%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56080 %T Promoting Health Literacy With Human-in-the-Loop Video Understandability Classification of YouTube Videos: Development and Evaluation Study %A Liu,Xiao %A Susarla,Anjana %A Padman,Rema %+ Heinz College of Information Systems and Public Policy, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 412 268 2180, rpadman@andrew.cmu.edu %K patient education %K video analysis %K video understandability %K machine learning %K cotraining %K human-in-the-loop %K augmented intelligence %K artificial intelligence %K AI %D 2025 %7 8.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: An estimated 93% of adults in the United States access the internet, with up to 80% looking for health information. However, only 12% of US adults are proficient enough in health literacy to interpret health information and make informed health care decisions meaningfully. With the vast amount of health information available in multimedia formats on social media platforms such as YouTube and Facebook, there is an urgent need and a unique opportunity to design an automated approach to curate online health information using multiple criteria to meet the health literacy needs of a diverse population. Objective: This study aimed to develop an automated approach to assessing the understandability of patient educational videos according to the Patient Education Materials Assessment Tool (PEMAT) guidelines and evaluating the impact of video understandability on viewer engagement. We also offer insights for content creators and health care organizations on how to improve engagement with these educational videos on user-generated content platforms. Methods: We developed a human-in-the-loop, augmented intelligence approach that explicitly focused on the human-algorithm interaction, combining PEMAT-based patient education constructs mapped to features extracted from the videos, annotations of the videos by domain experts, and cotraining methods from machine learning to assess the understandability of videos on diabetes and classify them. We further examined the impact of understandability on several dimensions of viewer engagement with the videos. Results: We collected 9873 YouTube videos on diabetes using search keywords extracted from a patient-oriented forum and reviewed by a medical expert. Our machine learning methods achieved a weighted precision of 0.84, a weighted recall of 0.79, and an F1-score of 0.81 in classifying video understandability and could effectively identify patient educational videos that medical experts would like to recommend for patients. Videos rated as highly understandable had an average higher view count (average treatment effect [ATE]=2.55; P<.001), like count (ATE=2.95; P<.001), and comment count (ATE=3.10; P<.001) than less understandable videos. In addition, in a user study, 4 medical experts recommended 72% (144/200) of the top 10 videos ranked by understandability compared to 40% (80/200) of the top 10 videos ranked by YouTube’s default algorithm for 20 ramdomly selected search keywords. Conclusions: We developed a human-in-the-loop, scalable algorithm to assess the understandability of health information on YouTube. Our method optimally combines expert input with algorithmic support, enhancing engagement and aiding medical experts in recommending educational content. This solution also guides health care organizations in creating effective patient education materials for underserved health topics. %R 10.2196/56080 %U https://www.jmir.org/2025/1/e56080 %U https://doi.org/10.2196/56080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59807 %T Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study %A Thorup,Charlotte Brun %A Uitto,Mika %A Butler-Henderson,Kerryn %A Wamala-Andersson,Sarah %A Hoffrén-Mikkola,Merja %A Schack Thoft,Diana %A Korsbakke Emtekær Hæsum,Lisa %A Irrazabal,Gabriela %A Pruneda González,Laura %A Valkama,Katja %+ Research Centre of Health and Applied Technology, University College of Northern Denmark, Selma Lagerløfs Vej 2, Aalborg, Aalborg, 9220, Denmark, 45 20729950, cbt@ucn.dk %K digital health literacy %K digital literacy %K Horizon Europe %K EU %K health technology %K life expectancy %K health literacy %K chronic disease %K digitalization %K digital health service %K digital health intervention %K technology %K healthcare %D 2025 %7 8.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project “The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)” with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview Objective: This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools. Methods: This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results. Results: The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes. Conclusions: The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the ‘adequacy’ of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels. %M 40198098 %R 10.2196/59807 %U https://www.jmir.org/2025/1/e59807 %U https://doi.org/10.2196/59807 %U http://www.ncbi.nlm.nih.gov/pubmed/40198098 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 10 %N %P e66117 %T eHealth Literacy and Its Association With Demographic Factors, Disease-Specific Factors, and Well-Being Among Adults With Type 1 Diabetes: Cross-Sectional Survey Study %A Stephen,Divya Anna %A Nordin,Anna %A Johansson,Unn-Britt %A Nilsson,Jan %K cross-sectional studies %K diabetes mellitus, type 1 %K digital technology %K eHealth literacy %K health literacy %D 2025 %7 31.3.2025 %9 %J JMIR Diabetes %G English %X Background: The use of digital health technology in diabetes self-care is increasing, making eHealth literacy an important factor to consider among people with type 1 diabetes. There are very few studies investigating eHealth literacy among adults with type 1 diabetes, highlighting the need to explore this area further. Objective: The aim of this study was to explore associations between eHealth literacy and demographic factors, disease-specific factors, and well-being among adults with type 1 diabetes. Methods: The study used data from a larger cross-sectional survey conducted among adults with type 1 diabetes in Sweden (N=301). Participants were recruited using a convenience sampling method primarily through advertisements on social media. Data were collected between September and November 2022 primarily through a web-based survey, although participants could opt to answer a paper-based survey. Screening questions at the beginning of the survey determined eligibility to participate. In this study, eHealth literacy was assessed using the Swedish version of the eHealth Literacy Scale (Sw-eHEALS). The predictor variables, well-being was assessed using the World Health Organization-5 Well-Being Index and psychosocial self-efficacy using the Swedish version of the Diabetes Empowerment Scale. The survey also included research group–developed questions on demographic and disease-specific variables as well as digital health technology use. Data were analyzed using multiple linear regression presented as nested models. A sample size of 270 participants was required in order to detect an association between the dependent and predictor variables using a regression model based on an F test. The final sample size included in the nested regression model was 285. Results: The mean Sw-eHEALS score was 33.42 (SD 5.32; range 8‐40). The model involving both demographic and disease-specific variables explained 31.5% of the total variation in eHealth literacy and was deemed the best-fitting model. Younger age (P=.01; B=–0.07, SE=0.03;95% CI –0.12 to –0.02), lower self-reported glycated hemoglobin levels (P=.04; B=–0.06, SE=0.03; 95% CI –0.12 to 0.00), and higher psychosocial self-efficacy (P<.001; B=3.72, SE=0.53; 95% CI 2.68-4.75) were found associated with higher Sw-eHEALS scores when adjusted for demographic and disease-specific variables in this model. Well-being was not associated with eHealth literacy in this study. Conclusions: The demographic and disease-specific factors explained the variation in eHealth literacy in this sample. Further studies in this area using newer eHealth literacy tools are important to validate our findings. The study highlights the importance of development and testing of interventions to improve eHealth literacy in this population for better glucose control. These eHealth literacy interventions should be tailored to meet the needs of people in varying age groups and with differing levels of psychosocial self-efficacy. %R 10.2196/66117 %U https://diabetes.jmir.org/2025/1/e66117 %U https://doi.org/10.2196/66117 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e64707 %T Accessibility of eHealth Before and During the COVID-19 Pandemic Among People With and People Without Impairment: Repeated Cross-Sectional Survey %A Pettersson,Linda %A Johansson,Stefan %A Demmelmaier,Ingrid %A von Koch,Lena %A Gulliksen,Jan %A Hedvall,Per-Olof %A Gummesson,Karl %A Gustavsson,Catharina %K eHealth %K impairment %K accessibility %K digital inclusion %K universal design %K disability %K digital divide %K electronic health %K COVID-19 %K pandemic %K cross-sectional study %K Sweden %K online booking %K digital identification %K web portal %K health information %K control group %K public health %K digital health %K digital literacy %K health informatics %K mobile phone %D 2025 %7 28.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The adoption of eHealth accelerated during the COVID-19 pandemic. Inequalities in the adoption of eHealth during the COVID-19 pandemic have been reported, but there are few such studies among people with impairment. Objectives: This study aimed to investigate self-reported use and difficulty in the use of eHealth before the COVID-19 pandemic compared to during late social distancing restrictions in Sweden, among people with and without impairment, as well as between different types of impairment. Methods: A cross-sectional survey was distributed twice by snowball sampling to people with self-reported impairment and a general population matched by age, gender, and county. Use and difficulty in the use of six eHealth services were compared between groups using chi-square test and logistic regression with year interaction terms, reported as odds ratio adjusted (aOR) for gender and age with 95% CI. Results: The surveys included 1631 (in 2019) and 1410 (in 2021) participants with impairment, and 1084 (in 2019) and 1223 (in 2021) participants without. Participants with impairment, compared to those without impairment, reported less use and more difficulty in booking health care appointments online, digital identification, and the Swedish national web portal for health information and eHealth services (1177.se), both before and during the pandemic (P=.003 or lower). Video health care appointments were the exception to this disability digital divide in eHealth as video appointment adoption was the most likely among participants with attention, executive, and memory impairments (interaction term aOR 2.10, 95% CI 1.30‐3.39). Nonuse and difficulty in the use of eHealth were consistently associated with language impairments and intellectual impairments. For example, language impairments were inversely associated with use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.49, 95% CI 0.36‐0.67) and were associated with difficulty in the use of 1177.se in 2019 (aOR 2.24, 95% CI 1.50‐3.36) and the logged-in eHealth services in 1177.se in 2021 (aOR 1.89, 95% CI 1.32‐2.70). Intellectual impairments were inversely associated with the use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.19, 95% CI 0.13‐0.27). Conclusions: This repeated cross-sectional survey study, including participants with diverse types of impairment and a control group without impairment, reveals persisting disability digital divides, despite an accelerated adoption of eHealth across the pandemic. eHealth services were not accessible to some groups of people who were identified as being at risk of severe disease during the COVID-19 pandemic. This implies that all people could not use eHealth as a measure of infection protection. %R 10.2196/64707 %U https://publichealth.jmir.org/2025/1/e64707 %U https://doi.org/10.2196/64707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66058 %T Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review %A Zhang,Chenglin %A Mohamad,Emma %A Azlan,Arina Anis %A Wu,Anqi %A Ma,Yilian %A Qi,Yihan %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia, 60 389215457, emmamohamad@ukm.edu.my %K eHealth literacy %K digital health literacy %K older adults %K social media %K health information %K systematic review %D 2025 %7 26.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments. Objective: We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults’ social media behaviors? and (4) What factors influence older adults’ use of social media for health-related purposes? Methods: Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21% (767/1591) of publications remained. Ultimately, 1% (16/1591) of studies met the inclusion criteria. A research question–driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework. Results: The results indicated that older adults’ general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75%), followed by self-management (8/16, 50%). Other themes included health decision-making (4/16, 25%), telemedicine (3/16, 19%), and health interventions (2/16, 13%). Cross-thematic analysis confirmed that older adults’ social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors. Conclusions: The reciprocal relationship between older adults’ social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults. %M 40138684 %R 10.2196/66058 %U https://www.jmir.org/2025/1/e66058 %U https://doi.org/10.2196/66058 %U http://www.ncbi.nlm.nih.gov/pubmed/40138684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63671 %T Decomposition and Comparative Analysis of Urban-Rural Disparities in eHealth Literacy Among Chinese University Students: Cross-Sectional Study %A Yu,Yao %A Liang,Zhenning %A Zhou,Qingping %A Tuersun,Yusupujiang %A Liu,Siyuan %A Wang,Chenxi %A Xie,Yuying %A Wang,Xinyu %A Wu,Zhuotong %A Qian,Yi %+ , School of Health Management, Southern Medical University, Number 1023, Shatai South Road, Baiyun District, Guangzhou, , China, 86 13632101533, qianyi_smu@163.com %K university students %K eHealth literacy %K urban-rural disparities %K Fairlie decomposition model %K health equity %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. Objective: This study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. Methods: The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. Results: The average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90%) compared with urban students (1298/2720, 47.72%; P<.001). The Fairlie decomposition analysis showed that 71.4% of the disparity in eHealth literacy was attributable to urban-rural factors and unobserved variables, while 28.6% resulted from observed factors. The primary contributors were monthly per capita household income (13.4%), exercise habits (11.7%), and 9-item Patient Health Questionnaire (PHQ-9) scores (2.1%). Conclusions: Rural university students exhibit lower eHealth literacy levels than their urban counterparts, a disparity influenced by differences in socioeconomic status, individual lifestyles, and personal health status. These findings highlight the need for targeted intervention strategies, including (1) improving access to eHealth resources in rural and underserved areas; (2) fostering an environment that encourages physical activity to promote healthy behaviors; (3) expanding school-based mental health services to enhance health information processing capacity; and (4) implementing systematic eHealth literacy training with ongoing evaluation. These strategies will support equitable access to and utilization of eHealth resources for all students, regardless of their geographic location. %M 40138681 %R 10.2196/63671 %U https://www.jmir.org/2025/1/e63671 %U https://doi.org/10.2196/63671 %U http://www.ncbi.nlm.nih.gov/pubmed/40138681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64591 %T Development and Validation of the Digital Health Literacy Questionnaire for Stroke Survivors: Exploratory Sequential Mixed Methods Study %A Ye,Qin %A Wang,Wei %A Zeng,Xuan %A Kuang,Yuxian %A Geng,Bingbing %A Zhou,Song %A Liu,Ning %+ Department of Basic Teaching and Research in General Medicine, Department of Fundamentals, Department of Nursing of Zunyi Medical University Zhuhai Campus, No. 368, Jinwan Road, Jinwan District, Zhuhai, 519041, China, 86 13631295806, ln761066906@163.com %K stroke survivors %K digital health literacy %K validation %K reliability %K mixed methods study %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, there is limited research on digital health literacy (DHL) among patients with stroke. This is mainly due to the lack of validated tools, which hinders the precision and sustainability of our country’s digital transformation. Objective: This study aimed to develop and validate a DHL scale specifically for stroke survivors in China. Methods: We used a sequential, exploratory, mixed methods approach to develop a DHL questionnaire for stroke survivors. This study comprised 418 patients with stroke aged 18 years and older. To evaluate the questionnaire’s psychometric qualities, we randomly assigned individuals to 2 groups (subsample 1: n=118, subsample 2: n=300). Construct validity was evaluated through internal consistency analysis, exploratory and confirmatory factor analyses, hypothesis testing for structural validity, measurement invariance assessments using the eHealth Literacy Scale, and Rasch analyses to determine the questionnaire’s validity and reliability. Results: This study underwent 4 stages of systematic development. The initial pool of items contained 25 items, 5 of which were eliminated after content validity testing; 19 items were subsequently retained through cognitive interviews. After an interitem correlation analysis, 2 more items were excluded, leaving 17 items for exploratory factor analysis. Finally, 2 items were excluded by Rasch analysis, resulting in a final version of the questionnaire containing 15 items. The total score range of the scale was 15-75, with higher scores indicating greater DHL competence. Results showed that principal component analysis confirmed the theoretical structure of the questionnaire (69.212% explained variance). The factor model fit was good with χ24=1.669; root mean square error of approximation=0.047; Tucker-Lewis Index=0.973; and Comparative Fit Index=0.977. In addition, hypothesis-testing construct validity with the eHealth Literacy Scale revealed a strong correlation (r=0.853). The internal consistency (Cronbach α) coefficient was 0.937. The retest reliability coefficient was 0.941. Rasch analysis demonstrated the item separation index was 3.81 (reliability 0.94) and the individual separation index was 2.91 (reliability 0.89). Conclusions: The DHL Questionnaire for Stroke Survivors is a reliable and valid measure to assess DHL among stroke survivors in China. %R 10.2196/64591 %U https://www.jmir.org/2025/1/e64591 %U https://doi.org/10.2196/64591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70483 %T New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach %A Chen,Si %A Ebrahimi,Omid V %A Cheng,Cecilia %+ Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K digital wellness %K affective well-being %K emotional regulation %K coping %K digital competence %K digital autonomy %K artificial intelligence %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play. Objective: This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure). Methods: The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors. Results: The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node—online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (χ24=10.7; P=.03) and emotion-focused coping (χ24=14.9; P=.01), while men scored higher on digital literacy (χ24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ρ=0.27; P<.001) and digital self-control (Spearman ρ=0.35; P<.001) and higher on both digital stress (Spearman ρ=−0.14; P<.001) and problematic internet use (Spearman ρ=−0.25; P<.001). Conclusions: The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency. %M 40132188 %R 10.2196/70483 %U https://www.jmir.org/2025/1/e70483 %U https://doi.org/10.2196/70483 %U http://www.ncbi.nlm.nih.gov/pubmed/40132188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60547 %T Digital Competence of Arabic-Speaking Immigrant and Refugee Older Adults Enacting Agency and Navigating Barriers: Qualitative Descriptive Study %A Salma,Jordana %A Au,Alesia %A Sayadi,Ghada %A Kleib,Manal %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 7804929469, alesia1@ualberta.ca %K digital competence %K Arab %K older adult %K co-design %K migrant %K information and communications technology %K ICT %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Canada’s immigrant and refugee older adult population is projected to grow substantially, making equitable access to information and communications technologies (ICTs) vital for enhancing quality of life in older age. Strengthening the digital competence of immigrant and refugee older adults can improve their social connectedness and access to local information. Objective: This study explored the digital competence of Arabic-speaking immigrant and refugee older adults, focusing on how they engage with ICTs to meet their information and communication needs and the strategies they use to navigate digital barriers. Methods: A qualitative descriptive methodology within a social constructivist paradigm was adopted, incorporating triangulated data collection and iterative co-design cycles. The qualitative approach facilitated an in-depth exploration of participants’ experiences, skills, and emotions and the contextual factors influencing their digital competence. Data were collected through storytelling approaches, qualitative interviews, and focus group discussions, which were effective in capturing the experiential aspects of aging and technology use. Co-design cycles informed 6 digital learning sessions tailored to participants’ immediate learning needs, fostering motivation and engagement and allowing for observation of ICT use. Digital competence was mapped across the learning domains of the Digital Competence Framework for Citizens 2.2. Results: This study engaged 31 Arabic-speaking immigrant and refugee older adults residing in Canada. Most participants had limited formal education (19/31, 61%), lived with family (22/31, 70%), and reported a low income (21/31, 68%). All participants (31/31, 100%) used smartphones as their primary ICT device, whereas few (3/31, 10%) had access to a computer. In total, 3 themes were identified from the analysis, grounded in Digital Competence Framework for Citizens 2.2 competencies on information and data literacy, communication and collaboration, and safety and problem-solving. The themes focused on agency, which is enhanced or constrained using ICTs, impacting older adults’ desire and ability to use these technologies to independently meet their daily needs. Conclusions: Immigrant and refugee older adults require support to navigate digital barriers and gain digital competence. Smartphones serve as a critical tool for enhancing digital agency, which can lead to greater social connectedness and improved access to local resources in older age. The findings will inform the design of future digital competence programs for older migrants, emphasizing community partnership and reciprocal learning. %M 40132193 %R 10.2196/60547 %U https://www.jmir.org/2025/1/e60547 %U https://doi.org/10.2196/60547 %U http://www.ncbi.nlm.nih.gov/pubmed/40132193 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67293 %T Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study %A Whittemore,Robin %A Jeon,Sangchoon %A Akyirem,Samuel %A Chen,Helen N C %A Lipson,Joanna %A Minchala,Maritza %A Wagner,Julie %+ School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, United States, 1 860 420 9623, robin.whittemore@yale.edu %K patient portal %K mobile phone %K diabetes %K community