Internet Use, Electronic Health Literacy, and Hypertension Control among the Elderly at an Urban Primary Care Center in Thailand: A Cross-Sectional Study

Exploring the interplay: Maternal electronic health literacy and its impact on early childhood development and parenting practices

BACKGROUND

Mothers need a competent electronic health literacy (eHL) skill for beneficial gains for the health of their children in the virtual environment, which is a new health platform. We predict that a competent eHL of mothers who play a central role in early childhood will positively affect the health of their children. This study aimed to determine the level of eHL of mothers of young children and investigate the relationship between mothers' eHL and early childhood development (ECD) and early parenting practices (EPP).

METHODS

This cross-sectional study was conducted on mothers with children aged 36-59 months using eHealth. Sociodemographic and personal characteristics form, Early Childhood Development Module and eHealth Literacy Scale were administered to the participating mothers.

RESULTS

The data from 440 mother-child pairs were analysed. Children of mothers with sufficient eHL levels were more likely to be Early Childhood Development Index (ECDI)-on-track, adjusted odds ratio (AOR), 95% confidence interval (CI): 2.16 (1.29-3.61); have adequate support in learning, AOR (%95 CI): 3.23 (1.69-6.18); and have adequate daily meals and snacks, AOR (%95 CI): 2.43 (1.56-3.78).

CONCLUSION

These results revealed that there is a need for interventions that will contribute to child health by improving mothers' eHL levels.

Attitudes toward stuttering of college students in the USA and China: A cross-cultural comparison using the POSHA-S

PURPOSE

This study compared the attitudes toward stuttering among college students in China and the USA using the POSHA-S survey, which assesses knowledge about stuttering and attitudes toward it. We investigated how cultural and social differences between the two groups influenced these attitudes.

METHODS

We collected 199 responses to the POSHA-S survey from various universities in China and the USA. We conducted a statistical analysis of 15 summary scores generated from the POSHA-S to determine if there were significant differences in attitudes toward stuttering between the two groups. Additionally, we retrieved percentile ranks relative to the global POSHA-S database to compare attitudes in both groups with global median scores.

RESULTS

The study revealed that Chinese college students hold more negative attitudes toward stuttering compared to their American counterparts and the global median scores. We discussed the social and cultural factors that may contribute to these attitudes. Furthermore, our findings emphasized the importance of addressing the lack of accurate information about stuttering in China, which could be a key factor driving these negative attitudes.

CONCLUSION

These results underscore the urgent need to raise awareness about stuttering and promote a shift in public attitudes, especially among college students in China, who play influential roles in society's future.

Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study

BACKGROUND

In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients.

OBJECTIVE

This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults.

METHODS

This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework.

RESULTS

The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use.

CONCLUSIONS

Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.

Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study

BACKGROUND

Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions.

OBJECTIVE

This study aims to explore the perceptions about telemedicine among older patients with multimorbidity.

METHODS

A qualitative study was conducted using semistructured interviews. The interview questions examined older adults' perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines.

RESULTS

In total, 29 patients with multimorbidity-21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years-were included. Overall, 4 themes and 7 subthemes emerged: theme 1-perceived benefit of telemedicine among older adults with multimorbidities, theme 2-appropriate use of telemedicine for multimorbid care, theme 3-telemedicine system catering to the needs of older patients, and theme 4-respect patients' decision to decline to use telemedicine.

CONCLUSIONS

Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

The impact of internet health information usage habits on older adults' e-health literacy

Objective

As the demand and supply sides of popular health services increasingly rely on the Internet, mastering e-health literacy should become an essential skill for older adults. The aim of this article is to analyse the effects of Internet health information usage habits on older adults' e- health literacy and to investigate the influencing mechanisms.

Methods

Using a combination of random sampling and convenient sampling, data were collected through questionnaire surveys. Data from 776 older adults was analysed using correlation and hierarchical regression to analyse.

Results

The mean scores for all aspects of older adults' habits of using health information on the Internet and electronic health literacy were relatively high. There was no statistically significant difference in the predictive power of the three aspects of electronic health literacy among older adults with different genders, health statuses, education levels and ages (p > 0.05). The four factors of older adults' habits of using Internet health information can increase the explanatory power of application ability, judgment ability and decision-making ability in Model 2 by 53.7%, 46.2% and 57%, respectively, with statistical significance (p < 0.001).

