability of Healthcare Undergraduates: The Chain Mediating Roles of eHealth Literacy and Resistance to Peer Influence

Health self-management is important for healthcare undergraduates who are at the late adolescent or early adulthood stage, and will play an important part in health promotion for the general population. Previous research has shown that perceived health status affects health self-management. However, few studies have uncovered the mechanism between self-rated health and health self-management among healthcare undergraduates. Based on social ecology theory and Pender's health promotion model, this study aimed to explore the associations between health self-management ability, self-rated health, eHealth literacy and resistance to peer influence of healthcare undergraduates, with a focus on identifying the mediating effects of eHealth literacy and resistance to peer influence. A cross-sectional study was conducted among 515 healthcare undergraduates in Eastern China between July and September 2021. Serial mediation analysis was performed using Haye's Model 6 PROCESS macro to examine the mediating effects. The study found that health self-management ability was significantly and positively correlated with eHealth literacy, resistance to peer influence and self-rated health. Self-rated health had a direct and positive predictive effect on health self-management, with a direct effect value of 0.654. eHealth literacy and resistance to peer influence played both an independent mediating and a chain-mediating role in the mechanism of self-rated health affecting health self-management among healthcare undergraduates, with indirect effect values of 0.085, 0.101, and 0.013, respectively. The results suggest that eHealth literacy and resistance to peer influence could be intervention targets in programs for improving these students' health self-management ability.

Factors associated with eHealth use among community dwelling older adults

BACKGROUND

With the proliferation of the internet and the development of internet-based healthcare interventions, eHealth is expected to be an effective complement to traditional healthcare services. However, without understanding the characteristics of the user population, eHealth itself can isolate older adults.

AIM

This study aims to identify the characteristics of internet use and the factors associated with eHealth use among older adults.

METHODS

A secondary data analysis was conducted from a cross-sectional descriptive study. A convenience sample of 186 community dwelling older adults was recruited at two senior welfare centres in Korea. The data collected included demographic characteristics, health related characteristics, internet use, eHealth use and eHealth literacy. Multiple linear regression was utilized to determine factors related to eHealth use.

RESULTS

Among 186 respondents, 98 reported that they used the internet. Internet usage was associated with educational attainment, marital status, cognitive function and possession of internet-enabled devices. The results of multiple regression analysis showed that greater eHealth usage was related to more positive perception of eHealth usability and better eHealth literacy among older adults.

CONCLUSION

Educational programmes for older adults should be developed to facilitate digital capability and eHealth literacy. Useful and effective online health resources that are easy to use should be also developed.

Self-Efficacy, Proxy Efficacy, Media Literacy, and Official Media Use in COVID-19 Pandemic in China: A Moderated Mediation Model

Purpose

COVID-19 pandemic is a significant threat toward the public health. However, the discussion of the mechanism of media literacy’s effect in fighting against pandemic is limited. Thus, this study aims to explore the mechanism with a sociocognitive perspective.

Methods

A survey was administrated to 420 college students in China. PROCESS macro of SPSS was applied to analyze the data and test the moderated mediation effect.

Results

The moderated mediation model of media literacy, proxy efficacy, self-efficacy, and official media use was tested and supported. Official media use was a negative moderator on the association between media literacy and proxy efficacy.

Conclusion

The study explored the media literacy’s role as a determinant of proxy efficacy and self-efficacy, which contributed to the sociocognitive theory.

Psycho-behavioural factors influencing COVID-19 vaccine hesitancy among Korean adults: The moderating role of age

Aims

This study aimed to identify the psycho‐behavioural factors influencing coronavirus disease 2019 (COVID‐19) vaccine hesitancy among Korean adults. We examined the primary effects of eHealth literacy, social responsibility and self‐efficacy on COVID‐19 vaccine hesitancy using the information‐motivation‐behavioural skills (IMB) model. The moderating effect of age on the relationship between psycho‐behavioural factors and COVID‐19 vaccine hesitancy was also examined.

Design

The study used a cross‐sectional survey design.

Methods

An online survey was completed by 500 Korean adults (253 men and 247 women) aged 20–60 years. Data collection took place in May 2021. The constructed hypothetical model for eHealth literacy, social responsibility, self‐efficacy and age was evaluated using partial least squares structural equation modelling (PLS‐SEM).