health center %K adults %K diabetic %K DM %K diabetes mellitus %K Type 2 diabetes %K T2D %K community health centers %K CHCs %K pilot study %K feasibility %K self-management %K glycemic control %K patient portals %K social determinants of health %K primary outcome %K digital health %K digital health literacy %K health technology %K health technologies %K psychosocial %K efficacy %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% 65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults’ transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors’ use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors’ perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21‐0421) was obtained. Interpretive description inquiry—a practice-based approach suitable for generating applied knowledge—supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. %R 10.2196/59391 %U https://cancer.jmir.org/2025/1/e59391 %U https://doi.org/10.2196/59391 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 2 %N %P e57361 %T A Local Training Program to Increase Awareness of Emerging Extended Reality Technologies Among Health Care Professionals: Development Study %A Galvin,Charlotte %A Watt,Jonathan %A Ghatnekar,Payal %A Peres,Nicholas %A Rees-Lee,Jacqueline %K health care XR %K extended reality in health care %K XR %K virtual reality in health care %K VR %K digital awareness training %K digital deep dive %K digital literacy %K emerging health care technology %K digital future %K extended reality %K virtual reality %D 2025 %7 27.2.2025 %9 %J JMIR XR Spatial Comput %G English %X Background: Demands on health care services can greatly outweigh capacity. Multifactorial causative factors present great challenges, forcing the National Health Service (NHS) to increase efficiency and adaptivity. Concurrently, digital advancements are excelling and long-term plans for NHS sustainability are focusing on the use of technological interventions to benefit patients. As a result, integration of extended reality (XR) technology has become an important focus of health care research. However, models of how the digital literacy of health care workforces can be developed and how frontline staff can be actively involved in the design and development of creative digital interventions are lacking. Such programs are essential to allow the development and upscaling of digital innovation within the NHS for the benefit of the patients. Such a program has been developed in the Digital Futures research lab at Torbay and South Devon NHS Foundation Trust, representing one of the first immersive digital technologies research spaces embedded within the NHS. A “Digital Deep Dive” training program has been developed, allowing local health care workers to recognize the possibilities of digital health care technologies and supporting them in the evolution of ideas for potential bespoke digital solutions appropriate to their own patient groups and care pathways. Objective: This paper aims to explain the development of this unique XR Deep Dive program and present the evaluation that informed future directions for its ongoing development. Methods: The Deep Dive sessions were designed according to relevant pedagogic principles, including experiential, active, and contextual learning theories. Voluntary pilot sessions were held for local clinical teams comprised of junior doctors, consultants, nurses, and allied health professionals. Self-selection sampling was used. Participants completed an anonymous postsession feedback form, which was used to conduct a service evaluation. Data were analyzed using descriptive statistics (quantitative) and thematic analysis (qualitative). Results: In total, 21 completed questionnaires were analyzed. Overall, the sessions were positively received: all participants reported increased awareness of the potential for digital health care innovation postsession and most found it useful and relevant to their clinical careers. Participants valued the sessions being grounded in a context relevant to local practice with opportunities to interact with the technology through the lens of use cases. Conclusions: We have developed a unique training initiative providing contextually relevant XR technology awareness training for health care professionals locally. Despite the growing pace of digital health care innovation, we recognized a knowledge gap in our local workforce regarding the potential of XR technologies within health care. We responded by developing a training program grounded in the concept of digital co-creation—working with staff and service users to develop bespoke solutions integrated within patient pathways. The results from this paper will help to inform future directions for developing digital awareness training in our trust and have implications for wider NHS digital literacy training. %R 10.2196/57361 %U https://xr.jmir.org/2025/1/e57361 %U https://doi.org/10.2196/57361 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58362 %T Examining Individuals’ Use of the Internet for Health Care Activities Over Time: Results from the US National Health Interview Survey %A Junkins,Zachary %A Zahan,Nusrath %A Neyens,David %+ Department of Industrial Engineering, Clemson University, 100 Freeman Hall, Clemson, SC, 29634, United States, 1 8646564719, dneyens@clemson.edu %K internet %K web search %K internet search %K internet use %K searching behavior %K access to health information %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K logistic regression model %K regression model %K National Health Interview Survey %K NHIS %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users. Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services. Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers. Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care–related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents’ collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs. Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user’s ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents’ use of telehealth. %M 40009837 %R 10.2196/58362 %U https://humanfactors.jmir.org/2025/1/e58362 %U https://doi.org/10.2196/58362 %U http://www.ncbi.nlm.nih.gov/pubmed/40009837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57730 %T Psychometric Analysis of the eHealth Literacy Scale in Portuguese Older Adults (eHEALS-PT24): Instrument Development and Validation %A Luz,Sara %A Nogueira,Paulo %A Costa,Andreia %A Henriques,Adriana %+ , Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Av. Dom João II, Lote 4.69.01, Lisbon, 1990-096, Portugal, 351 217913400, sara.luz@esel.pt %K eHealth %K health literacy %K older adults %K psychometric properties %K public health %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In this era of digitalization, eHealth interventions are used to engage patients in health care and help them manage their health. Previous studies showed that this can be particularly interesting for chronic disease self-management and self-care in older adults. Despite older adults becoming increasingly active on the internet, they continue to struggle in using eHealth information due to inadequate eHealth literacy. Thus, assessing and monitoring eHealth literacy is critical to support eHealth interventions. Objective: This study aimed to describe the translation, adaptation, and validation process of the eHealth Literacy Scale (eHEALS) in Portuguese older adults. Methods: The cross-cultural adaption followed the steps of forward and blinded backward translations, evaluation of the translations by a committee of judges, pilot-testing, and full psychometric testing. We tested the psychometric properties of the eHEALS by carrying out two studies: general psychometric analysis (study 1) and confirmatory factor analysis (study 2). Study 1 included 80 older adults conveniently selected from a Health Family Unit. Data were collected by in-person questionnaires between May and July 2022. Study 2 included 301 older adults randomly selected from two distinct Health Family Units. Data were collected by in-person questionnaires between May and July 2023. Results: We tested stability, reliability, construct validity (exploratory and confirmatory factor analyses and known groups), and model fit. Study 1 had 58.8% (47/80) male and 41.3% (33/80) female respondents (mean age 71.20, SD 5.26 years). Study 2 had 56.5% (170/301) male and 43.5% (131/301) female respondents (mean age 71.77, SD 5.15 years). Moderate and strong correlations were identified in the scale items (study 1: 0.42≤r≤0.91 and study 2: 0.81≤r≤0.96; P<.001). The scale showed good internal consistency for study 1 (α=.92) and study 2 (α=.98), with high correlations between items. The exploratory factor analysis yielded a single-factor structure, explaining 58.3% of the variance in study 1 and 86.4% in study 2. In the confirmatory analysis (study 2), the model fit was mixed (χ²20=265, P<.001; comparative fit index=0.94; Tucker-Lewis Index=0.91; root mean square error of approximation=0.20). Thus, we compared 1-, 2-, and 3-factor structures, deciding on the unidimensional one. In study 1, the eHEALS-PT24 (Portuguese version of the eHealth Literacy Scale for older adults) mean score was 27.25 (SD 5.61), with 43.8% (35/80) and 11.3% (9/80) of participants showing low and high eHealth literacy levels, respectively. In study 2, the eHEALS-PT24 mean score was 23.31 (SD 9.53), with 38.2% (115/301) and 23.6% (71/301) of participants showing low and high eHealth literacy levels, respectively. The known-groups analysis showed statistically significant differences between eHealth literacy and demographic variables (P<.001). Conclusions: The findings suggest that the eHEALS-PT24 is a reliable and valid tool to assess eHealth literacy in Portuguese older adults. Therefore, this instrument can be integrated to support the implementation process of eHealth interventions. %M 40009846 %R 10.2196/57730 %U https://www.jmir.org/2025/1/e57730 %U https://doi.org/10.2196/57730 %U http://www.ncbi.nlm.nih.gov/pubmed/40009846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60699 %T Perceptions, Experiences, and Beliefs About Patient Portals Among Women With Limited English Proficiency: Multicultural Qualitative Interview Study %A Han,Hae-Ra %A Chepkorir,Joyline %A Kim,Tina %A Zamora,Martha %A Huang,Emma %+ Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 614 2669, hhan3@jhu.edu %K patient portal %K limited English proficiency %K immigrant %K women %K mobile phone %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals in the United States with limited English proficiency (LEP) experience a disproportionate disease burden. Patient portals provide patient education, outreach, and linkage to preventive health services. While patient portals have been found to be effective in facilitating the use of preventive services, they have predominantly engaged well-educated, English-speaking, White populations. There is limited research investigating experiences and beliefs about patient portals among populations with LEP. Objective: This study aims to explore perceptions, experiences, and beliefs about patient portals among women with LEP. Methods: We used a qualitative semistructured interview design and recruited a purposive sample of women through diverse methods. The interview guide covered topics including experiences with patient portals, the perceived feasibility and relevance of patient portals, and perceptions of patient portals targeted toward women with LEP for health promotion. The interviews were audio recorded for verbatim transcription and analysis. Each bilingual interviewer reached data saturation after interviewing 12 (43%), 9 (32%), and 7 (25%) Korean-, Spanish-, and Swahili-speaking women, respectively, yielding a total of 28 women in the study. Results: We identified 4 main themes that were common across all linguistic groups: perceived benefits of patient portals, perceived facilitators of patient portal use, perceived barriers to patient portal use, and preferred features and suggested improvements. Perceived benefits of patient portals had 5 subthemes: easier communication with health care providers and health systems, getting connected and staying connected with health systems, easier and efficient access to one’s health records over time, staying informed of and engaged with one’s health and health management, and better patient engagement in medical visits. Subthemes for perceived facilitators of patient portal use were availability of time, widespread use and availability of smartphones and the internet in the United States, family support, and parenthood. Subthemes for perceived barriers to patient portal use were limited digital literacy and limited access to technology, LEP, lack of awareness and knowledge about patient portals, and illiteracy. Finally, subthemes for preferred features and suggested improvements were expanded language access to accommodate non-English speakers, improved accessibility to health information using graphics and patient education materials, and user onboarding education and technical support. Of note, while most subthemes were shared across all 3 groups, the widespread use and availability of smartphones and the internet in the United States and illiteracy subthemes were unique to Swahili-speaking women. Conclusions: Women with LEP recognized multiple benefits of patient portals; however, several barriers were also identified. These included limited digital literacy, restricted access to technology, LEP, and illiteracy. Barriers to patient portal use were closely tied to social determinants of health, which are commonly experienced by women with LEP. To expedite the attainment of health equity, it is important to promote access to health resources such as patient portals. %M 40009438 %R 10.2196/60699 %U https://www.jmir.org/2025/1/e60699 %U https://doi.org/10.2196/60699 %U http://www.ncbi.nlm.nih.gov/pubmed/40009438 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66690 %T Experiences of Older Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Interview Study %A Meier-Diedrich,Eva %A Esch,Tobias %A Hägglund,Maria %A Heinze,Martin %A Hochwarter,Stefan %A Speck,Justin %A Wagener,Marie %A Dahling,Volker %A Schwarz,Julian %+ Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 33638 83 501, Eva.Meier-Diedrich@mhb-fontane.de %K psychiatry %K eHealth %K mental health %K digital literacy %K older patients %K older adult %K care partner %K proxy access %K open record access %K Open Notes %K patient portal %K artificial intelligence %K AI %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Older patients with serious mental illnesses such as cognitive disorders often rely on family members or spouses (care partners [CPs]) to meet their health care needs. CPs frequently lack essential information to fully understand the patients’ illnesses and effectively support their treatment. Open Notes provide patients with digital access to their health care professionals’ clinical notes and are associated with many positive outcomes, such as increased adherence and empowerment. However, older patients who use Open Notes may encounter use barriers such as limited digital literacy. Recent developments allow CPs to access Open Notes (proxy access) and receive valuable information, which holds significant potential for improving the care of older patients. Objective: This study explored the experiences, barriers, and opportunities of older mental health patients and their CPs related to using Open Notes. Furthermore, influencing factors and interdependencies were identified. Methods: Older patients (n=10) and their CPs (n=10) were provided with web-based proxy access to clinical documentation through a web-based patient portal. In-depth qualitative interviews (N=20) were conducted to explore experiences with this access. Data analysis was conducted in accordance with the constructivist grounded theory approach. Results: The prerequisites for using Open Notes with proxy access were sufficient digital literacy on the part of the patient or CP, as well as the establishment of a trusting relationship between patients and CPs. Access to Open Notes enabled patients and CPs to gain a deeper understanding of the illness and its treatment while also facilitating enhanced contact with health care professionals. This resulted in greater involvement in the treatment process but may also prompt changes in relationship dynamics—CPs are better equipped to support patients in their health care but may also tend to monitor or control them through Open Notes. As a result, the introduction of Open Notes was accompanied by mixed feelings. Conclusions: It is of utmost importance to provide older patients with comprehensive access to Open Notes to preserve their health autonomy. However, the involvement of CPs through proxy access is of great value in improving the care of older patients, especially those with cognitive impairments. %M 39993284 %R 10.2196/66690 %U https://aging.jmir.org/2025/1/e66690 %U https://doi.org/10.2196/66690 %U http://www.ncbi.nlm.nih.gov/pubmed/39993284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e71897 %T Authors’ Reply: “Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders” %A Lewis,Callum C %A Taba,Melody %A Allen,Tiffany B %A Caldwell,Patrina H.Y %A Skinner,S Rachel %A Kang,Melissa %A Henderson,Hamish %A Bray,Liam %A Borthwick,Madeleine %A Collin,Philippa %A McCaffery,Kirsten %A Scott,Karen M %+ Education Office, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Room 208D, Edward Ford Building, Sydney, 2006, Australia, 1 298453385, karen.scott@sydney.edu.au %K adolescent health %K digital health literacy %K adolescents %K online health information %K co-design %K health education %K eHealth literacy %K social media %D 2025 %7 20.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39977857 %R 10.2196/71897 %U https://www.jmir.org/2025/1/e71897 %U https://doi.org/10.2196/71897 %U http://www.ncbi.nlm.nih.gov/pubmed/39977857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70020 %T Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders %A Yang,Alina %+ Scarsdale High School, 1057 Post Road, Scarsdale, NY, 10583, United States, 1 (914) 721 2500, alinayang5@gmail.com %K adolescent health %K digital health literacy %K adolescents %K online health information %K co-design %K health education %K eHealth literacy %K social media %D 2025 %7 20.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39977854 %R 10.2196/70020 %U https://www.jmir.org/2025/1/e70020 %U https://doi.org/10.2196/70020 %U http://www.ncbi.nlm.nih.gov/pubmed/39977854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57122 %T Identifying Profiles of Digital Literacy Among Community-Dwelling Korean Older Adults: Latent Profile Analysis %A Shin,Jiyoung %A Kang,Hun %A Choi,Seongmi %A Chu,Sang Hui %A Choi,JiYeon %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3301, jychoi610@yuhs.ac %K digital literacy %K digital divide %K older adults %K South Korea %K latent profile analysis %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital divide is apparent not only between older and younger generations but also within the older adult population itself. Identifying digital literacy profiles among older adults is crucial for developing targeted strategies to narrow this divide. Objective: This study aimed to identify profiles of digital literacy among community-dwelling older adults and to examine factors associated with these profiles. Methods: Data were collected from community-dwelling older adults in South Korea through a nationwide cross-sectional survey that assessed digital literacy and related factors. Digital literacy was evaluated across 3 domains: information and communication (9 items), content creation and management (4 items), and safety and security (9 items). Latent profile analysis was used to identify profiles of digital literacy among community-dwelling older adults, and multinomial logistic regression was used to identify predictors of profile membership. Results: A total of 1016 older adults completed structured questionnaires (average age 68, SD 6.5 years; 486/1016, 47.8% men). Three digital literacy profiles were identified (P<.001): “low level” (346/1016, 34.1%), “middle level” (374/1016, 36.8%), and “high level” (296/1016, 29.1%). With the “middle-level” digital literacy group as the reference group, older adult participants (odds ratio [OR] 1.11, 95% CI 1.07-1.15) with less than a middle school education (vs with a college degree or higher; OR 7.22, 95% CI 2.31-22.54), who needed help with one of the 10 instrumental daily activities (vs ≥2 activities; OR 3.06, 95% CI 1.11-8.40) and who did not engage in in-person social activities (OR 1.81, 95% CI 1.07-3.07), were more likely to be in the “low-level” group. Women were less likely to be in the “high-level” digital literacy group than men (OR 0.45, 95% CI 0.25-0.80). Participants with less than a college education were also less likely to be in the “high-level” group, with those having less than a middle school education showing the lowest OR (OR 0.17, 95% CI 0.07-0.41). Those who had never worked (OR 0.23, 95% CI 0.06-0.90) and those not engaging in regular physical exercise (OR 0.58, 95% CI 0.40-0.84) were also less likely to be in the “high-level” digital literacy group. Participants with greater social support were more likely to be in the “high-level” digital literacy group (OR 1.70, 95% CI 1.22-2.37). Conclusions: These findings underscore the characteristics linked to lower digital literacy and suggest a tailored approach to meet the needs of diverse groups of older adults in a digitalizing society. To promote digital literacy among older adults, potential strategies include improving access to and guidance for using digital devices, specifically designed for this demographic, as well as promoting social support and encouraging participation in social activities. %M 39969960 %R 10.2196/57122 %U https://www.jmir.org/2025/1/e57122 %U https://doi.org/10.2196/57122 %U http://www.ncbi.nlm.nih.gov/pubmed/39969960 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e59317 %T A Model of Trust in Online COVID-19 Information and Advice: Cross-Sectional Questionnaire Study %A Sillence,Elizabeth %A Branley-Bell,Dawn %A Moss,Mark %A Briggs,Pam %+ Department of Psychology, Northumbria University, Ellison Terrace, Newcastle upon Tyne, NE1 8ST, United Kingdom, 44 1912437251, elizabeth.sillence@northumbria.ac.uk %K eHealth %K electronic health %K digital intervention %K trust %K online information seeking %K scientific credibility %K digital resources %K COVID-19 %K SARS-CoV-2 %K respiratory %K infectious %K pulmonary %K pandemic %K public health %K health information %K global health %K surveys %K social media %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, many people sought information from websites and social media. Understanding the extent to which these sources were trusted is important in relation to health communication. Objective: This study aims to identify the key factors influencing UK citizens’ trust and intention to act on advice about COVID-19 found via digital resources and to test whether an existing model of trust in eHealth provided a good fit for COVID-19–related information seeking online. We also wished to identify any differences between the evaluation of general information and information relating specifically to COVID-19 vaccines. Methods: In total, 525 people completed an online survey in January 2022 encompassing a general web trust questionnaire, measures of information corroboration, coping perceptions, and intention to act. Data were analyzed using principal component analysis and structural equation modeling. The evaluation responses of general information and COVID-19 vaccine information were also compared. Results: The principal component analysis revealed 5 trust factors: (1) credibility and impartiality, (2) familiarity, (3) privacy, (4) usability, and (5) personal experiences. In the final structural equation modeling model, trust had a significant direct effect on intention to act (β=.65; P<.001). Of the trust factors, credibility and impartiality had a significant positive direct effect on trust (β=.82; P<.001). People searching for vaccination information felt less at risk, less anxious, and more optimistic after reading the information. We noted that most people sought information from “official” sources. Finally, in the context of COVID-19, “credibility and impartiality” remain a key predictor of trust in eHealth resources, but in comparison with previous models of trust in online health information, checking and corroborating information did not form a significant part of trust evaluations. Conclusions: In times of uncertainty, when faced with a global emergent health concern, people place their trust in familiar websites and rely on the perceived credibility and impartiality of those digital sources above other trust factors. %M 39946705 %R 10.2196/59317 %U https://infodemiology.jmir.org/2025/1/e59317 %U https://doi.org/10.2196/59317 %U http://www.ncbi.nlm.nih.gov/pubmed/39946705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64290 %T Laypeople’s Use of and Attitudes Toward Large Language Models and Search Engines for Health Queries: Survey Study %A Mendel,Tamir %A Singh,Nina %A Mann,Devin M %A Wiesenfeld,Batia %A Nov,Oded %+ Department of Technology Management and Innovation, Tandon School of Engineering, New York University, 2 Metrotech Center, Brooklyn, New York, NY, 11201, United States, 1 8287348968, tamir.mendel@nyu.edu %K large language model %K artificial intelligence %K LLMs %K search engine %K Google %K internet %K online health information %K United States %K survey %K mobile phone %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Laypeople have easy access to health information through large language models (LLMs), such as ChatGPT, and search engines, such as Google. Search engines transformed health information access, and LLMs offer a new avenue for answering laypeople’s questions. Objective: We aimed to compare the frequency of use and attitudes toward LLMs and search engines as well as their comparative relevance, usefulness, ease of use, and trustworthiness in responding to health queries. Methods: We conducted a screening survey to compare the demographics of LLM users and nonusers seeking health information, analyzing results with logistic regression. LLM users from the screening survey were invited to a follow-up survey to report the types of health information they sought. We compared the frequency of use of LLMs and search engines using ANOVA and Tukey post hoc tests. Lastly, paired-sample Wilcoxon tests compared LLMs and search engines on perceived usefulness, ease of use, trustworthiness, feelings, bias, and anthropomorphism. Results: In total, 2002 US participants recruited on Prolific participated in the screening survey about the use of LLMs and search engines. Of them, 52% (n=1045) of the participants were female, with a mean age of 39 (SD 13) years. Participants were 9.7% (n=194) Asian, 12.1% (n=242) Black, 73.3% (n=1467) White, 1.1% (n=22) Hispanic, and 3.8% (n=77) were of other races and ethnicities. Further, 1913 (95.6%) used search engines to look up health queries versus 642 (32.6%) for LLMs. Men had higher odds (odds ratio [OR] 1.63, 95% CI 1.34-1.99; P<.001) of using LLMs for health questions than women. Black (OR 1.90, 95% CI 1.42-2.54; P<.001) and Asian (OR 1.66, 95% CI 1.19-2.30; P<.01) individuals had higher odds than White individuals. Those with excellent perceived health (OR 1.46, 95% CI 1.1-1.93; P=.01) were more likely to use LLMs than those with good health. Higher technical proficiency increased the likelihood of LLM use (OR 1.26, 95% CI 1.14-1.39; P<.001). In a follow-up survey of 281 LLM users for health, most participants used search engines first (n=174, 62%) to answer health questions, but the second most common first source consulted was LLMs (n=39, 14%). LLMs were perceived as less useful (P<.01) and less relevant (P=.07), but elicited fewer negative feelings (P<.001), appeared more human (LLM: n=160, vs search: n=32), and were seen as less biased (P<.001). Trust (P=.56) and ease of use (P=.27) showed no differences. Conclusions: Search engines are the primary source of health information; yet, positive perceptions of LLMs suggest growing use. Future work could explore whether LLM trust and usefulness are enhanced by supplementing answers with external references and limiting persuasive language to curb overreliance. Collaboration with health organizations can help improve the quality of LLMs’ health output. %M 39946180 %R 10.2196/64290 %U https://www.jmir.org/2025/1/e64290 %U https://doi.org/10.2196/64290 %U http://www.ncbi.nlm.nih.gov/pubmed/39946180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59023 %T Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study %A Yang,Lu %A Lynch,Chris %A Lee,John Tayu %A Oldenburg,Brian %A Haregu,Tilahun %+ School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210049, China, 86 18094233761, Lindsay.yanglu@outlook.com %K digital divide %K health inequity %K China %K longitudinal study %K broadband %K internet connection %K internet %K well-being %K psychosocial %K middle age %K older adult %K inequality %K digital connectivity %K logistic regression %K questionnaire %K survey %K panel data approach %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5% in 2015 to 59.8% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. %M 39928942 %R 10.2196/59023 %U https://www.jmir.org/2025/1/e59023 %U https://doi.org/10.2196/59023 %U http://www.ncbi.nlm.nih.gov/pubmed/39928942 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e62936 %T Assessment of Technology Readiness in Norwegian Older Adults With Long-Term Health Conditions Receiving Home Care Services: Cross-Sectional Questionnaire Study %A Bergh,Sverre %A Benth,Jūratė Šaltytė %A Høgset,Lisbeth Dyrendal %A Rydjord,Britt %A Kayser,Lars %+ , Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, Ottestad, 2312, Norway, 47 45679393, sverre.bergh@sykehuset-innlandet.no %K eHealth literacy %K digital health services %K technology readiness %K Readiness and Enablement Index for Health Technology %K READHY %K chronic conditions %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: With the increasing number of older adults globally, there is a constant search for new ways to organize health care services. Digital health services are promising and may reduce workload and at the same time improve patient well-being. A certain level of eHealth literacy is needed to be able to use digital health services. However, knowledge of technology readiness in this target group of older adults is unclear. Objective: The aim of this study was to understand the technology readiness level of a group of older adults who were provided home care services in order to address the present and future needs of this group in relation to the implementation of digital health care services. Methods: This quantitative cross-sectional study included 149 older adults from Norway receiving home care services. The participants completed the Readiness and Enablement Index for Health Technology (READHY) instrument, assessments of well-being (World Health Organization-Five Well-Being Index [WHO-5]), and assessments of demographic and clinical variables (sex, age, education, living situation, comorbidity, use of digital devices, and use of IT). Cluster analyses were used to group the users according to their technology readiness. Results: The mean participant age was 78.6 (SD 8.0) years, and 55.7% (83/149) were women. There was good consistency within the assumed READHY scales (Cronbach α=.61-.91). The participants were grouped into 4 clusters, which differed in terms of READHY scores, demographic variables, and the use of IT in daily life. Participants in cluster 1 (n=40) had the highest scores on the READHY scales, were younger, had a larger proportion of men, had higher education, and had better access to digital devices and IT. Participants in cluster 4 (n=16) scored the lowest on eHealth literacy knowledge. Participants in cluster 1 had relatively high levels of eHealth literacy knowledge and were expected to benefit from digital health services, while participants in cluster 4 had the lowest level of eHealth literacy and would not easily be able to start using digital health services. Conclusions: The technology readiness level varied in our cohort of Norwegian participants receiving home care. Not all elderly people have the eHealth literacy to fully benefit from digital health services. Participants in cluster 4 (n=16) had the lowest scores in the eHealth Literacy Questionnaire scales in the READHY instrument and should be offered nondigital services or would need extensive management support. The demographic differences between the 4 clusters may inform stakeholders about which older people need the most training and support to take advantage of digital health care services. %M 39918862 %R 10.2196/62936 %U https://aging.jmir.org/2025/1/e62936 %U https://doi.org/10.2196/62936 %U http://www.ncbi.nlm.nih.gov/pubmed/39918862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68163 %T Mediating Effect of Social Capital on the Association Between Digital Literacy and Life Satisfaction Among Older Adults in South Korea: Cross-Sectional Study %A Jung,Hyein %A Lee,Hocheol %A Nam,Eun Woo %K digital literacy %K digital access %K digital competency %K digital utilization %K life satisfaction %K older adults %K social capital %K mediating effect %K aging %D 2025 %7 6.2.2025 %9 %J JMIR Form Res %G English %X Background: As Korea rapidly transforms into a super-aged society, research indicates that digital literacy among older adults enhances their life satisfaction. Digital literacy refers to the ability to efficiently use digital technologies, encompassing access, competency, and utilization. It reflects the capacity to navigate and benefit from digital environments effectively. Furthermore, social capital positively influences the quality of life, and digital literacy facilitates social capital formation. However, since most studies have only focused on the direct relationship between digital literacy and life satisfaction, research on the mediating role of social capital remains limited. Objective: To analyze the effect of digital literacy on the life satisfaction of older adults in South Korea and to verify whether social capital acts as a mediating factor in this process. Methods: This descriptive cross-sectional study used data from the 2023 Report on the Digital Divide—an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. The study targeted individuals aged 65 years or older. Descriptive statistics, the Pearson correlation analyses, and the 3-step multiple regression analysis proposed by Baron and Kenny were performed. The bootstrap method was employed, and all analyses were conducted using R, version 4.4.1. Results: The study included 869 participants. Digital literacy had a significant positive effect on their life satisfaction (β=0.103; P=.008). Social capital was also positively associated with life satisfaction (β=0.337; P<.001). Mediation analysis showed that digital literacy influenced life satisfaction both directly (β=0.103; P=.006) and indirectly through social capital (β=0.037; P=.03). Bootstrapping confirmed the significance of the indirect effect (β=0.037, 95% CI 0.005‐0.070; P=.03). The total effect of digital literacy on life satisfaction was also significant (β=0.140, 95% CI 0.058‐0.230; P=.002). Conclusions: This study analyzed the association between digital literacy, social capital, and life satisfaction among older adults in Korea. We identified that social capital mediates the association between digital literacy and life satisfaction among older adults. These findings indicate that tailored digital literacy programs and support policies that promote social capital formation could help bridge the digital divide and foster social inclusion. These measures would enable older adults to access essential services, reduce social isolation, and enhance health and well-being, ultimately improving the overall quality of life. %R 10.2196/68163 %U https://formative.jmir.org/2025/1/e68163 %U https://doi.org/10.2196/68163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65492 %T Measuring Digital Health Literacy in Older Adults: Development and Validation Study %A Kim,SungMin %A Park,Choonghee %A Park,Sunghyeon %A Kim,Dai-Jin %A Bae,Ye-Seul %A Kang,Jae-Heon %A Chun,Ji-Won %+ Department of Medical Informatics, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 9727, jwchun@catholic.ac.kr %K digital health care %K older adults %K digital health literacy %K exploratory factor analysis %K confirmatory factor analysis %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults’ digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. %M 39908081 %R 10.2196/65492 %U https://www.jmir.org/2025/1/e65492 %U https://doi.org/10.2196/65492 %U http://www.ncbi.nlm.nih.gov/pubmed/39908081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63449 %T eHealth Literacy and Cyberchondria Severity Among Undergraduate Students: Mixed Methods Study %A Hsu, Wan -Chen %K eHealth literacy %K undergraduate student %K cyberchondria %K compucondria %K web-based health information %K health information seeking %K college students %D 2025 %7 3.2.2025 %9 %J JMIR Form Res %G English %X Background: With the development of the internet, health care websites have become increasingly important by enabling easy access to health information, thereby influencing the attitudes and behaviors of individuals toward health issues. However, few studies have addressed public access to health information and self-diagnosis. Objective: This study investigated the background factors and status of cyberchondria severity among college students by conducting a nationwide sample survey using the Cyberchondria Severity Scale. Further, we explored the perspective of eHealth literacy of those with scores higher than 1 SD from the mean by analyzing their recent experiences using web-based health information. Methods: A nationally representative sample of college students was surveyed, and 802 valid responses were obtained (male: 435/802, 54.2%; female: 367/802, 45.8%; mean age 20.3, SD 1.4 years). The Cyberchondria Severity Scale was used, which consisted of 4 dimensions (increased anxiety, obsessive-compulsive hypochondria, perceived controllability, and web-based physician-patient interaction). Additionally, we recruited 9 volunteers who scored more than 1 SD above the mean for in-depth interviews on their web-based health information–seeking behaviors. Results: Significant differences were found across the 4 dimensions of cyberchondria severity (F3,2403=256.26; P<.001), with perceived controllability scoring the highest (mean 2.75, SD 0.87) and obsessive-compulsive hypochondria scoring the lowest (mean 2.19, SD 0.77). Positive correlations were observed between perceived controllability, web-based physician-patient interactions, increased anxiety, and obsessive-compulsive hypochondria (r=0.46-0.75, P<.001). Regression analysis indicated that health concern significantly predicted perceived controllability (β coefficient=0.12; P<.05) and web-based physician-patient interaction (β coefficient=0.16; P<.001). Interview data revealed that students often experienced heightened anxiety (8/9, 89%) and stress (7/9, 78%) after exposure to web-based health information, highlighting the need for improved health literacy and reliable information sources. Conclusions: The study identified both benefits and risks in college students’ use of web-based health information, emphasizing the importance of critical consciousness and eHealth literacy. Future research should examine how college students move from self-awareness to actionable change and the development of critical health literacy, which are essential for effective digital health engagement. %R 10.2196/63449 %U https://formative.jmir.org/2025/1/e63449 %U https://doi.org/10.2196/63449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65399 %T Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study %A Guo,Lin %A Li,Yunwei %A Cheng,Kai %A Zhao,Ying %A Yin,Wenqiang %A Liu,Ying %+ School of Humanities and Management, Zhejiang Chinese Medical University, No. 260 Baichuan Street, Fuyang District, Hangzhou, 311402, China, 86 18667013568, skyliu2171@163.com %K internet usage %K depression %K older people %K mechanism %K heterogeneity %K mobile phone %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. Objective: This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. Results: The findings indicate that internet usage results in a 1.41% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Conclusions: Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults. %M 39890098 %R 10.2196/65399 %U https://www.jmir.org/2025/1/e65399 %U https://doi.org/10.2196/65399 %U http://www.ncbi.nlm.nih.gov/pubmed/39890098 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e56941 %T Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis %A Specht,Lisa %A Scheible,Raphael %A Boeker,Martin %A Farin-Glattacker,Erik %A Kampel,Nikolas %A Schmölz,Marina %A Schöpf-Lazzarino,Andrea %A Schulz,Stefan %A Schlett,Christian %A Thomczyk,Fabian %A Voigt-Radloff,Sebastian %A Wegner,Constanze %A Wollmann,Katharina %A Maun,Andy %+ Institute of General Practice, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2m, Freiburg, 79110, Germany, 49 761 270 72490, lisa.specht@uniklinik-freiburg.de %K medical information %K health information %K search engine %K user behavior %K health literacy %K digital health literacy %K navigational needs %K information-seeking behavior %K evidence-based content %K Germany %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The internet is a key source of health information, but the quality of content from popular search engines varies, posing challenges for users—especially those with low health or digital health literacy. To address this, the “tala-med” search engine was developed in 2020 to provide access to high-quality, evidence-based content. It prioritizes German health websites based on trustworthiness, recency, user-friendliness, and comprehensibility, offering category-based filters while ensuring privacy by avoiding data collection and advertisements. Objective: This study aims to evaluate the acceptance and usability of this independent, noncommercial search engine from the users’ perspectives and their actual use of the search engine. Methods: For the questionnaire study, a cross-sectional study design was used. In total, 802 participants were recruited through a web-based panel and were asked to interact with the new search engine before completing a web-based questionnaire. Descriptive statistics and multiple regression analyses were used to assess participants’ acceptance and usability ratings, as well as predictors of acceptance. Furthermore, from October 2020 to June 2021, we used the open-source web analytics platform Matomo to collect behavior-tracking data from consenting users of the search engine. Results: The study indicated positive findings on the acceptance and usability of the search engine, with more than half of the participants willing to reuse (465/802, 58%) and recommend it (507/802, 63.2%). Of the 802 users, 747 (93.1%) valued the absence of advertising. Furthermore, 92.3% (518/561), 93.9% (553/589), 94.7% (567/599), and 96.5% (600/622) of those users who used the filters agreed at least partially that the filter functions were helpful in finding trustworthy, recent, user-friendly, or comprehensible results. Participants criticized some of the search results regarding the selection of domains and shared ideas for potential improvements (eg, for a clearer design). Regression analyses showed that the search engine was especially well accepted among older users, frequent internet users, and those with lower educational levels, indicating an effective targeting of segments of the population with lower health literacy and digital health literacy. Tracking data analysis revealed 1631 sessions, comprising 3090 searches across 1984 unique terms. Users performed 1.64 (SD 1.31) searches per visit on average. They prioritized the search terms “corona,” “back pain,” and “cough.” Filter changes were common, especially for recency and trustworthiness, reflecting the importance that users placed on these criteria. Conclusions: User questionnaires and behavior tracking showed the platform was well received, particularly by older and less educated users, especially for its advertisement-free design and filtering system. While feedback highlighted areas for improvement in design and filter functionality, the search engine’s focus on transparency, evidence-based content, and user privacy shows promise in addressing health literacy and navigational needs. Future updates and research will further refine its effectiveness and impact on promoting access to quality health information. %M 39847765 %R 10.2196/56941 %U https://humanfactors.jmir.org/2025/1/e56941 %U https://doi.org/10.2196/56941 %U http://www.ncbi.nlm.nih.gov/pubmed/39847765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54460 %T Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study %A Weidinger,Florian %A Dietzel,Nikolas %A Graessel,Elmar %A Prokosch,Hans-Ulrich %A Kolominsky-Rabas,Peter %K dementia %K mild cognitive impairment %K cognitive impairment %K information sources %K health information %K health information–seeking behavior %K Digital Dementia Registry Bavaria %K digiDEM %D 2025 %7 15.1.2025 %9 %J JMIR Form Res %G English %X Background: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information–seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information–seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context. Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression. Methods: This study is part of the ongoing project “Digital Dementia Registry Bavaria – digiDEM Bayern.” The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group. Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were “Personal visit to a medical professional” (mean 3.9, SD 1.1) and “Family / Friends” (mean 3.9, SD 1.2). “Internet” was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources “Internet” (F2,921=61.23; P<.001), “Courses / Lectures” (F2,921=18.88; P<.001), and “Family / Friends” (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as “Internet” (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were “TV / Radio” and “Family / Friends,” with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from “Internet” (mean difference=0.4; t685=4.97; P<.001). Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043473 %R 10.2196/54460 %U https://formative.jmir.org/2025/1/e54460 %U https://doi.org/10.2196/54460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62645 %T The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey %A Wu,Mengqiu %A Xue,Yongxi %A Ma,Chengyu %+ School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China, 86 10 83911576, machengyu@ccmu.edu.cn %K older adults %K digital divide %K internet use %K internet access %K health inequalities %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score–matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. %M 39813666 %R 10.2196/62645 %U https://www.jmir.org/2025/1/e62645 %U https://doi.org/10.2196/62645 %U http://www.ncbi.nlm.nih.gov/pubmed/39813666 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 8 %N %P e64548 %T Exploring Educators’ Perceptions and Experiences of Online Teaching to Foster Caring Profession Students’ Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study %A Nowell,Lorelli %A Johnston,Sonja %A Dolan,Sara %A Jacobsen,Michele %A Lorenzetti,Diane L %A Oddone Paolucci,Elizabeth %+ Faculty of Nursing, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada, 1 4036209822, lnowell@ucalgary.ca %K health care education %K virtual care %K telehealth %K online teaching %K mixed methods study %K student %K teaching %K virtual caring skills %K cross-sectional survey %K interview %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Nursing %G English %X Background: Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators’ perceptions and experiences of teaching caring profession students about virtual caring skills within online environments. Objective: This study aims to better understand caring profession educators’ online teaching experiences to foster student development of virtual caring skills and competencies. Methods: We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators’ online teaching experiences to foster student development of virtual caring skills and competencies. The survey’s primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators’ perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators’ experiences and perspectives. Results: A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators’ level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators’ faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability). Conclusions: Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions’ programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts. %M 39608377 %R 10.2196/64548 %U https://nursing.jmir.org/2025/1/e64548 %U https://doi.org/10.2196/64548 %U http://www.ncbi.nlm.nih.gov/pubmed/39608377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e50862 %T Jargon and Readability in Plain Language Summaries of Health Research: Cross-Sectional Observational Study %A Lang,Iain A %A King,Angela %A Boddy,Kate %A Stein,Ken %A Asare,Lauren %A Day,Jo %A Liabo,Kristin %+ Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, , United Kingdom, 44 7500 786180, i.lang@exeter.ac.uk %K readability %K jargon %K reading %K accessibility %K health research %K science communication %K public understanding of science %K open science %K patient and public involvement %K health literacy %K plain language summary %K health communication %D 2025 %7 13.