Conclusion

The better the habits of older adults in using health information on the Internet, the higher their level of electronic health literacy. Families, communities and social groups should help older adults use online health resources to improve their e-health literacy. Older adults can use WeChat or other interpersonal information platforms to share online health information with each other.

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand

Diabetes self-management education and support (DSMES) is recommended as a standard of care for patients with diabetes worldwide. Alcohol consumption is one aspect mentioned within the DSMES program in Thailand where alcohol consumption is the highest among Southeast Asian countries. Many diabetes guidelines suggest limiting alcohol intake to not more than one standard drink per day for adult women and two for adult men if they cannot abstain from drinking. In practice, however, the conversion of alcohol consumption into standard drinks, and nutritional information about the calorie and sugar contents of alcoholic beverages, especially domestically produced spirits, are not commonly available in Thailand. By reviewing the diabetes guidelines internationally and the Thailand alcoholic beverage industry, a visual health education tool to help convert different alcoholic beverages into standard drinks and to provide the calorie and sugar content of alcoholic beverages was developed as a part of the DSMES program. It was finalized following pilot testing and focus group discussions with policymakers, healthcare providers, and type 2 diabetes patients. The personalized counseling tool, integrated with guidelines and culturally tailored to the Thai setting is distributed to counselors/educators. It is a potentially useful tool for patients to make informed choices for their self-management of diabetes.

Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study

Background

Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring.

Objective

The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF).

Methods

This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis.

Results

Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance.

Conclusion

Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.

The technological intervention in e-health management: evidence from Thailand

Purpose

The e-health services came up as an effective tool to mitigate effects of COVID-19 and following social distance norms. This study highlighted an issue of contentious usage intentions of e-health services among Thai older citizens. This study aims to examine the relationship of social influence (SI), information quality (IQ) and the digital literacy (DL) to contentious usage intentions.

Design/methodology/approach

This study follows quantitative techniques, and the sample size is 140 to analyze, that is collected from the older Thai citizens. The convenient sampling technique was used to collect the data and the items were measured by using a five-point Likert scale.

Findings

The findings of this study are having mixed results. The effect of DL and satisfaction (SAT) on continuous usage intention (CUI) is significant. The effect of IQ and SI on CUI is non-significant. The effect of IQ and SI on SAT is significant. Further, the mediating effect of SAT between IQ and CUI is non-significant. However, the mediating effect of SAT between SI and CUI is significant.

Originality/value

This study contributes to knowledge by empirical testing of DL and usage of the medicine. Furthermore, to the best of the authors’ knowledge, this study is one of the rare studies that incorporate technological intervention for drug usage intentions.

Concerns of Home Isolating COVID-19 Patients While Receiving Care via Telemedicine during the Pandemic in the Northern Thailand: A Qualitative Study on Text Messaging

As there were strict limits on contact between health professionals and patients during the COVID-19 pandemic, telemedicine increased in importance with regard to improving the provision of health care and became the preferred method of care. This study aims to determine the topics of concern expressed by individuals with COVID-19 receiving care at home via teleconsultation. The qualitative study was conducted using secondary data of chat messages from 213 COVID-19 patients who had consented to online consultation with the health care team. The messages were sent during the home isolation period, which was between 29th October and 20th December 2021. Thematic analysis was used to analyze the data. All patients had consented to the use of their data. A small majority of the patients were female (58.69%). The average age was 32.26 ± 16.92 years. A total of 475 questions were generated by 150 patients during the isolation period. Nearly thirty percent (29.58%) never asked any questions. From the analysis, the questions could be divided into three themes including: (1) complex care system; (2) uncertainty about self-care and treatment plan with regard to lack of knowledges and skills; and (3) concern about recovery and returning to the community after COVID-19 infection. In conclusion, there were enquiries about many aspects of medical care during home isolation, detailed answers from professionals were useful for the self-care of patients and to provide guidance for their future health behavior. The importance of the service being user friendly and accessible to all became increasingly evident.