Results

eHealth literacy, social responsibility and self‐efficacy had significant negative effects on COVID‐19 vaccine hesitancy. Age had a significant moderating effect on COVID‐19 vaccine hesitancy. The moderating effects of age on the relationship between eHealth literacy and COVID‐19 vaccine hesitancy and between social responsibility and COVID‐19 vaccine hesitancy enhanced the explanatory power by high effect size. The overall fitness of the hypothetical model was good. The standardized root mean square residual value was 0.007, which explained 18.5% of the COVID‐19 vaccine hesitancy.

Conclusion

To reduce COVID‐19 vaccine hesitancy among Korean adults, a strategic approach that considers age should be adopted to enhance eHealth literacy, social responsibility and self‐efficacy.

Impact

The findings of this study suggest that providing correct health information online related to the COVID‐19 vaccine is likely to be effective in decreasing COVID‐19 vaccine hesitancy in older individuals, whereas inspiring a sense of social responsibility is more likely to be effective in younger individuals. These strategic nursing interventions could contribute to improving COVID‐19 vaccination rates among Korean adults.

Factors Associated with a Health-promoting Lifestyle among Adults and Older Adults in the Era of COVID-19: An Integrative Review

AIM: To identify the factors associated with a health-promoting lifestyle (HPL) among adults or older adults during the COVID-19 pandemic. METHODS: On the basis of the PRISMA guidelines, primary articles published in English within the period from December 2019 to December 2021 were searched for on five databases: PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL Plus with Full Text. RESULTS: The current review identified nine relevant studies with a total of 4,509 adults and older adults. We found that sociodemographic were associated with HPL among both adults and older adults in the COVID-19 era. The findings also asserted that a nurse-led lifestyle intervention is an effective program for improving the self-efficacy and HPL of older adults with chronic illnesses. CONCLUSION: According to this review’s findings, individuals and healthcare professionals should consider the sociodemographic and social factors associated with HPL among adults and older adults, it is important to improve and standardize the guidelines for home-based services so that they can be used properly to help them deal with the COVID-19 pandemic and similar health crises.

Electronic health literacy and health-related outcomes among older adults: A systematic review

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.

A Visualized and Scientometric Analysis of Health Literacy Research

PURPOSE

The health literacy concerned by numerous policy and advocacy organizations is springing up rapidly and has evolved substantially over the past few decades. During the period of COVID-19, people who are in the absence of effective treatment and limited availability of vaccination need a higher health literacy to protective themselves. In order to provide a summary of the health literacy research, a visualized and Scientometric analysis is applied in this study.

METHODS

Based on a scientific review of 3,670 data on health literacy from Web of Science, this research uses Citespace software to systematically and objectively describe health literacy to determine the knowledge evolution structure between articles and investigate research trends.

RESULTS

The results show that the annual outputs of publications have grown rapidly since 2003. The USA and Australia make larger contributions compared with other countries in terms of quantity of publications and worldwide collaboration relationship between them. The "Soc Sci Med," "J Health Commun." "Patient Educ Couns" and "J Gen Intern Med" pay more attention to health literacy research. The leading authors with influence and authority are Wolf MS, Osborne RH, and Paasche-Orlow MK. Health literacy research in this field focuses on care, knowledge, and education, and so on. An emerging trend of health literacy with Covid-19, online tools, nursing, and obesity will spread across the globe.

CONCLUSION

Compared with simply reviewing existing articles, the major contribution in this study is a comprehensive review of yearly scientific output, journals, countries, institutions, contributors, highly cited papers, and keywords for health literacy research. The review also provides valuable and seminal guidelines for interested researchers on health literacy research.

Electronic Health Literacy in Individuals with Chronic Pain and Its Association with Psychological Function

Electronic health literacy skills and competences are important for empowering people to have an active role in making appropriate health care decisions. The aims of this cross-sectional study were to (1) examine the frequency of use of the Internet for seeking online information about chronic pain, (2) determine the level of eHealth literacy skills in the study sample, (3) identify the factors most closely associated with higher levels of eHealth literacy, and (4) examine self-efficacy as a potential mediator of the association between eHealth literacy and measures of pain and function in a sample of adults with chronic pain. One-hundred and sixty-one adults with chronic pain completed measures assessing internet use, eHealth literacy, pain interference, anxiety, depression, and pain-related self-efficacy. Results indicated that 70% of the participants are active users of the Internet for seeking information related to their health. The level of eHealth literacy skills was not statistically significantly associated with participants’ age or pain interference but was significantly negatively associated with both anxiety and depression. In addition, the findings showed that self-efficacy fully explained the relationship between eHealth literacy and depression and partially explained the relationship between eHealth literacy and anxiety. Self-efficacy should be considered as a treatment target in eHealth literacy interventions, due to its role in explaining the potential benefits of eHealth literacy.

Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption

[Background]: In recent years, aging has become a global social problem. Intelligent health management technology (IHMT) provides solutions for the elderly to deal with various health risks. However, the elderly are facing many difficulties in using IHMT. Studying the application types of IHMT and the influencing factors of the elderly’s acceptance of it will help to improve the use behavior of the elderly. [Methods]: This paper summarizes the application types of IHMT, identifies the influencing factors of the elderly’s adaption of IHMT, and makes a systematic comment on the influencing factors. [Results]: We divide the different functions of IHMT for the elderly into four types: self-monitoring, medical care, remote monitoring, and health education. The influencing factors are divided into three types: individual, social, and technology. [Conclusions]: This study finds that IHMT’s application covers all aspects of the health services of the elderly. Among these applications, self-monitoring is the most used. We divided the influencing factors of the elderly’s acceptance of IHMT into three categories and nine subcategories, having 25 variables.

The Relationship between E-Health Literacy and Health-Promoting Behaviors in Nursing Students: A Multiple Mediation Model

The availability of a wide range of online health-related information on the internet has made it an increasingly popular source of health information, particularly for people in their 20s. This study aimed to explore possible multistep and indirect pathways of association between e-health literacy and health-promoting behaviors through social media use for health information, online health information-seeking behaviors, and self-care agency among nursing students. The study included 558 nursing students from three different universities in South Korea. Data were collected using structured questionnaires from 2 August to 29 August, 2019. The results show that e-health literacy had a significant direct effect on health-promoting behaviors through the three mediators. Moreover, the overall model explained 46% of the total variance in health-promoting behaviors. Based on these findings, it is necessary to introduce interventions that improve e-health literacy and develop a strategy to promote healthy behaviors. It is also necessary to develop programs to improve e-health literacy competency in nursing students. Moreover, health interventions that improve health-promoting behaviors should be developed, and research to evaluate the effect of the interventions should be conducted.

Benefiting From Digital Use: Prospective Association of Internet Use With Knowledge and Preventive Behaviors Related to Alzheimer Disease in the Israeli Survey of Aging

BACKGROUND

Previous work documented the beneficial association between internet use and improved cognition, functional capacity, and less cognitive decline among people in late adulthood. This work focused on potential mechanisms of such an association: knowledge on Alzheimer disease (AD) and preventive behaviors related to AD.

OBJECTIVE

The aim of this study was to examine prospective associations of internet use and perceived computer skills with knowledge on AD and preventive behaviors related to AD.

METHODS

The sample included 1232 older adults (mean age 71.12 [SD 9.07]) drawn from the Israeli branch of the Survey of Health, Aging, and Retirement in Europe (SHARE-Israel). The sample is representative of Israeli households of adults aged 50 or older and their spouses. Data analyzed were collected in person during 2015 (Wave 6), and in a drop-off questionnaire following the in-person 2017 data collection (Wave 7).

RESULTS

Although both internet use and perceived computer skills were prospectively associated with knowledge and behaviors related to AD in bivariate analyses, after controlling for sociodemographics, only internet use was associated with more such knowledge (β=.13, P<.001) and behaviors (β=.22, P<.001).

CONCLUSIONS

Internet use emerged as a prospective predictor of protective factors against AD. Policymakers should advance digital engagement so as to enhance knowledge on AD and preventive behaviors among older adults.

Educational Intervention to Improve Citizen's Healthcare Participation Perception in Rural Japanese Communities: A Pilot Study

In this mixed-methods study, we hypothesized that social cognitive theory (SCT)-based educational interventions for healthcare participation can improve the self-efficacy of older rural citizens in participating in their health management without any difficulties. Quasi-experimental study before and after SCT-based educational interventions and semi-structured interviews were conducted. Participants were Japanese elderly (>65 years) from rural communities. Propensity score matching was performed to estimate the effectiveness of educational interventions on participants' perception (intervention: n = 156; control: n = 121). Interview contents were transcribed verbatim and analyzed based on thematic analysis. The intervention group scored significantly higher than the control group for participation in planning and managing self-care. Interviews revealed three themes: ability to manage health conditions, relationship with medical professionals, and relationship among citizens. Participants reported difficulties in judging symptoms and communicating with medical professionals. Hierarchy and low motivation to participate in healthcare hindered collaboration. The findings suggest that SCT-based educational interventions can positively impact rural citizens' self-efficacy in healthcare participation.