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The idea of making science more accessible to nonscientists has prompted health researchers to involve patients and the public more actively in their research. This sometimes involves writing a plain language summary (PLS), a short summary intended to make research findings accessible to nonspecialists. However, whether PLSs satisfy the basic requirements of accessible language is unclear. Objective: We aimed to assess the readability and level of jargon in the PLSs of research funded by the largest national clinical research funder in Europe, the United Kingdom’s National Institute for Health and Care Research (NIHR). We also aimed to assess whether readability and jargon were influenced by internal and external characteristics of research projects. Methods: We downloaded the PLSs of all NIHR National Journals Library reports from mid-2014 to mid-2022 (N=1241) and analyzed them using the Flesch Reading Ease (FRE) formula and a jargon calculator (the De-Jargonizer). In our analysis, we included the following study characteristics of each PLS: research topic, funding program, project size, length, publication year, and readability and jargon scores of the original funding proposal. Results: Readability scores ranged from 1.1 to 70.8, with an average FRE score of 39.0 (95% CI 38.4-39.7). Moreover, 2.8% (35/1241) of the PLSs had an FRE score classified as “plain English” or better; none had readability scores in line with the average reading age of the UK population. Jargon scores ranged from 76.4 to 99.3, with an average score of 91.7 (95% CI 91.5-91.9) and 21.7% (269/1241) of the PLSs had a jargon score suitable for general comprehension. Variables such as research topic, funding program, and project size significantly influenced readability and jargon scores. The biggest differences related to the original proposals: proposals with a PLS in their application that were in the 20% most readable were almost 3 times more likely to have a more readable final PLS (incidence rate ratio 2.88, 95% CI 1.86-4.45). Those with the 20% least jargon in the original application were more than 10 times as likely to have low levels of jargon in the final PLS (incidence rate ratio 13.87, 95% CI 5.17-37.2). There was no observable trend over time. Conclusions: Most of the PLSs published in the NIHR’s National Journals Library have poor readability due to their complexity and use of jargon. None were readable at a level in keeping with the average reading age of the UK population. There were significant variations in readability and jargon scores depending on the research topic, funding program, and other factors. Notably, the readability of the original funding proposal seemed to significantly impact the final report’s readability. Ways of improving the accessibility of PLSs are needed, as is greater clarity over who and what they are for. %M 39805102 %R 10.2196/50862 %U https://www.jmir.org/2025/1/e50862 %U https://doi.org/10.2196/50862 %U http://www.ncbi.nlm.nih.gov/pubmed/39805102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55828 %T Development and Validation of the Digital Sensitivity Scale for Adults: Cross-Sectional Observational Study %A Park,Hae In %A Jeon,Minjeong %A Ahn,Ji Seon %A Chung,Kyungmi %A Park,Jin Young %+ Department of Psychiatry, Yongin Severance Hospital, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Republic of Korea, 82 5189 8148, empathy@yuhs.ac %K information literacy %K health literacy %K computer literacy %K self-efficacy %K attitude %K digital divide %D 2025 %7 10.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has accelerated the digitalization of modern society, extending digital transformation to daily life and psychological evaluation and treatment. However, the development of competencies and literacy in handling digital technology has not kept pace, resulting in a significant disparity among individuals. Existing measurements of digital literacy were developed before widespread information and communications technology device adoption, mainly focusing on one’s perceptions of their proficiency and the utility of device operation. In the contemporary landscape, digital transformation is evolving within specialized domains, necessitating a comprehensive evaluation of digital competencies, attitudes, and proficiency in technology application to bridge the digital divide and ensure digital compliance. Objective: This study was designed to address the shortcomings of existing scales and formulate a digital sensitivity scale tailored to the requirements of today’s society. Methods: Initial items of the Yongin Severance Digital Sensitivity Scale (YI-DSS) were collected through a literature review, and expert opinions were gathered to ensure content validity. An exploratory and confirmatory factor analysis included 986 adult participants evaluating 14 digital literacy items and 6 digital efficacy items. The Cronbach α confirmed internal consistency reliability, and 2-tailed t tests, ANOVAs, and post hoc tests analyzed demographic differences in digital literacy and efficacy. Results: A robust 4-factor digital literacy solution was identified: digital application, digital communication, critical thinking, and digital ethics (Kaiser-Meyer-Olkin=0.891; Bartlett × 2=9829.713; P<.001; Cronbach α=0.782-0.947). A 2-factor solution defined digital efficacy: digital confidence and digital anxiety (Kaiser-Meyer-Olkin=0.735; Bartlett × 2=3282.217; P<.001; Cronbach α=0.787-0.912). Confirmatory factor analysis was conducted for each model (digital literacy model: χ271=676.0, comparative fit index=0.938, Tucker-Lewis index=0.921, standardized root mean square residual=0.73, and root mean square error of approximation=0.093; digital efficacy model: χ28=81.9, comparative fit index=0.977, Tucker-Lewis index=0.958, standardized root mean square residual=0.73, and root mean square error of approximation=0.097), which indicated a good fit. The YI-DSS also showed high correlation with the previously developed Digital Literacy Scale (r=0.809; P<.001). Conclusions: The YI-DSS, as a self-assessment tool, has the potential to bridge the generational information gap by promoting acceptance, motivation, and adaptation to digital technology. Furthermore, given the remote nature of digital therapeutics, an individual’s familiarity with required technologies and digital communication strongly influences their acceptance of digital treatments and the efficacy thereof. This scale can play a pivotal role in enhancing compliance with digital therapeutics by preemptively assessing individuals’ technological literacy and competency. %M 39793004 %R 10.2196/55828 %U https://www.jmir.org/2025/1/e55828 %U https://doi.org/10.2196/55828 %U http://www.ncbi.nlm.nih.gov/pubmed/39793004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62824 %T The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study %A Valla,Luca Guido %A Rossi,Michele %A Gaia,Alessandra %A Guaita,Antonio %A Rolandi,Elena %+ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Room 101, 55-59 Gordon Square, London, WC1H 0AL, United Kingdom, 44 02076792000, a.gaia@ucl.ac.uk %K older adults %K information and communication technology %K ICT %K ICT use %K COVID-19 %K social capital %K health %K mental health %K digital divide %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships (β=–4.35, 95% CI 6.38 to –2.32; P<.001), cultural activities (β=–.55, 95% CI –0.75 to –0.35; P<.001), cognitive functioning (β=–1.00, 95% CI –1.28 to –0.72; P<.001), depressive symptoms (β=.42, 95% CI 0.10-0.74; P=.009), physical health (β=.07, 95% CI 0.04-0.10; P<.001), and ICT use (β=–.11, 95% CI –0.18 to –0.03; P=.008). Internet use predicts reduced depressive symptoms (β=–.56, 95% CI –1.07 to –0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities (β=–.73, 95% CI –1.22 to –0.24; P=.003) and cognitive functioning (β=1.36, 95% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults’ health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 %M 39784108 %R 10.2196/62824 %U https://www.jmir.org/2025/1/e62824 %U https://doi.org/10.2196/62824 %U http://www.ncbi.nlm.nih.gov/pubmed/39784108 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65065 %T Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study %A Jin,Hengjiang %A Qu,Ying %+ School of Journalism, Chongqing University, Number 174, Shazheng Street, Shapingba District, Chongqing, China, 86 15523596050, jinhj@cqu.edu.cn %K intergenerational support %K older adults %K internet medical intentions %K perceived technology %K trust %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults’ intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults’ intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5%). Of the 958 participants, 559 (58.4%) resided in rural areas, while 399 (41.6%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use (β=.292, P<.001), perceived usefulness (β=.437, P<.001), trust (β=.322, P<.001), and the intention to seek medical care online (β=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults (β=.109, P<.001). Perceived ease of use (β=.029, 95% CI 0.009-0.054), perceived usefulness (β=.089, 95% CI 0.050-0.130), and trust (β=.063, 95% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online (β=.015, 95% CI 0.008-0.027; β=.022, 95% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use (β=.177, P<.001), perceived usefulness (β=.073, P<.05), trust (β=.090, P<.01), and the intention to seek medical care online (β=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. %M 39761564 %R 10.2196/65065 %U https://www.jmir.org/2025/1/e65065 %U https://doi.org/10.2196/65065 %U http://www.ncbi.nlm.nih.gov/pubmed/39761564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54506 %T Influencers in Policy Fields on Social Media: Global Longitudinal Study of Dietary Sodium Reduction Posts, 2006-2022 %A Montoya,Alana %A Mao,Lingchao %A Drewnowski,Adam %A Chen,Joshua %A Shi,Ella %A Liang,Aileen %A Weiner,Bryan J %A Su,Yanfang %+ Evans School of Public Policy and Governance, University of Washington, 4105 George Washington Lane Northeast, Seattle, WA, 98105, United States, 1 2066165418, yfsu@uw.edu %K policy field %K sodium intake %K sodium consumption %K cardiovascular disease %K social media %K health education %K health promotion %K dissemination %K influence %K Twitter %K X %K activity %K priority %K originality %K popularity %D 2024 %7 30.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive sodium intake is a major concern for global public health. Despite multiple dietary guidelines, population sodium intakes are above recommended levels. Lack of health literacy could be one contributing issue and contemporary health literacy is largely shaped by social media. Objective: This study aims to quantify the posting behaviors and influence patterns on dietary sodium–related content by influencers in the policy field on X (formerly Twitter) across time. Methods: We first identified X users with a scope of work related to dietary sodium and retrieved their posts (formerly Tweets) from 2006 to 2022. Users were categorized into the policy groups of outer-setting organization, inner-setting organization, or individual, based on their role in the conceptual policy field. Network analysis was used to analyze interactions among users and identify the top influencers in each policy group. A 4D influence framework was applied to measure the overall influence, activity, priority, originality, and popularity scores. These measures were used to reveal the user-level, group-level, and temporal patterns of sodium-related influence. Results: We identified 78 users with content related to dietary sodium, with 1,099,605 posts in total and 14,732 dietary sodium posts. There was an increasing volume of sodium posts from 2010 to 2015; however, the trend has been decreasing since 2016, especially among outer-setting organizations. The top influencers from the three policy groups were the World Health Organization (WHO), the American Heart Association, and Tom Frieden. Simon Capewell and the WHO ranked the highest in activity; the World Action on Salt, Sugar, and Health and Action on Salt had the highest priority for dietary sodium content; General Mills and Tom Frieden had the highest originality; and WHO, Harvard University School of Medicine, and Tom Frieden received the highest popularity. Outer-setting organizations tend to interact with more users in the network compared to inner-setting organizations and individuals, while inner-setting organizations tend to receive more engagements from other users in the network than the other two groups. Monthly patterns showed a significant peak in the number of sodium posts in March compared with other months. Conclusions: Despite the increased use of social media, recent trends of sodium intake education on social media are decreasing and the priority of sodium among other topics is low. To improve policy implementation effectiveness and meet recommended dietary targets, there is an increasing need for health leaders to consistently and collectively advocate for sodium intake reduction on social media. %M 39753214 %R 10.2196/54506 %U https://www.jmir.org/2024/1/e54506 %U https://doi.org/10.2196/54506 %U http://www.ncbi.nlm.nih.gov/pubmed/39753214 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52448 %T Social Media Recruitment as a Potential Trigger for Vulnerability: Multistakeholder Interview Study %A Matthes,Nina %A Willem,Theresa %A Buyx,Alena %A Zimmermann,Bettina M %K vulnerability %K social media %K clinical study enrollment %K clinical study recruitment %K clinical trials %K stigma %K discrimination %K injustice %K recruitment %K clinical study %K hepatitis B %K TherVacB %K clinical research %K attitudes %K patient privacy %K utilization %D 2024 %7 30.12.2024 %9 %J JMIR Hum Factors %G English %X Background: More clinical studies use social media to increase recruitment accrual. However, empirical analyses focusing on the ethical aspects pertinent when targeting patients with vulnerable characteristics are lacking. Objective: This study aims to explore expert and patient perspectives on vulnerability in the context of social media recruitment and seeks to explore how social media can reduce or amplify vulnerabilities. Methods: As part of an international consortium that tests a therapeutic vaccine against hepatitis B (TherVacB), we conducted 30 qualitative interviews with multidisciplinary experts in social media recruitment (from the fields of clinical research, public relations, psychology, ethics, philosophy, law, and social sciences) about the ethical, legal, and social challenges of social media recruitment. We triangulated the expert assessments with the perceptions of 6 patients with hepatitis B regarding social media usage and attitudes relative to their diagnosis. Results: Experts perceived social media recruitment as beneficial for reaching hard-to-reach populations and preserving patient privacy. Features that may aggravate existing vulnerabilities are the acontextual point of contact, potential breaches of user privacy, biased algorithms disproportionately affecting disadvantaged groups, and technological barriers such as insufficient digital literacy skills and restricted access to relevant technology. We also report several practical recommendations from experts to navigate these triggering effects of social media recruitment, including transparent communication, addressing algorithm bias, privacy education, and multichannel recruitment. Conclusions: Using social media for clinical study recruitment can mitigate and aggravate potential study participants’ vulnerabilities. Researchers should anticipate and address the outlined triggering effects within this study’s design and proactively define strategies to overcome them. We suggest practical recommendations to achieve this. %R 10.2196/52448 %U https://humanfactors.jmir.org/2024/1/e52448 %U https://doi.org/10.2196/52448 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63034 %T Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study %A Tartaglia,Julia %A Jaghab,Brendan %A Ismail,Mohamed %A Hänsel,Katrin %A Meter,Anna Van %A Kirschenbaum,Michael %A Sobolev,Michael %A Kane,John M %A Tang,Sunny X %+ Department of Psychiatry, Northwell Health, Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY, 11004, United States, 1 914 682 5482, jut4006@med.cornell.edu %K digital literacy %K attitudes %K mental health %K digital health technology %K cluster analysis %K psychiatry %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients’ digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9%), Black (39/256, 15.2%), Latinx (44/256, 17.2%), Asian (59/256, 23%), and other races and ethnicities (15/256, 5.7%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. %M 39753220 %R 10.2196/63034 %U https://mental.jmir.org/2024/1/e63034 %U https://doi.org/10.2196/63034 %U http://www.ncbi.nlm.nih.gov/pubmed/39753220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60483 %T Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors %A Chadwick,Helen %A Laverty,Louise %A Finnigan,Robert %A Elias,Robert %A Farrington,Ken %A Caskey,Fergus J %A van der Veer,Sabine N %K aged %K digital health %K health equity %K intersectionality, qualitative research %K social deprivation %D 2024 %7 26.12.2024 %9 %J JMIR Form Res %G English %X Background: The potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized. Objective: This study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived. Methods: We conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework. Results: We interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were “not for them.” We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care. Conclusions: We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity. %R 10.2196/60483 %U https://formative.jmir.org/2024/1/e60483 %U https://doi.org/10.2196/60483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59843 %T Large Language Models May Help Patients Understand Peer-Reviewed Scientific Articles About Ophthalmology: Development and Usability Study %A Kianian,Reza %A Sun,Deyu %A Rojas-Carabali,William %A Agrawal,Rupesh %A Tsui,Edmund %+ Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, 200 Stein Plaza, Los Angeles, CA, 90095, United States, 1 310 825 5440, etsui@mednet.ucla.edu %K uveitis %K artificial intelligence %K ChatGPT %K readability %K peer review %K large language models %K LLMs %K health literacy %K patient education %K medical information %K ophthalmology %D 2024 %7 24.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adequate health literacy has been shown to be important for the general health of a population. To address this, it is recommended that patient-targeted medical information is written at a sixth-grade reading level. To make well-informed decisions about their health, patients may want to interact directly with peer-reviewed open access scientific articles. However, studies have shown that such text is often written with highly complex language above the levels that can be comprehended by the general population. Previously, we have published on the use of large language models (LLMs) in easing the readability of patient-targeted health information on the internet. In this study, we continue to explore the advantages of LLMs in patient education. Objective: This study aimed to explore the use of LLMs, specifically ChatGPT (OpenAI), to enhance the readability of peer-reviewed scientific articles in the field of ophthalmology. Methods: A total of 12 open access, peer-reviewed papers published by the senior authors of this study (ET and RA) were selected. Readability was assessed using the Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook tests. ChatGPT 4.0 was asked “I will give you the text of a peer-reviewed scientific paper. Considering that the recommended readability of the text is 6th grade, can you simplify the following text so that a layperson reading this text can fully comprehend it? - Insert Manuscript Text -”. Appropriateness was evaluated by the 2 uveitis-trained ophthalmologists. Statistical analysis was performed in Microsoft Excel. Results: ChatGPT significantly lowered the readability and length of the selected papers from 15th to 7th grade (P<.001) while generating responses that were deemed appropriate by expert ophthalmologists. Conclusions: LLMs show promise in improving health literacy by enhancing the accessibility of peer-reviewed scientific articles and allowing the general population to interact directly with medical literature. %M 39719077 %R 10.2196/59843 %U https://www.jmir.org/2024/1/e59843 %U https://doi.org/10.2196/59843 %U http://www.ncbi.nlm.nih.gov/pubmed/39719077 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63054 %T Factors Associated With Digital Capacity for Health Promotion Among Primary Care Workers: Cross-Sectional Survey Study %A Wang,Yining %A Ren,Hui %A Xiao,Shaotan %A Meng,Tian %A Sun,Shuyue %A Yu,Siyu %A Liu,Qing %A Wang,Fan %+ Fudan Development Institute, Fudan University, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K health promotion %K digital capacity %K primary care workers %K Digital Capabilities Framework %K online survey %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers’ inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers. Objective: This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers. Methods: A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp). Results: We included 1199 participants. Among them, 47.5% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage–related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4% of the total variance. Master’s degree or above (β=.077; P=.013), perceived usability (β=.235; P<.001), attitudes toward digital media health promotion (β=.095; P=.002), and past digital media health promotion practices (β=.377; P<.001) had significantly positive associations with digital capacities for health promotion. However, senior (β=–.076; P=.008) or median (β=–.074; P=.01) titles had a significant negative association with capacity levels. Conclusions: A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices. %M 39705686 %R 10.2196/63054 %U https://www.jmir.org/2024/1/e63054 %U https://doi.org/10.2196/63054 %U http://www.ncbi.nlm.nih.gov/pubmed/39705686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63288 %T eHealth Literacy and Health-Related Internet Use Among Swedish Primary Health Care Visitors: Cross-Sectional Questionnaire Study %A Sjöström,Anna %A Hajdarevic,Senada %A Hörnsten,Åsa %A Isaksson,Ulf %K eHealth literacy %K primary health care %K health-related internet information %K health literacy %K digitalization %K eHealth %K cost-effective care %K internet %K health applications %K digital health %K patient participation %K health behaviors %K questionnaire %K well-being %D 2024 %7 5.12.2024 %9 %J JMIR Form Res %G English %X Background: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. Objective: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. Methods: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. Results: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8‐3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2‐3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2‐3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2‐3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2‐3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1‐1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02‐1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1‐1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Conclusions: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users’ individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible. %R 10.2196/63288 %U https://formative.jmir.org/2024/1/e63288 %U https://doi.org/10.2196/63288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48882 %T Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design %A Lungu,Daniel Adrian %A Røislien,Jo %A Smeets,Ionica %A Wiig,Siri %A Brønnick,Kolbjørn Kallesten %+ SHARE – Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, PO Box 8600, Stavanger, 4021, Norway, 47 91532327, daniel.a.lungu@uis.no %K video communication %K COVID-19 pandemic %K comprehension %K health literacy %K video %K videos %K health communication %K psychology %K perception %K comprehend %K understanding %K coronavirus disease 2019 %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension—age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). %M 39631064 %R 10.2196/48882 %U https://www.jmir.org/2024/1/e48882 %U https://doi.org/10.2196/48882 %U http://www.ncbi.nlm.nih.gov/pubmed/39631064 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e55677 %T Health and eHealth Literacy of Patients With Diabetes in Low-Income Countries: Perspective From Guinea and Burkina Faso %A Ouedraogo,Ismaila %A Some,Borlli Michel J %A Benedikter,Roland %A Diallo,Gayo %K health literacy %K eHealth literacy %K diabetic patients %K Guinea %K Burkina Faso %K patients with diabetes %K diabetes %D 2024 %7 3.12.2024 %9 %J JMIR Diabetes %G English %X Background: Diabetes is a significant health concern in sub-Saharan Africa, emphasizing the importance of assessing the health literacy and eHealth skills of hospitalized patients with diabetes. This study evaluated the health literacy and eHealth literacy of patients with diabetes at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mobile health (mHealth) solutions to improve self-management and treatment outcomes. Objective: The aim of this study is to evaluate the levels of health literacy and eHealth literacy among patients at Sanou Sourou Hospital in Burkina Faso and Donka Hospital in Guinea. Methods: The study included 45 participants from Donka Hospital and 47 from Sanou Sourou Hospital. Data collection took place in May 2022, focusing on variables such as gender, age, education, income, and technology access. Health literacy and eHealth literacy were measured using the Brief Health Literacy Screen (BHLS) and the eHealth Literacy Scale (eHEALS), respectively. Statistical analysis was performed using SPSS 28. Results: The results indicated that 64% (64/99) of participants at Donka Hospital and 57% (57/99) at Sanou Sourou Hospital were female. The majority of participants (48/98, 49% in both hospitals) fell within the age range of 25-50 years. High rates of illiteracy were observed (62/100, 62% in Donka Hospital and 59/100, 59% in Sanou Sourou Hospital). Smartphone ownership was prevalent (62/99, 62% at Donka Hospital and 64/100, 64% at Sanou Sourou Hospital). Participants reported occasional use of technology for basic purposes and frequent internet usage for accessing health information. However, a significant proportion of participants demonstrated low health literacy (73/99, 73% at Donka Hospital; 79/101, 78% at Sanou Sourou Hospital) and inadequate eHealth literacy (57/100, 57% at Donka Hospital; 62/100, 62% at Sanou Sourou Hospital). Education was observed to positively correlate with health literacy, while age displayed a moderate negative correlation. Weak correlations were observed between gender, income, and health literacy, but these were not statistically significant. No significant correlation was found between the scores of the BHLS and the eHEALS in either hospital. Conclusions: This study highlights the importance of targeted educational interventions and mHealth solutions aimed at enhancing health and eHealth literacy among hospitalized patients with diabetes. Addressing both health literacy and eHealth literacy is paramount for improving diabetes management and treatment outcomes in Guinea and Burkina Faso. Targeted interventions and mHealth solutions have the potential to empower patients, enabling their active involvement in health care decisions and ultimately improving overall health outcomes. %R 10.2196/55677 %U https://diabetes.jmir.org/2024/1/e55677 %U https://doi.org/10.2196/55677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57301 %T Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study %A Chen,Bowen %A Yang,Chun %A Ren,Shanshan %A Li,Penggao %A Zhao,Jin %+ Department of Hospital Epidemiology and Infection Control, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 571 86006435, enqizhao@zju.edu.cn %K aging %K cognitive function %K internet use %K longitudinal study %K fixed effects model %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults. %M 39539034 %R 10.2196/57301 %U https://www.jmir.org/2024/1/e57301 %U https://doi.org/10.2196/57301 %U http://www.ncbi.nlm.nih.gov/pubmed/39539034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52498 %T Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=–.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=–.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=–.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. %M 39576987 %R 10.2196/52498 %U https://www.jmir.org/2024/1/e52498 %U https://doi.org/10.2196/52498 %U http://www.ncbi.nlm.nih.gov/pubmed/39576987 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63031 %T Assessing the Digital Advancement of Public Health Systems Using Indicators Published in Gray Literature: Narrative Review %A Maaß,Laura %A Badino,Manuel %A Iyamu,Ihoghosa %A Holl,Felix %+ SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, Bremen, 28359, Germany, 49 421 218 58610, laura.maass@uni-bremen.de %K digital public health %K health system %K indicator %K interdisciplinary %K information and communications technology %K maturity assessment %K readiness assessment %K narrative review %K gray literature %K digital health %K mobile phone %D 2024 %7 20.11.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Revealing the full potential of digital public health (DiPH) systems requires a wide-ranging tool to assess their maturity and readiness for emerging technologies. Although a variety of indices exist to assess digital health systems, questions arise about the inclusion of indicators of information and communications technology maturity and readiness, digital (health) literacy, and interest in DiPH tools by the society and workforce, as well as the maturity of the legal framework and the readiness of digitalized health systems. Existing tools frequently target one of these domains while overlooking the others. In addition, no review has yet holistically investigated the available national DiPH system maturity and readiness indicators using a multidisciplinary lens. Objective: We used a narrative review to map the landscape of DiPH system maturity and readiness indicators published in the gray literature. Methods: As original indicators were not published in scientific databases, we applied predefined search strings to the DuckDuckGo and Google search engines for 11 countries from all continents that had reached level 4 of 5 in the latest Global Digital Health Monitor evaluation. In addition, we searched the literature published by 19 international organizations for maturity and readiness indicators concerning DiPH. Results: Of the 1484 identified references, 137 were included, and they yielded 15,806 indicators. We deemed 286 indicators from 90 references relevant for DiPH system maturity and readiness assessments. The majority of these indicators (133/286, 46.5%) had legal relevance (targeting big data and artificial intelligence regulation, cybersecurity, national DiPH strategies, or health data governance), and the smallest number of indicators (37/286, 12.9%) were related to social domains (focusing on internet use and access, digital literacy and digital health literacy, or the use of DiPH tools, smartphones, and computers). Another 14.3% (41/286) of indicators analyzed the information and communications technology infrastructure (such as workforce, electricity, internet, and smartphone availability or interoperability standards). The remaining 26.2% (75/286) of indicators described the degree to which DiPH was applied (including health data architecture, storage, and access; the implementation of DiPH interventions; or the existence of interventions promoting health literacy and digital inclusion). Conclusions: Our work is the first to conduct a multidisciplinary analysis of the gray literature on DiPH maturity and readiness assessments. Although new methods for systematically researching gray literature are needed, our study holds the potential to develop more comprehensive tools for DiPH system assessments. We contributed toward a more holistic understanding of DiPH. Further examination is required to analyze the suitability and applicability of all identified indicators in diverse health care settings. By developing a standardized method to assess DiPH system maturity and readiness, we aim to foster informed decision-making among health care planners and practitioners to improve resource distribution and continue to drive innovation in health care delivery. %M 39566910 %R 10.2196/63031 %U https://publichealth.jmir.org/2024/1/e63031 %U https://doi.org/10.2196/63031 %U http://www.ncbi.nlm.nih.gov/pubmed/39566910 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59293 %T Developing and Validating the Health Literacy Scale for Migrant Workers: Instrument Development and Validation Study %A Kang,Soo Jin %A Oh,Hye-Kyung %A Han,Hae-Ra %K transients and migrants %K psychometrics %K scale development %K health literacy %K validation study %K Rasch model %D 2024 %7 13.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Research concerning health literacy among migrant workers in South Korea has been limited, especially given the lack of validated instruments and the lack of focus on the cultural diversity of migrant workers. Objective: This study aimed to develop and validate a health literacy scale for unskilled migrant workers (HLS-MW) in South Korea. Methods: We first generated a pool of potential items based on a literature review and in-depth interviews with 23 migrant workers. Subsequently, we reviewed empirical referents from the first step to select relevant medical terminologies and passages, ultimately choosing 709 words. The study team initially generated 35 items with 709 health-related terms through empirical referent reviews. After content validity testing by an expert panel, 28 items comprising 89 terms on the 2 subscales of prose and documents were selected for psychometric testing. Overall, 402 unskilled migrant workers in South Korea completed a web-based survey between August and September 2021, with 334 responses included in the final analysis. We used multiple analytic approaches, including exploratory factor analysis, Rasch analysis (item response theory), and descriptive analysis, to examine the new scale’s validity and reliability. Results: The final sample primarily included young male workers from South Asian countries. The HLS-MW yielded 2 factors: prose and documents. The item difficulty scores ranged from −1.36 to 2.56. The scale was reduced to 13 items (10 prose and 3 document items), with the final version exhibiting good internal reliability (Kuder-Richardson index=0.88; intraclass correlation coefficient=0.94, 95% CI 0.93‐0.95) and test-retest reliability (r=0.74, 95% CI 0.57‐0.92). HLS-MW scores differed significantly by Korean language proficiency (F2,331=3.54, P=.004). Conclusions: The HLS-MW is a reliable and valid measure to assess health literacy among migrant workers in South Korea. Further studies are needed to test the psychometric properties of the HLS-MW in diverse migrant groups in South Korea while also establishing cutoffs to help identify those in need of health literacy support. %R 10.2196/59293 %U https://publichealth.jmir.org/2024/1/e59293 %U https://doi.org/10.2196/59293 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e67634 %T Authors’ Reply: Promoting Oral Health Literacy Among UAE Public Sector Employees %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Dussart,Claude %A Lan,Romain %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %K United Arab Emirates %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/67634 %U https://publichealth.jmir.org/2024/1/e67634 %U https://doi.org/10.2196/67634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66452 %T Promoting Oral Health Literacy Among UAE Public Sector Employees %A Nair,Satish C %K health literacy %K Gulf countries %K oral health literacy %K health promotion %K United Arab Emirates %K workplace %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/66452 %U https://publichealth.jmir.org/2024/1/e66452 %U https://doi.org/10.2196/66452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54200 %T Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study %A Chen,Xing-Ling %A Li,Jin %A Sun,Shu-Ning %A Zhao,Qiang-Qiang %A Lin,Sheng-Rong %A Wang,Ling-Jun %A Yang,Zhong-Qi %A Ni,Shi-Hao %A Lu,Lu %+ State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 12 Airport Road, Baiyun District, Guangzhou, 510405, China, 86 02036585059, coinland@gzucm.edu.cn %K daily internet use %K intrinsic capacity %K IC %K middle-aged and older adult %K healthy aging %K social participation %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Intrinsic capacity (IC), as a comprehensive measure of an individual’s functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ≥45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9%) did not use the internet, while 521 (4.1%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78% (95% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. %M 39531641 %R 10.2196/54200 %U https://www.jmir.org/2024/1/e54200 %U https://doi.org/10.2196/54200 %U http://www.ncbi.nlm.nih.gov/pubmed/39531641 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58641 %T Older Adults’ Perspectives and Experiences With Digital Health in Singapore: Qualitative Study %A Leong,Qiao Ying %A Lee,V Vien %A Ng,Wei Ying %A Vijayakumar,Smrithi %A Lau,Ni Yin %A Mauritzon,Ingela %A Blasiak,Agata %A Ho,Dean %+ The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 6601 7515, biedh@nus.edu.sg %K digital health %K gerontology %K geriatrics %K elder %K aging %K Singapore %K qualitative %K mHealth %K mobile health %K experience %K technology use %K interview %K perspective %K acceptance %K technology adoption %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. %M 39527787 %R 10.2196/58641 %U https://humanfactors.jmir.org/2024/1/e58641 %U https://doi.org/10.2196/58641 %U http://www.ncbi.nlm.nih.gov/pubmed/39527787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48696 %T Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study %A Nowels,Molly Aideen %A McDarby,Meghan %A Brody,Lilla %A Kleiman,Evan %A Sagui Henson,Sara %A Castro Sweet,Cynthia %A Kozlov,Elissa %+ Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY, 10065, United States, 1 212 746 4888, mon2007@med.cornell.edu %K digital health %K mental health %K health care benefit %K prediction %K technology %K digital mental health %K employer-based %K teletherapy %K coaching %K utilization %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming “super users” of all resources. %R 10.2196/48696 %U https://www.jmir.org/2024/1/e48696 %U https://doi.org/10.2196/48696 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55086 %T Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis %A Chandrasekaran,Ranganathan %A Sadiq T,Muhammed %A Moustakas,Evangelos %+ University of Illinois at Chicago, 601 S Morgan Street, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K health misinformation %K digital divide %K racial disparities %K social media %K national survey-based analysis %K health information %K interventions %D 2024 %7 6.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals’ cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61% (1740/4959) of respondents reported encountering “a lot” of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing “some” amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. %M 39504121 %R 10.2196/55086 %U https://www.jmir.org/2024/1/e55086 %U https://doi.org/10.2196/55086 %U http://www.ncbi.nlm.nih.gov/pubmed/39504121 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58711 %T Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study %A Jordan,Arne %A Nothacker,Julia %A Paucke,Valentina %A Hager,Klaus Heinz %A Hueber,Susann %A Karimzadeh,Arian %A Kötter,Thomas %A Löffler,Christin %A Müller,Beate Sigrid %A Tajdar,Daniel %A Lühmann,Dagmar %A Scherer,Martin %A Schäfer,Ingmar %+ Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, 49 40 7410 52760, in.schaefer@uke.de %K climate change %K online survey %K open internet data %K climate %K environment %K rising temperature %K heatexposure %K chronic disease management %K epidemiology %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients’ issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=–0.25, 95% CI –0.49 to –0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=–0.39, 95% CI –0.54 to –0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 %M 39496153 %R 10.2196/58711 %U https://publichealth.jmir.org/2024/1/e58711 %U https://doi.org/10.2196/58711 %U http://www.ncbi.nlm.nih.gov/pubmed/39496153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56386 %T Relationships Among eHealth Literacy, Physical Literacy, and Physical Activity in Chinese University Students: Cross-Sectional Study %A Jiang,Shan %A Ng,Johan Y Y %A Choi,Siu Ming %A Ha,Amy S %+ Department of Sport Science and Physical Education, The Chinese University of Hong Kong, G05 Kwok Sports Building, Shatin, N.T., Hong Kong, China (Hong Kong), 852 39436083, sauchingha@cuhk.edu.hk %K eHealth literacy %K physical literacy %K physical activity %K university students %K health behavior %D 2024 %7 4.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one’s understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL. Objective: This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables. Methods: In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables. Results: The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t636=4.94; P<.001) and PL (t636=3.18; P<.001), but no significant differences were found in eHealth literacy (t636=1.23; P=.22). Conclusions: The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities. %M 39496161 %R 10.2196/56386 %U https://www.jmir.org/2024/1/e56386 %U https://doi.org/10.2196/56386 %U http://www.ncbi.nlm.nih.gov/pubmed/39496161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57040 %T How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars %A Sakhuja,Mayank %A Yelton,Brooks %A Kavarana,Simone %A Schaurer,Lauren %A Rumthao,Jancham Rachel %A Noblet,Samuel %A Arent,Michelle A %A Macauda,Mark M %A Donelle,Lorie %A Friedman,Daniela B %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall, Chapel Hill, NC, 27599-7295, United States, 1 8034468063, msakhuja@unc.edu %K health literacy %K digital health literacy %K eHealth literacy %K social determinants of health %K SDoH %K research scholarship %K health care %K public health research %K digital health tools %K community health %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators’ research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. %M 39481097 %R 10.2196/57040 %U https://www.jmir.org/2024/1/e57040 %U https://doi.org/10.2196/57040 %U http://www.ncbi.nlm.nih.gov/pubmed/39481097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54827 %T The Online Health Information–Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study %A Clancy,Brigid %A Bonevski,Billie %A English,Coralie %A Guillaumier,Ashleigh %+ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4055 3222, brigid.clancy@newcastle.edu.au %K stroke %K online health information seeking %K information-seeking behavior %K consumer health information %K digital health %K eHealth %K long-term care %K health-risk behaviors %K qualitative research %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. Objective: This study aims to explore the online health information–seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Methods: Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive–deductive approach. In the deductive analysis, responses were mapped to an online health information–seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. Results: A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information–seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants’ online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. Conclusions: People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support. %M 39423365 %R 10.2196/54827 %U https://formative.jmir.org/2024/1/e54827 %U https://doi.org/10.2196/54827 %U http://www.ncbi.nlm.nih.gov/pubmed/39423365 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54135 %T Online Health Information Seeking, eHealth Literacy, and Health Behaviors Among Chinese Internet Users: Cross-Sectional Survey Study %A Liu,Diyi %A Yang,Shuhang %A Cheng,Calvin Yixiang %A Cai,Lin %A Su,Jing %+ School of Humanities, Tsinghua University, 314A7 Mingli Building, Beijing, 100084, China, 86 13520625867, sujingxw@tsinghua.edu.cn %K eHealth literacy %K online health information seeking %K health behavior %K perceived information quality %K health promotion %K China %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has become an increasingly vital platform for health-related information, especially in upper-middle-income countries such as China. While previous research has suggested that online health information seeking (OHIS) can significantly impact individuals’ engagement in health behaviors, most research focused on patient-centered health communication. Objective: This study aims to examine how OHIS influences health behavior engagement among Chinese internet users, focusing on the role of eHealth literacy and perceived information quality in influencing relationships. Methods: An online cross-sectional survey was conducted in November 2021 among 10,000 Chinese internet users, using quota sampling based on sex, age, and urban and rural residence, in line with the 48th Statistical Report on Internet Development of China. Nonparametric tests were used to examine the differences in eHealth literacy across sociodemographic groups. Partial correlation analysis and stepwise linear regression were conducted to test the associations between key variables. Confirmatory factor analysis and structural equation modeling were conducted to test the hypotheses. Results: Our study identified significant disparities in functional and critical eHealth literacy between urban and rural residents across age groups, income levels, education backgrounds, and health conditions (all P<.001). In terms of sex and regional differences, we found higher functional literacy among female users than male users, and critical literacy varied significantly across different regions. The proposed structural model showed excellent fit (χ2404=4183.6, χ2404=10.4,P<.001; root mean square error of approximation value of 0.031, 95% CI 0.030-.031; standardized root mean square residual value of 0.029; and comparative fit index value of 0.955), highlighting reciprocal associations between 2 types of eHealth literacy and OHIS. Participants’ functional eHealth literacy, critical eHealth literacy, and OHIS have positive impacts on their health behavioral engagement. Perceived information quality was found to mediate the influence of OHIS on health behavior (b=0.003, 95% CI 0.002-0.003; P<.001). Conclusions: The study revealed the pathways linking sociodemographic factors, eHealth literacy, OHIS, and perceived information quality and how they together influenced health outcomes. The findings underscore the significance of enhancing eHealth literacy and improving information quality to promote better health outcomes among Chinese internet users. %M 39423374 %R 10.2196/54135 %U https://www.jmir.org/2024/1/e54135 %U https://doi.org/10.2196/54135 %U http://www.ncbi.nlm.nih.gov/pubmed/39423374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53705 %T Exploring Physicians’ Perceptions of Digital Health’s Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study %A Sze,Kai Ping %A Fong,Qi Wei %A De Roza,Jacqueline Giovanna %A Lee,Eng Sing %A Tan,Shu Yun %+ National Healthcare Group Polyclinics, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore, 65 63553000, kai_ping_sze@nhgp.com.sg %K patient-physician relationship %K patient communication %K trust %K primary care medicine %K digital health %K primary care %K longitudinal care %K policy %K implementation %D 2024 %7 15.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. Objective: This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. Methods: This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. Results: We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised “social and personal,” “technical and material,” and “organization and policy” factors. Conclusions: The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship. %M 39405515 %R 10.2196/53705 %U https://www.jmir.org/2024/1/e53705 %U https://doi.org/10.2196/53705 %U http://www.ncbi.nlm.nih.gov/pubmed/39405515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49704 %T Evaluating Expert-Layperson Agreement in Identifying Jargon Terms in Electronic Health Record Notes: Observational Study %A Lalor,John P %A Levy,David A %A Jordan,Harmon S %A Hu,Wen %A Smirnova,Jenni Kim %A Yu,Hong %+ Center for Biomedical and Health Research in Data Sciences, Miner School of Computer and Information Sciences, University of Massachusetts Lowell, 1 University Ave, Lowell, MA, 01854, United States, 1 978 934 3620, Hong_Yu@uml.edu %K expert-layperson agreement %K medical jargon %K jargon identification %K EHR %K electronic health record notes %K crowdsourcing %K clinical notes %D 2024 %7 15.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have shown that patients have difficulty understanding medical jargon in electronic health record (EHR) notes, particularly patients with low health literacy. In creating the NoteAid dictionary of medical jargon for patients, a panel of medical experts selected terms they perceived as needing definitions for patients. Objective: This study aims to determine whether experts and laypeople agree on what constitutes medical jargon. Methods: Using an observational study design, we compared the ability of medical experts and laypeople to identify medical jargon in EHR notes. The laypeople were recruited from Amazon Mechanical Turk. Participants were shown 20 sentences from EHR notes, which contained 325 potential jargon terms as identified by the medical experts. We collected demographic information about the laypeople’s age, sex, race or ethnicity, education, native language, and health literacy. Health literacy was measured with the Single Item Literacy Screener. Our evaluation metrics were the proportion of terms rated as jargon, sensitivity, specificity, Fleiss κ for agreement among medical experts and among laypeople, and the Kendall rank correlation statistic between the medical experts and laypeople. We performed subgroup analyses by layperson characteristics. We fit a beta regression model with a logit link to examine the association between layperson characteristics and whether a term was classified as jargon. Results: The average proportion of terms identified as jargon by the medical experts was 59% (1150/1950, 95% CI 56.1%-61.8%), and the average proportion of terms identified as jargon by the laypeople overall was 25.6% (22,480/87,750, 95% CI 25%-26.2%). There was good agreement among medical experts (Fleiss κ=0.781, 95% CI 0.753-0.809) and fair agreement among laypeople (Fleiss κ=0.590, 95% CI 0.589-0.591). The beta regression model had a pseudo-R2 of 0.071, indicating that demographic characteristics explained very little of the variability in the proportion of terms identified as jargon by laypeople. Using laypeople’s identification of jargon as the gold standard, the medical experts had high sensitivity (91.7%, 95% CI 90.1%-93.3%) and specificity (88.2%, 95% CI 86%-90.5%) in identifying jargon terms. Conclusions: To ensure coverage of possible jargon terms, the medical experts were loose in selecting terms for inclusion. Fair agreement among laypersons shows that this is needed, as there is a variety of opinions among laypersons about what is considered jargon. We showed that medical experts could accurately identify jargon terms for annotation that would be useful for laypeople. %M 39405109 %R 10.2196/49704 %U https://www.jmir.org/2024/1/e49704 %U https://doi.org/10.2196/49704 %U http://www.ncbi.nlm.nih.gov/pubmed/39405109 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 3 %N %P e53505 %T The Dual Nature of AI in Information Dissemination: Ethical Considerations %A Germani,Federico %A Spitale,Giovanni %A Biller-Andorno,Nikola %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 41 44 634 40 81, biller-andorno@ibme.uzh.ch %K AI %K bioethics %K infodemic management %K disinformation %K artificial intelligence %K ethics %K ethical %K infodemic %K infodemics %K public health %K misinformation %K information dissemination %K information literacy %D 2024 %7 15.10.2024 %9 Viewpoint %J JMIR AI %G English %X Infodemics pose significant dangers to public health and to the societal fabric, as the spread of misinformation can have far-reaching consequences. While artificial intelligence (AI) systems have the potential to craft compelling and valuable information campaigns with positive repercussions for public health and democracy, concerns have arisen regarding the potential use of AI systems to generate convincing disinformation. The consequences of this dual nature of AI, capable of both illuminating and obscuring the information landscape, are complex and multifaceted. We contend that the rapid integration of AI into society demands a comprehensive understanding of its ethical implications and the development of strategies to harness its potential for the greater good while mitigating harm. Thus, in this paper we explore the ethical dimensions of AI’s role in information dissemination and impact on public health, arguing that potential strategies to deal with AI and disinformation encompass generating regulated and transparent data sets used to train AI models, regulating content outputs, and promoting information literacy. %M 39405099 %R 10.2196/53505 %U https://ai.jmir.org/2024/1/e53505 %U https://doi.org/10.2196/53505 %U http://www.ncbi.nlm.nih.gov/pubmed/39405099 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54736 %T How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study %A Pani,Jasmine %A Lorusso,Letizia %A Toccafondi,Lara %A D'Onofrio,Grazia %A Ciccone,Filomena %A Russo,Sergio %A Giuliani,Francesco %A Sancarlo,Daniele %A Calamida,Novella %A Vignani,Gianna %A Pihl,Tarmo %A Rovini,Erika %A Cavallo,Filippo %A Fiorini,Laura %K active aging %K longitudinal study %K technostress %K technology usability and acceptance %K scaling up %D 2024 %7 9.10.2024 %9 %J JMIR Aging %G English %X Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults’ and their ecosystem’s perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults’ attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=−.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=−.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. %R 10.2196/54736 %U https://aging.jmir.org/2024/1/e54736 %U https://doi.org/10.2196/54736 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58035 %T Digital Health Readiness: Making Digital Health Care More Inclusive %A Bober,Timothy %A Rollman,Bruce L %A Handler,Steven %A Watson,Andrew %A Nelson,Lyndsay A %A Faieta,Julie %A Rosland,Ann-Marie %+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States, 1 412 692 4821, bobertm@upmc.edu %K digital health %K digital health literacy %K informatics %K digital disparities %K digital health readiness %K inclusivity %K digital health tool %K literacy %K patient support %K health system %D 2024 %7 9.10.2024 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person’s stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person’s goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care. %M 39383524 %R 10.2196/58035 %U https://mhealth.jmir.org/2024/1/e58035 %U https://doi.org/10.2196/58035 %U http://www.ncbi.nlm.nih.gov/pubmed/39383524 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e57077 %T Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course %A Doueiri,Zakaria Nadeem %A Bajra,Rika %A Srinivasan,Malathi %A Schillinger,Erika %A Cuan,Nancy %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 211 Quarry Road, Suite 402, Palo Alto, CA, 94304, United States, 1 650 724 1800, cuannan@stanford.edu %K service learning %K medical education %K access to care %K telehealth %K telemedicine %K health disparities %K social determinants of health %K digital literacy %K vulnerable populations %K community engagement %K value-added medical education %K digital health %K digital divide %K health equity %K collegiate navigator %K experimental %K education %K student %K qualitative analysis %K technology %K mobile phone %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Limited digital literacy is a barrier for vulnerable patients accessing health care. Objective: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. Methods: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. Results: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. Conclusions: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals. %M 39353186 %R 10.2196/57077 %U https://mededu.jmir.org/2024/1/e57077 %U https://doi.org/10.2196/57077 %U http://www.ncbi.nlm.nih.gov/pubmed/39353186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57801 %T Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple’s ResearchKit and CareKit: Usability Study %A Donawa,Alyssa %A Powell,Christian %A Wang,Rong %A Chih,Ming-Yuan %A Patel,Reema %A Zinner,Ralph %A Aronoff-Spencer,Eliah %A Baker,Corey E %+ Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Hughes Aircraft Electrical Engineering Center, 3740 McClintock Ave Suite 100, Los Angeles, CA, 90089, United States, 1 (213) 821 0415, donawa@usc.edu %K usability %K usability testing %K digital literacy %K ehealth literacy %K digital divide %K mobile health %K mHealth %K patients with cancer %K rural health %K distress %K apps %K ehealth adoption %K HealthKit %K CareKit %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple’s ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80%), from rural areas (25/30, 83%), had up to a high school education (19/30, 63%), and were unfamiliar with mHealth apps (21/30, 70%). General mobile app use was split, with 43% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ≥80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple’s ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. %M 39326043 %R 10.2196/57801 %U https://formative.jmir.org/2024/1/e57801 %U https://doi.org/10.2196/57801 %U http://www.ncbi.nlm.nih.gov/pubmed/39326043 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54467 %T Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study %A Guo,Ying %A Hong,Zixuan %A Cao,Chenglin %A Cao,Wenwen %A Chen,Ren %A Yan,Jing %A Hu,Zhi %A Bai,Zhongliang %K eHealth literacy %K medication adherence %K frailty %K older people %K China %D 2024 %7 11.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82‐1.63), less evaluation (AOR 1.29, 95% CI 0.92‐1.81), and less decision ability (AOR 1.20, 95% CI 0.86‐1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56‐2.13), less evaluation (AOR 1.05, 95% CI 0.61‐1.79), and less decision ability (AOR 1.10, 95% CI 0.64‐1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48‐1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47‐1.54), evaluation (AOR 0.89, 95% CI 0.50‐1.57), and decision ability (AOR 0.99, 95% CI 0.55‐1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48‐1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62‐2.44), evaluation (AOR 0.98, 95% CI 0.53‐1.82), and decision ability (AOR 0.90, 95% CI 0.49‐1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions. %R 10.2196/54467 %U https://publichealth.jmir.org/2024/1/e54467 %U https://doi.org/10.2196/54467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49688 %T Mediating Effects of Information Access on Internet Use and Multidimensional Health Among Middle-Aged and Older Adults: Nationwide Cross-Sectional Study %A Fu,Liping %A Liu,Caiping %A Dong,Yongqing %A Ma,Xiaodong %A Cai,Quanling %A Li,Dongli %A Di,Kaisheng %+ College of Management and Economics, Tianjin University, Weijin Road Campus No. 92, Xuefu Street, Nankai District, Tianjin, 300072, China, 86 13997138522, liucaiping@tju.edu.cn %K internet use %K health %K middle-aged and older adults %K information access %K mediation analysis %D 2024 %7 9.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. Objective: This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Methods: Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. Results: In our sample, nearly half (n=3036, 46.3%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health (β=.28, 95% CI 0.23-0.32), physical health (β=.40, 95% CI 0.35-0.45), and mental health (β=.16, 95% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. Conclusions: The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China. %M 39250790 %R 10.2196/49688 %U https://www.jmir.org/2024/1/e49688 %U https://doi.org/10.2196/49688 %U http://www.ncbi.nlm.nih.gov/pubmed/39250790 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52666 %T Changes in Infectious Disease–Specific Health Literacy in the Post–COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study %A Zhao,Yusui %A Xu,Yue %A Yao,Dingming %A Wu,Qingqing %A Chen,Heni %A Hu,Xiujing %A Huang,Yu %A Zhang,Xuehai %K survey %K infectious disease–specific health literacy %K COVID-19 %K health education %K factors %K postpandemic %D 2024 %7 30.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Infectious disease–specific health literacy (IDSHL) is a crucial factor in the development of infectious diseases. It plays a significant role not only in mitigating the resurgence of infectious diseases but also in effectively averting the emergence of novel infections such as COVID-19. During the 3 years of the COVID-19 pandemic, China primarily adopted nonpharmaceutical interventions, advocating for people to avoid crowded places and wear masks to prevent the spread of COVID-19. Consequently, there has been a dearth of research concerning IDSHL and its corresponding focal points for health education. Objective: This study aimed to (1) evaluate the changes in IDSHL scores between 2019 (before the COVID-19 pandemic) and 2022 (the postepidemic period of COVID-19) and (2) explore the risk factors affecting IDSHL using a multivariate logistic regression analysis. Methods: This study used 2-round cross-sectional surveys, conducted in 2019 and 2022, respectively, in 30 counties in Zhejiang Province, China. Multiple-stage stratified random sampling was used to select households, and a Kish grid was used to identify participants. An identical standardized questionnaire consisting of 12 closed-ended questions was used to measure IDSHL scores before and after the COVID-19 pandemic (2019 and 2022). Standard descriptive statistics, chi-square tests, t tests, and multivariate logistic regression analyses were used to analyze the data. Results: The 2-round cross-sectional surveys conducted in 2019 and 2022 yielded, out of 19,366 and 19,221 total questionnaires, 19,257 (99.44% response rate) and 18,857 (98.11% response rate) valid questionnaires, respectively. The correct response rate for the respiratory infectious diseases question “When coughing or sneezing, which of the following is correct?” increased from 29.10% in 2019 to 37.92% in 2022 (χ²1=332.625; P<.001). The correct response rate for the nonrespiratory infectious diseases question “In which of the following ways can hepatitis B be transmitted to others?” decreased from 64.28% to 59.67% (χ²1=86.059; P<.001). In terms of IDSHL scores, a comparison between 2022 and 2019 revealed notable statistical differences in the overall scores (t1=10.829; P<.001) and across the 3 dimensions of knowledge (t1=8.840; P<.001), behavior (t1=16.170; P<.001), and skills (t1=9.115; P<.001). With regard to the questions, all but 4 exhibited statistical differences (P<.001). Multivariate logistic regression analyses indicated that the 2022 year group had a higher likelihood of possessing acquired IDSHL than the 2019 group (odds ratio 1.323, 95% CI 1.264‐1.385; P<.001). Conclusions: When conducting health education, it is imperative to enhance efforts in nonrespiratory infectious disease health education, as well as respiratory infectious diseases such as COVID-19. Health education interventions should prioritize ethnic minority populations with a poor self-health status and low education. %R 10.2196/52666 %U https://publichealth.jmir.org/2024/1/e52666 %U https://doi.org/10.2196/52666 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54173 %T The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees %A Lawrence,Katharine %A Levine,Defne L %K digital health %K digital determinants of health %K digital health competencies %K medical education curriculum %K competency development %K digital health education %K training competencies %K digital health skills %K digital care delivery %K health professions training %D 2024 %7 29.8.2024 %9 %J JMIR Med Educ %G English %X Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of “virtual-first” care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a “digital determinants of health” (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education. %R 10.2196/54173 %U https://mededu.jmir.org/2024/1/e54173 %U https://doi.org/10.2196/54173 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52017 %T The Impact and Acceptance of Gamification by Learners in a Digital Literacy Course at the Undergraduate Level: Randomized Controlled Trial %A Alnuaim,Abeer %K gamification %K games %K technology integration %K information literacy %K technology acceptance %D 2024 %7 23.8.2024 %9 %J JMIR Serious Games %G English %X Background: In recent years, the integration of technology in education has revolutionized traditional learning paradigms. Digital literacy, a crucial skill in the 21st century, has become a vital aspect of modern education, enabling students to navigate, critically assess, and effectively use digital tools. As educators strive to boost engagement and learning outcomes, gamification has appeared as an auspicious pedagogical approach. By applying game mechanics to nongame contexts, gamification seeks to create a more immersive and digital learning experience. Objective: This research paper aims to investigate the impact and acceptance of gamification by learners in a digital literacy course at the undergraduate level. Methods: In a pre-post intervention study, 168 undergraduate students were randomly assigned either to the experimental group (gamification based) or control group (conventional) learning condition. Both groups of participants learned the same topics in digital literacy. Results: Empirical findings showed that participants from the experimental group had better academic performance in digital literacy than those who were not exposed to the game-based learning environment. The participants’ prior experience with gamification was not found to be a significant predictor of their acceptance of gamification in a digital literacy course. Conclusions: The study provides evidence supporting the potential benefits of gamification in enhancing digital literacy education and opens the door for further exploration and implementation of gamified learning approaches in higher education settings. %R 10.2196/52017 %U https://games.jmir.org/2024/1/e52017 %U https://doi.org/10.2196/52017 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e53258 %T Newly Qualified Canadian Nurses’ Experiences With Digital Health in the Workplace: Comparative Qualitative Analysis %A Kleib,Manal %A Arnaert,Antonia %A Nagle,Lynn M %A Sugars,Rebecca %A da Costa,Daniel %+ Faculty of Nursing, University of Alberta, 5-112 Edmonton Clinic Health Academy, Edmonton, AB, T6G1C9, Canada, 1 7802481422, manal.kleib@ualberta.ca %K digital health %K new graduate nurses %K nursing practice %K workplace %K informatics %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates’ experiences as they transition to the workplace. Objective: This study aims to (1) describe newly qualified nurses’ experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates’ transition and practice with digital health. Methods: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. Results: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. Conclusions: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future. %M 39159452 %R 10.2196/53258 %U https://mededu.jmir.org/2024/1/e53258 %U https://doi.org/10.2196/53258 %U http://www.ncbi.nlm.nih.gov/pubmed/39159452 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58942 %T Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Lan,Romain %A Dussart,Claude %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %D 2024 %7 15.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people’s lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population. Objective: This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces. Methods: A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed. Results: A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores. Conclusions: Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases. %R 10.2196/58942 %U https://publichealth.jmir.org/2024/1/e58942 %U https://doi.org/10.2196/58942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55138 %T Characterizing the Adoption and Experiences of Users of Artificial Intelligence–Generated Health Information in the United States: Cross-Sectional Questionnaire Study %A Ayo-Ajibola,Oluwatobiloba %A Davis,Ryan J %A Lin,Matthew E %A Riddell,Jeffrey %A Kravitz,Richard L %+ Division of General Medicine, University of California Davis, 4150 V Street, PSSB Suite 2400, Sacramento, CA, 95817, United States, 1 916 734 7005, rlkravitz@ucdavis.edu %K artificial intelligence %K ChatGPT %K health information %K patient information-seeking %K online health information %K health literacy %K ResearchMatch %K users %K diagnosis %K decision-making %K cross-sectional %K survey %K surveys %K adoption %K utilization %K AI %K less-educated %K poor health %K worse health %K experience %K experiences %K user %K users %K non user %K non users %K AI-generated %K health information %K implication %K implications %K medical practice %K medical practices %K public health %K descriptive statistics %K t test %K t tests %K chi-square test %K chi-square tests %K health-seeking behavior %K health-seeking behaviors %K patient-provider %K interaction %K interactions %K patient %K patients %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: OpenAI’s ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals’ health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what. Objective: This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform. Methods: In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers. Results: Of 2406 respondents, 21.5% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9% vs 67%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2% vs 22.8%, P<.001). Around 39.3% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4%, n=245) or to explore alternative treatment (46.2%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7%, n=429) and their doctor (81%, n=407). About one-third of respondents requested a referral (35.6%, n=184) or changed medications (31%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9%, n=336), most turned to their physicians (67.5%, n=349). Conclusions: This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology. %M 39141910 %R 10.2196/55138 %U https://www.jmir.org/2024/1/e55138 %U https://doi.org/10.2196/55138 %U http://www.ncbi.nlm.nih.gov/pubmed/39141910 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56061 %T Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey %A Kyaw,Myat Yadana %A Aung,Myo Nyein %A Koyanagi,Yuka %A Moolphate,Saiyud %A Aung,Thin Nyein Nyein %A Ma,Hok Ka Carol %A Lee,Hocheol %A Nam,Hae-Kweun %A Nam,Eun Woo %A Yuasa,Motoyuki %K eHealth literacy %K eHEALS %K electronic health information %K eHealth information %K health literacy %K health education %K eHealth education %K health training %K eHealth training %K digital health %K digital technology %K digital intervention %K digital interventions %K gray digital divide %K healthy aging %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K older person %K older people %K aging %K aging %K eHealth Literacy Scale %D 2024 %7 13.8.2024 %9 %J JMIR Aging %G English %X Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02‐15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. %R 10.2196/56061 %U https://aging.jmir.org/2024/1/e56061 %U https://doi.org/10.2196/56061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58497 %T Development and Validation of a Mobile-Centered Digital Health Readiness Scale (mDiHERS): Health Literacy and Equity Scale %A Kim,Hana %A Schnall,Rebecca %A Yoon,Nagyeom %A Koh,Seong-Joon %A Lee,Jisan %A Cheon,Jae Hee %+ Department of Nursing, Gangneung-Wonju National University, Department of Nursing, Gangneung-Wonju National University, Wonju, 26403, Republic of Korea, 82 337608646, saan2mari@gmail.com %K digital health %K health literacy %K health equity %K inflammatory bowel diseases %K telemedicine %K patient participation %K validation %K validate %K IBD %K bowel %K inflammatory %K inflammation %K gastrointestinal %K GI %K internal medicine %K gastroenterology %K scale %K readiness %K adoption %K measure %K measures %K measurement %K measurements %K assessment %K assessments %K scales %K eHealth %K e-health %K literacy %K mHealth %K mobile health %K chronic %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness. Objective: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services. Methods: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale’s validity and reliability were assessed through exploratory factor analysis and Cronbach α. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings. Results: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale’s construct validity, with 4 factors explaining 65.05% of the total variance. The scale’s reliability was established with Cronbach α values ranging from 0.84 to 0.91. The scale’s development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy. Conclusions: The mDiHERS is a validated tool for measuring patients’ readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care. %M 39137409 %R 10.2196/58497 %U https://www.jmir.org/2024/1/e58497 %U https://doi.org/10.2196/58497 %U http://www.ncbi.nlm.nih.gov/pubmed/39137409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49453 %T Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology %A Lewis,Callum C %A Taba,Melody %A Allen,Tiffany B %A Caldwell,Patrina HY %A Skinner,S Rachel %A Kang,Melissa %A Henderson,Hamish %A Bray,Liam %A Borthwick,Madeleine %A Collin,Philippa %A McCaffery,Kirsten %A Scott,Karen M %+ Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, 2145, Australia, 61 298453385, karen.scott@sydney.edu.au %K Adolescent health %K digital health literacy %K adolescents %K online health information %K co-design %K health education %K eHealth literacy %K social media %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. Objective: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents’ DHL. Methods: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. Results: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants’ relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Conclusions: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents’ DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents’ DHL. %R 10.2196/49453 %U https://www.jmir.org/2024/1/e49453 %U https://doi.org/10.2196/49453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52058 %T A Multidimensional Approach for Evaluating Reality in Social Media: Mixed Methods Study %A Cho,HyunYi %A Li,Wenbo %A Lopez,Rachel %+ The Ohio State University, 154 N Oval Mall, Columbus, OH, 43210, United States, 1 6142923400, cho.919@osu.edu %K fake %K fact %K misinformation %K reality %K social media %K scale %K measure %K instrument %K user-centric %K tailoring %K digital media literacy %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Misinformation is a threat to public health. The effective countering of misinformation may require moving beyond the binary classification of fake versus fact to capture the range of schemas that users employ to evaluate social media content. A more comprehensive understanding of user evaluation schemas is necessary. Objective: The goal of this research was to advance the current understanding of user evaluations of social media information and to develop and validate a measurement instrument for assessing social media realism. Methods: This research involved a sequence of 2 studies. First, we used qualitative focus groups (n=48). Second, building on the first study, we surveyed a national sample of social media users (n=442). The focus group data were analyzed using the constant comparison approach. The survey data were analyzed using confirmatory factor analyses and ordinary least squares regression. Results: The findings showed that social media reality evaluation involves 5 dimensions: falsity, naturality, authenticity, resonance, and social assurance. These dimensions were differentially mapped onto patterns of social media use. Authenticity was strongly associated with the existing global measure of social media realism (P<.001). Naturality, or the willingness to accept artificiality and engineered aspects of social media representations, was linked to hedonic enjoyment (P<.001). Resonance predicted reflective thinking (P<.001), while social assurance was strongly related to addictive use (P<.001). Falsity, the general belief that much of what is on social media is not real, showed a positive association with both frequency (P<.001) and engagement with (P=.003) social media. These results provide preliminary validity data for a social media reality measure that encompasses multiple evaluation schemas for social media content. Conclusions: The identification of divergent schemas expands the current focus beyond fake versus fact, while the goals, contexts, and outcomes of social media use associated with these schemas can guide future digital media literacy efforts. Specifically, the social media reality measure can be used to develop tailored digital media literacy interventions for addressing diverse public health issues. %M 39106092 %R 10.2196/52058 %U https://www.jmir.org/2024/1/e52058 %U https://doi.org/10.2196/52058 %U http://www.ncbi.nlm.nih.gov/pubmed/39106092 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e46888 %T Digital Health Literacy and Its Association With Sociodemographic Characteristics, Health Resource Use, and Health Outcomes: Rapid Review %A Yuen,Eva %A Winter,Natalie %A Savira,Feby %A Huggins,Catherine E %A Nguyen,Lemai %A Cooper,Paul %A Peeters,Anna %A Anderson,Kate %A Bhoyroo,Rahul %A Crowe,Sarah %A Ugalde,Anna %+ School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 03 92517074, e.yuen@deakin.edu.au %K digital health literacy %K eHealth literacy %K health literacy %K digital health %K web-based database %K health information %D 2024 %7 26.7.2024 %9 Review %J Interact J Med Res %G English %X Background: Digital health literacy has emerged as a critical skill set to navigate the digital age. Objective: This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. Methods: A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: “measured digital health literacy,” “digital literacy,” “ehealth literacy,” “e-health literacy,” “electronic health literacy,” or “internet health literacy” in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Results: Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. Conclusions: The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation. %M 39059006 %R 10.2196/46888 %U https://www.i-jmr.org/2024/1/e46888 %U https://doi.org/10.2196/46888 %U http://www.ncbi.nlm.nih.gov/pubmed/39059006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52314 %T Associations Between Sociodemographic Characteristics, eHealth Literacy, and Health-Promoting Lifestyle Among University Students in Taipei: Cross-Sectional Validation Study of the Chinese Version of the eHealth Literacy Scale %A Chao,Dan-Ping %+ Department of Tourism and Leisure Management, China University of Technology, 3 Xinglong Road, Wunshan District, Taipei, 11695, Taiwan, 886 2 2931 3416 ext 2264, chaodp39@cute.edu.tw %K college students %K online health information %K eHealth literacy %K search literacy %K usage literacy %K evaluation literacy %K health-promoting behavior %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularization of the internet and rapid development of mobile devices have led to an increased inclination and opportunities to obtain health-related information online. The eHealth Literacy Scale (eHEALS), widely used for measuring eHealth literacy, assesses an individual’s ability to search, understand, appraise, and use eHealth information. However, the Chinese version of the eHEALS multiple-factor model remains to be validated, and the correlation between eHEALS and the health-promoting lifestyle profile (HPLP) among university students is rarely explored in Taiwan. Objective: This study aimed to examine the fit, validity, and reliability of the Chinese eHEALS multiple-factor model and to clarify the predictive effects of eHEALS on the HPLP among university students. Methods: University students in Taipei, the capital of Taiwan, were recruited, and 406 valid questionnaires including sociodemographic characteristics, eHEALS, and HPLP responses were collected. Confirmatory factor analysis was performed to validate the Chinese eHEALS. Independent sample t test, 1-way ANOVA, and multiple linear regression analyses were conducted to examine the relationship between sociodemographic variables and the HPLP. Pearson product-moment correlation and binary logistic regression analyses were performed to ascertain the predictive effects of eHEALS on the HPLP. Results: The Chinese eHEALS exhibited an optimal fit when delineated into the search, usage, and evaluation 3-factor model (comparative fit index=0.991, Tucker-Lewis index=0.984, root mean square error of approximation=0.062), and its validity and reliability were confirmed. The mean eHEALS score of university students was 3.17/4.00 (SD 0.48) points, and the score for the evaluation subscale was the lowest (mean 3.08, SD 0.56 points). Furthermore, there were significant sex, institution orientation, daily reading time, daily screen time, primary information channel, and perceived health status differences in the HPLP: male participants (t404=2.346, P=.02), participants attending general university (t404=2.564, P=.01), those reading ≥1 hour daily (F2,403=17.618, P<.001), those spending <3 hours on mobile devices or computers daily (F2,403=7.148, P<.001), those acquiring information from others (t404=3.892, P<.001), and those with a good perceived health status (F2,403=24.366, P<.001) had a significantly higher score. After adjusting for sociodemographic variables, the eHEALS score remained an independent predictor of the HPLP. Compared to students with relatively high eHEALS scores, those with relatively low eHEALS scores had a 3.37 times risk of a negative HPLP (adjusted odds ratio [OR]=3.37, 95% CI 1.49-7.61), which could explain 14.7%-24.4% of the variance (Cox-Snell R2=0.147, Nagelkerke R2=0.244, P=.004). Conclusions: There is room for improvement in eHealth literacy among university students in Taipei. eHEALS may be used to screen students who require HPLP improvement, thereby providing appropriate eHealth literacy training programs, particularly those targeting evaluation literacy. Additionally, the 3-factor model of the Chinese eHEALS used in this study results in more definite scale content, thus increasing the practicality and applicability of this scale in health-promoting studies. %M 39024006 %R 10.2196/52314 %U https://www.jmir.org/2024/1/e52314 %U https://doi.org/10.2196/52314 %U http://www.ncbi.nlm.nih.gov/pubmed/39024006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59131 %T Age Differences in Electronic Mental Health Literacy: Qualitative Study %A Xu,Richard Huan %A Tian,Lidan %A Zhu,Liling %A Cao,Yuan %A Chan,Sherry Kit-wa %A Dong,Dong %A Cheung,Wai-ling Annie %A Wong,Eliza Lai-yi %+ Department of Rehabilitaion Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K eHealth literacy %K mental health %K mental health literacy %K age-related difference %K electronic mental health literacy %K eMHL %D 2024 %7 16.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic mental health literacy (eMHL) is critical for accessing and effectively using digital mental health resources. However, there is a paucity of research on how eMHL varies across age groups. Objective: This study aimed to investigate differences in eMHL among young, middle-aged, and older adults; provide insights into the needs, behaviors, and attitudes of different age groups in relation to digital mental health resources; and ultimately, inform the improvement of mental health services. Methods: A qualitative investigation was conducted to examine the differences in eMHL across different age demographics in the Chinese population in 2023. The study sample comprised 3 distinct age groups: 18-34 years, 35-64 years, and 65 years and older. Participants were recruited through purposive sampling to ensure a diverse representation of the population. Data were collected through semistructured one-on-one interviews, which allowed for in-depth exploration of individual experiences and perceptions. The gathered data were subsequently subjected to rigorous thematic analysis to enable the identification and interpretation of recurring patterns and themes. Results: The principal outcomes derived from these interviews were synthesized into 5 distinct dimensions: emotional needs, use of digital mental health resources, assessment of digital mental health information, engagement with social media to regulate emotions, and coping strategies. These dimensions were uniformly observed across the 3 age groups. Conclusions: We identified differences in knowledge, skills, and attitudes regarding the use of web-based information for managing mental health problems between the 3 age groups. The findings highlight the importance of age-specific strategies for improving eMHL. %M 39012686 %R 10.2196/59131 %U https://www.jmir.org/2024/1/e59131 %U https://doi.org/10.2196/59131 %U http://www.ncbi.nlm.nih.gov/pubmed/39012686 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57842 %T eHealth Literacy and Web-Based Health Information–Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study %A Mitsutake,Seigo %A Oka,Koichiro %A Okan,Orkan %A Dadaczynski,Kevin %A Ishizaki,Tatsuro %A Nakayama,Takeo %A Takahashi,Yoshimitsu %+ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabahshi-ku, Tokyo, 173-0015, Japan, 81 3 3964 3241, mitsu@tmig.or.jp %K COVID-19 %K infectious %K public health %K SARS-COV-2 %K respiratory %K eHealth %K health communication %K web-based information %K DHLI %K eHEALS %K internet %K mixed methods study %K adult population %K Asia %K Asian %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K Japan %K Japanese %K information seeking %K information behavior %K information behavior %K health literacy %K eHealth literacy %K digital health literacy %D 2024 %7 11.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. Objective: This study examines the association between eHL and web-based health information–seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. Methods: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information–seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. Results: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding “information quality and credibility,” “abundance and shortage of relevant information,” “public trust and skepticism,” and “credibility of COVID-19–related information.” Additionally, they disclosed more specific concerns, including “privacy and security concerns,” “information retrieval challenges,” “anxieties and panic,” and “movement restriction.” Conclusions: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the “Health 2.0” era. The identified categories and themes from the qualitative content analysis, such as “information quality and credibility,” suggest a framework for addressing the myriad challenges anticipated in future infodemics. %M 38990625 %R 10.2196/57842 %U https://www.jmir.org/2024/1/e57842 %U https://doi.org/10.2196/57842 %U http://www.ncbi.nlm.nih.gov/pubmed/38990625 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54623 %T Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial %A Li,Yun %A Xiao,Qiuli %A Chen,Min %A Jiang,Chunhua %A Kang,Shurong %A Zhang,Ying %A Huang,Jun %A Yang,Yulin %A Li,Mu %A Jiang,Hong %K health literacy %K WeChat %K cluster randomized controlled trial %K RCT %K randomized %K controlled trial %K controlled trials %K parental %K parenting %K parents %K parent %K China %K Chinese %K mHealth %K mobile health %K app %K apps %K applications %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K toddler %K toddlers %D 2024 %7 4.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Parental health literacy is important to children’s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)–based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children’s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention’s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children’s health outcomes. Furthermore, despite slight subgroup differences in the intervention’s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model–based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 %R 10.2196/54623 %U https://publichealth.jmir.org/2024/1/e54623 %U https://doi.org/10.2196/54623 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e55424 %T Development and Validation of a Measure for Seeking Health Information in the Diabetes Online Community: Mixed Methods Study %A Hughes,Allyson S %A Beach,Sarah %A Vasistha,Spruhaa %A Heydarian,Nazanin %A Morera,Osvaldo %+ Department of Primary Care, Ohio University Heritage College of Osteopathic Institution, 1 University Green, Athens, OH, 45701, United States, 1 419 302 5711, ashughes@ohio.edu %K online health information %K health information seeking %K digital health %K digital technology %K digital intervention %K social support %K social media %K diabetes distress %K diabetes %K type 2 diabetes %K type 1 diabetes %K scale development %K chronic disease %K telehealth %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Individuals with chronic diseases often search for health information online. The Diabetes Online Community (DOC) is an active community with members who exchange health information; however, few studies have examined health information brokering in the DOC. Objective: The aim of this study was to develop and validate the Attitudes Toward Seeking Health Information Online (ATSHIO) scale in a sample of adults with type 1 diabetes (T1D). Methods: People with T1D were recruited through the DOC, specifically Facebook and Twitter. They were provided with a Qualtrics link to complete the survey. This was a mixed methods study that used thematic analysis along with existing theory and formative research to design the quantitative ATSHIO scale. Results: A total of 166 people with T1D participated in this study. Confirmatory factor analyses determined a 2-factor scale (Trusting and Evaluating Online Health Information in the DOC and Engaging With Online Health Information in the DOC) with good convergent validity and discriminant validity. Correlations were found between social support, online health information–seeking, diabetes distress, and disease management. Conclusions: The ATSHIO scale can be used to investigate how people with diabetes are using the internet for obtaining health information, which is especially relevant in the age of telehealth and Health 2.0. %M 38963699 %R 10.2196/55424 %U https://diabetes.jmir.org/2024/1/e55424 %U https://doi.org/10.2196/55424 %U http://www.ncbi.nlm.nih.gov/pubmed/38963699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53334 %T Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders %A Faccio,Elena %A Reggiani,Margherita %A Rocelli,Michele %A Cipolletta,Sabrina %+ Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Via Venezia 14, 35131, Padua, 35131, Italy, 39 3479607182, elena.faccio@unipd.it %K visual social networks %K body image %K eating disorders %K risks %K potentials %K social networks %K social network %K social media %K literacy %K food intake %K appetite disorders %K appetite disorder %K eating disorder %K patient safety %K patient-centered approach %K recovery %K body comparison %K users %K semistructured interviews %K semistructured interview %K girls %K adolescent %K adolescents %K content analysis %K online %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user’s perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. Objective: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. Methods: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. Results: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. Conclusions: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered. %M 38954459 %R 10.2196/53334 %U https://www.jmir.org/2024/1/e53334 %U https://doi.org/10.2196/53334 %U http://www.ncbi.nlm.nih.gov/pubmed/38954459 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e51573 %T The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials %A Maheta,Bhagvat %A Shehabat,Mouhamad %A Khalil,Ramy %A Wen,Jimmy %A Karabala,Muhammad %A Manhas,Priya %A Niu,Ashley %A Goswami,Caroline %A Frezza,Eldo %+ California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, United States, 1 (916) 378 3491, eldo.frezza@cnsuedu.onmicrosoft.com %K patient %K education %K surgeries %K laparoscopic %K postoperative %K outcomes %K systematic review %D 2024 %7 27.6.2024 %9 Review %J JMIR Perioper Med %G English %X Background: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. Objective: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. Methods: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Results: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Conclusions: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. Trial Registration: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698 %M 38935953 %R 10.2196/51573 %U https://periop.jmir.org/2024/1/e51573 %U https://doi.org/10.2196/51573 %U http://www.ncbi.nlm.nih.gov/pubmed/38935953 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e51350 %T How to Elucidate Consent-Free Research Use of Medical Data: A Case for “Health Data Literacy” %A Richter,Gesine %A Krawczak,Michael %K health data literacy %K informed consent %K broad consent %K data sharing %K data collection %K data donation %K data linkage %K personal health data %D 2024 %7 18.6.2024 %9 %J JMIR Med Inform %G English %X The extensive utilization of personal health data is one of the key success factors of modern medical research. Obtaining consent to the use of such data during clinical care, however, bears the risk of low and unequal approval rates and risk of consequent methodological problems in the scientific use of the data. In view of these shortcomings, and of the proven willingness of people to contribute to medical research by sharing personal health data, the paradigm of informed consent needs to be reconsidered. The European General Data Protection Regulation gives the European member states considerable leeway with regard to permitting the research use of health data without consent. Following this approach would however require alternative offers of information that compensate for the lack of direct communication with experts during medical care. We therefore introduce the concept of “health data literacy,” defined as the capacity to find, understand, and evaluate information about the risks and benefits of the research use of personal health data and to act accordingly. Specifically, health data literacy includes basic knowledge about the goals and methods of data-rich medical research and about the possibilities and limits of data protection. Although the responsibility for developing the necessary resources lies primarily with those directly involved in data-rich medical research, improving health data literacy should ultimately be of concern to everyone interested in the success of this type of research. %R 10.2196/51350 %U https://medinform.jmir.org/2024/1/e51350 %U https://doi.org/10.2196/51350 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e52290 %T A Call for a Health Data–Informed Workforce Among Clinicians %A Doll,Joy %A Anzalone,A Jerrod %A Clarke,Martina %A Cooper,Kathryn %A Polich,Ann %A Siedlik,Jacob %K health data–informed workforce %K health data %K health informaticist %K data literacy %K workforce development %D 2024 %7 17.6.2024 %9 %J JMIR Med Educ %G English %X A momentous amount of health data has been and is being collected. Across all levels of health care, data are driving decision-making and impacting patient care. A new field of knowledge and role for those in health care is emerging—the need for a health data–informed workforce. In this viewpoint, we describe the approaches needed to build a health data–informed workforce, a new and critical skill for the health care ecosystem. %R 10.2196/52290 %U https://mededu.jmir.org/2024/1/e52290 %U https://doi.org/10.2196/52290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55548 %T Remote Inclusion of Vulnerable Users in mHealth Intervention Design: Retrospective Case Analysis %A Straand,Ingjerd J %A Baxter,Kimberley A %A Følstad,Asbjørn %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K user testing %K user participation in research %K COVID-19 %K remote testing %K intervention design %K mobile phone %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods. Objective: In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations. Methods: Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions. Results: Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people’s lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants. Conclusions: Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants’ environment via webcams and screen share and how technology mediates participants’ action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants’ privacy. %M 38875700 %R 10.2196/55548 %U https://mhealth.jmir.org/2024/1/e55548 %U https://doi.org/10.2196/55548 %U http://www.ncbi.nlm.nih.gov/pubmed/38875700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56493 %T Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment %A Philpot,Lindsey M %A Ramar,Priya %A Roellinger,Daniel L %A Njeru,Jane W %A Ebbert,Jon O %+ Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 538 1882, Philpot.Lindsey@mayo.edu %K electronic health records %K digital determinants of health %K patient portals %K eHealth %K digital health %K technology acceptance model %K digital health literacy %K digital inclusion %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. %M 38695754 %R 10.2196/56493 %U https://formative.jmir.org/2024/1/e56493 %U https://doi.org/10.2196/56493 %U http://www.ncbi.nlm.nih.gov/pubmed/38695754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50376 %T eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey %A Turnbull,Joanne %A Prichard,Jane %A MacLellan,Jennifer %A Pope,Catherine %+ School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 2380597940, j.c.turnbull@soton.ac.uk %K urgent care %K digital health %K access to health care %K eHealth %K health care system %K COVID-19 %K urgent %K emergency %K health literacy %K eHealth literacy %K digital literacy %K access %K cross-sectional %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. “Digital first” may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. %M 38833297 %R 10.2196/50376 %U https://www.jmir.org/2024/1/e50376 %U https://doi.org/10.2196/50376 %U http://www.ncbi.nlm.nih.gov/pubmed/38833297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52457 %T Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study %A Cai,Wenfei %A Liang,Wei %A Liu,Huaxuan %A Zhou,Rundong %A Zhang,Jie %A Zhou,Lin %A Su,Ning %A Zhu,Hanxiao %A Yang,Yide %+ School of Physical Education, Shenzhen University, 3688 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 15217940540, wliang1020@szu.edu.cn %K eHealth literacy %K measurement %K Web 3.0 %K psychometric properties %K NCD %K older adults %K noncommunicable diseases %K Electronic Health Literacy %K health literacy %K eHealth %K reliability %K validity %D 2024 %7 3.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals’ abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=–.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. %M 38830207 %R 10.2196/52457 %U https://www.jmir.org/2024/1/e52457 %U https://doi.org/10.2196/52457 %U http://www.ncbi.nlm.nih.gov/pubmed/38830207 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44827 %T An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis %A Koks-Leensen,Monique CJ %A Menko,Anouk %A Raaijmakers,Fieke %A Fransen-Kuppens,Gerdine AJ %A Bevelander,Kirsten E %+ Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, monique.koks-leensen@radboudumc.nl %K monitoring %K mental health %K intellectual disabilities %K low literacy %K COVID-19 %K web-based survey %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. Objective: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. Methods: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. Results: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample’s percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. Conclusions: General COVID-19–related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey’s results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general. %M 38607229 %R 10.2196/44827 %U https://publichealth.jmir.org/2024/1/e44827 %U https://doi.org/10.2196/44827 %U http://www.ncbi.nlm.nih.gov/pubmed/38607229 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51675 %T Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study %A Miller,Lisa M Soederberg %A Callegari,Rachel A %A Abah,Theresa %A Fann,Helen %+ Human Ecology, University of California, Davis, One Shields Avenue, Hart Hall, Davis, CA, 95616, United States, 1 5307523955, lmsmiller@ucdavis.edu %K community-engaged learning %K digital divide %K underserved older adults %K digital literacy training %K intergenerational programs %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technology is a social determinant of health that affects older people’s ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults. Objective: In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach. Methods: The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys. Results: Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students’ fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program. Conclusions: A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults’ digital literacy as well as other potential benefits to both older and younger adults. %M 38599620 %R 10.2196/51675 %U https://aging.jmir.org/2024/1/e51675 %U https://doi.org/10.2196/51675 %U http://www.ncbi.nlm.nih.gov/pubmed/38599620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41573 %T A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study %A Noori,Sofia %A Khasnavis,Siddharth %A DeCroce-Movson,Eliza %A Blay-Tofey,Morkeh %A Vitiello,Evan %+ Department of Psychiatry, University of North Carolina School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27514, United States, 1 9194450221, evan.vitiello@gmail.com %K digital psychiatry %K digital mental health %K didactic curriculum %K residency training %K psychiatry residency %K training classes %K trainee response %K residency curriculum %K trainee feedback %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient’s digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed “somewhat comfortable” on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. %M 38739423 %R 10.2196/41573 %U https://formative.jmir.org/2024/1/e41573 %U https://doi.org/10.2196/41573 %U http://www.ncbi.nlm.nih.gov/pubmed/38739423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49227 %T Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study %A Hernández Encuentra,Eulàlia %A Robles,Noemí %A Angulo-Brunet,Ariadna %A Cullen,David %A del Arco,Ignacio %+ Faculty of Psychology and Education, Universitat Oberta de Catalunya, Campus UOC. Rambla Poblenou, 156, Barcelona, 08018, Spain, 34 933263898, ehernandez@uoc.edu %K eHealth literacy %K eHealth %K digital health %K health literacy %K questionnaire %K eHealth Literacy Questionnaire %K eHLQ %K validation %D 2024 %7 10.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise of digital health services, especially following the outbreak of COVID-19, has led to a need for health literacy policies that respond to people’s needs. Spain is a country with a highly developed digital health infrastructure, but there are currently no tools available to measure digital health literacy fully. A well-thought-through questionnaire with strong psychometric properties such as the eHealth Literacy Questionnaire (eHLQ) is important to assess people’s eHealth literacy levels, especially in the context of a fast-growing field such as digital health. Objective: This study aims to adapt the eHLQ and gather evidence of its psychometric quality in 2 of Spain’s official languages: Spanish and Catalan. Methods: A systematic cultural adaptation process was followed. Data from Spanish-speaking (n=400) and Catalan-speaking (n=400) people were collected. Confirmatory factor analysis was used to confirm the previously established factor structure. For reliability, the Cronbach α and categorical ω were obtained for every subscale. Evidence of convergent and discriminant validity was provided through the correlation with the total score of the eHealth Literacy Scale. Evidence based on relations to other variables was evaluated by examining extreme values for educational level, socioeconomic level, and use of technology variables. Results: Regarding the confirmatory factor analysis, the 7-factor correlated model and the 7 one-factor models had adequate goodness-of-fit indexes for both Spanish and Catalan. Moreover, measurement invariance was established between the Spanish and Catalan versions. Reliability estimates were considered adequate as all the scales in both versions had values of >0.80. For convergent and discriminant validity evidence, the eHealth Literacy Scale showed moderate correlation with eHLQ scales in both versions (Spanish: range 0.57-0.76 and P<.001; Catalan: range 0.41-0.64 and P<.001). According to the relationship with external variables, all the eHLQ scales in both languages could discriminate between the maximum and minimum categories in level of education, socioeconomic level, and level of technology use. Conclusions: The Spanish and Catalan versions of the eHLQ appear to be psychometrically sound questionnaires for assessing digital health literacy. They could both be useful tools in Spain and Catalonia for researchers, policy makers, and health service managers to explore people’s needs, skills, and competencies and provide interesting insights into their interactions and engagement regarding their own experiences with digital health services, especially in the context of digital health growth in Spain. %M 38728072 %R 10.2196/49227 %U https://www.jmir.org/2024/1/e49227 %U https://doi.org/10.2196/49227 %U http://www.ncbi.nlm.nih.gov/pubmed/38728072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57963 %T Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users %A Vujkovic,Branko %A Brkovic,Voin %A Pajičić,Ana %A Pavlovic,Vedrana %A Stanisavljevic,Dejana %A Krajnović,Dušanka %A Jovic Vranes,Aleksandra %+ Institute of Public Health of Sabac, 1 Jovana Cvijica, Sabac, 15000, 381 648623647, vujkovicb@gmail.com %K eHealth %K digital health %K eHLQ %K eHealth Literacy Questionnaire %K digital health literacy %K primary healthcare %K Serbia %K questionnaire %K technology %K communication %D 2024 %7 9.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. Objective: This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. Methods: The validation study was conducted in 8 PHC centers in the territory of the Mačva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. Results: A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P<.05) for all 7 eHLQ scores were observed for age, education, perceived material status, perceived health status, searching for health information on the internet, and occupation (except domain 4). In multivariable regression models, searching for health information on the internet and being aged younger than 65 years were associated with higher values of all domain scores except the domain feel safe and in control for variable age. Conclusions: This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of EHL and in the planning of digital health interventions at the population and individual level due to its strong psychometric properties in the Serbian context. %M 38722675 %R 10.2196/57963 %U https://www.jmir.org/2024/1/e57963 %U https://doi.org/10.2196/57963 %U http://www.ncbi.nlm.nih.gov/pubmed/38722675 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45837 %T Health Literacy and Health Care System Confidence as Determinants of Attitudes to Vaccines in France: Representative Cross-Sectional Study %A Khoury,Georges %A Ward,Jeremy K %A Mancini,Julien %A Gagneux-Brunon,Amandine %A Luong Nguyen,Liem Binh %+ CIC Cochin Pasteur, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, 19 Avenue de la Bourdonnais, Paris, 75007, France, 33 0610581889, georgeskhoury2000@hotmail.com %K vaccine hesitancy %K health literacy %K trust %K attitude toward vaccines %K public health %K vaccination %K COVID-19 %K adult %K sociodemographic factor %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health literacy involves individuals’ knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community. Objective: This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors. Methods: We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents’ different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis. Results: Among the participants, 440.4 (21.8%) were classified as “distrustful of vaccines in general,” 729.2 (36.1%) were “selectively hesitant,” and 852.4 (42.2%) were “nonhesitant.” In our model, the level of health literacy was not statistically different between the “distrustful of vaccines in general” and the “selectively hesitant” (P=.48), but it was associated with being a “nonhesitant” (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a “nonhesitant” attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model. Conclusions: Health literacy was associated with a “nonhesitant” attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population’s confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens. %M 38713494 %R 10.2196/45837 %U https://publichealth.jmir.org/2024/1/e45837 %U https://doi.org/10.2196/45837 %U http://www.ncbi.nlm.nih.gov/pubmed/38713494 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54124 %T Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial %A Cunningham,Adam C %A Prentice,Carley %A Peven,Kimberly %A Wickham,Aidan %A Bamford,Ryan %A Radovic,Tara %A Klepchukova,Anna %A Fomina,Maria %A Cunningham,Katja %A Hill,Sarah %A Hantsoo,Liisa %A Payne,Jennifer %A Zhaunova,Liudmila %A Ponzo,Sonia %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 7770032146, l_zhaunova@flo.health %K digital health %K health literacy %K menstrual cycle %K period tracking app %K women’s health %K PMS %K PMDD %K tracking %K app %K application %K tracking app %K tracking application %K menstrual %K women %K efficacy %K general health %K wellbeing %K randomized controlled trial %K awareness %K symptoms %K manage %K management %K premenstrual %K premenstrual syndrome %K premenstrual dysphoric disorder %K reproductive %K reproductive health %K health management %K communication %K pregnancy %K quality of life %K productivity %K education %K functionality %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one’s own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=–7.08; t115=–5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=–0.61; t311=–2.73, P=.007), and fear of unplanned pregnancies (D̄=–0.22; t311=–2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=–1.67; t144=–2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq %M 38696773 %R 10.2196/54124 %U https://mhealth.jmir.org/2024/1/e54124 %U https://doi.org/10.2196/54124 %U http://www.ncbi.nlm.nih.gov/pubmed/38696773 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51127 %T Perceptions of Health Misinformation on Social Media: Cross-Sectional Survey Study %A Gaysynsky,Anna %A Senft Everson,Nicole %A Heley,Kathryn %A Chou,Wen-Ying Sylvia %+ Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, United States, 1 240 276 5284, anna.gaysynsky@nih.gov %K social media %K misinformation %K health communication %K health literacy %K patient-provider communication %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public’s experience with health misinformation on social media. Objective: The goal of this analysis was to examine perceptions of the social media information environment and identify associations between health misinformation perceptions and health communication behaviors among US adults. Methods: Analyses used data from the 2022 Health Information National Trends Survey (N=6252). Weighted unadjusted proportions described respondents’ perceptions of the amount of false or misleading health information on social media (“perceived misinformation amount”) and how difficult it is to discern true from false information on social media (“perceived discernment difficulty”). Weighted multivariable logistic regressions examined (1) associations of sociodemographic characteristics and subjective literacy measures with misinformation perceptions and (2) relationships between misinformation perceptions and health communication behaviors (ie, sharing personal or general health information on social media and using social media information in health decisions or in discussions with health care providers). Results: Over one-third of social media users (35.61%) perceived high levels of health misinformation, and approximately two-thirds (66.56%) reported high perceived discernment difficulty. Odds of perceiving high amounts of misinformation were lower among non-Hispanic Black/African American (adjusted odds ratio [aOR] 0.407, 95% CI 0.282-0.587) and Hispanic (aOR 0.610, 95% CI 0.449-0.831) individuals compared to White individuals. Those with lower subjective health literacy were less likely to report high perceived misinformation amount (aOR 0.602, 95% CI 0.374-0.970), whereas those with lower subjective digital literacy were more likely to report high perceived misinformation amount (aOR 1.775, 95% CI 1.400-2.251). Compared to White individuals, Hispanic individuals had lower odds of reporting high discernment difficulty (aOR 0.620, 95% CI 0.462-0.831). Those with lower subjective digital literacy (aOR 1.873, 95% CI 1.478-2.374) or numeracy (aOR 1.465, 95% CI 1.047-2.049) were more likely to report high discernment difficulty. High perceived misinformation amount was associated with lower odds of sharing general health information on social media (aOR 0.742, 95% CI 0.568-0.968), using social media information to make health decisions (aOR 0.273, 95% CI 0.156-0.479), and using social media information in discussions with health care providers (aOR 0.460, 95% CI 0.323-0.655). High perceived discernment difficulty was associated with higher odds of using social media information in health decisions (aOR 1.724, 95% CI 1.208-2.460) and health care provider discussions (aOR 1.389, 95% CI 1.035-1.864). Conclusions: Perceptions of high health misinformation prevalence and discernment difficulty are widespread among social media users, and each has unique associations with sociodemographic characteristics, literacy, and health communication behaviors. These insights can help inform future health communication interventions. %M 38687591 %R 10.2196/51127 %U https://infodemiology.jmir.org/2024/1/e51127 %U https://doi.org/10.2196/51127 %U http://www.ncbi.nlm.nih.gov/pubmed/38687591 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54913 %T The Use of Digital Technologies in the Promotion of Health Literacy and Empowerment of Informal Caregivers: Scoping Review %A Soares,Suzete %A Hoffmeister,Louíse Viecili %A Fernandes,Maria de Fátima %A Henriques,Adriana %A Costa,Andreia %+ Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Avenida Prof Egas Moniz, Lisbon, 1600 - 190, Portugal, 351 217913400 ext 21778, andreia.costa@esel.pt %K health literacy %K empowerment %K digital technology %K informal caregiver %K family caregiver %D 2024 %7 29.4.2024 %9 Review %J JMIR Aging %G English %X Background: Informal caregivers (IC) play an important role in the community as health care providers for people who are dependent on self-care. Health literacy contributes to empowerment, better care, and self-management of one’s own health and can be developed using digital technologies. Objective: This study aims to map scientific evidence about the use of digital technologies to promote health literacy and the empowerment of ICs. Methods: We conducted a scoping review following the Joanna Briggs Institute methodology. The CINAHL, MEDLINE, Scopus, and PubMed databases were searched to find primary studies on the theme. Inclusion criteria were based on the Population, Concept, and Context logic. To be selected for analysis, studies must have involved informal or family caregivers aged ≥18 years who provide care to dependent persons and who have access to the internet and digital devices (computer, smartphone, and tablet). A total of 2 independent researchers (SS and LVH) performed the screening process. This study is part of a main project that was approved by the Ethics Committee for Health of the Regional Health Administration of Lisbon and Tagus Valley (reference 058/CES/INV/2022). Results: A total of 9 studies were included in the review. The analysis of the studies showed that ICs use digital tools, such as computers and smartphones, with smartphones being the preferred tool. ICs use the internet to access information; manage home tasks; communicate with relatives, their peers, and health care professionals; and take part in forums. Due to difficulties in leaving their houses, forums are highly valued to preserve human connections. Conclusions: The use of digital technologies to convey clear, objective, reliable, and accessible information is a strategic action for promoting health literacy and for contemplating the variable care needs of ICs. By working with ICs in the development of new technologies, researchers are building a new tool that meets ICs’ needs. %M 38683655 %R 10.2196/54913 %U https://aging.jmir.org/2024/1/e54913 %U https://doi.org/10.2196/54913 %U http://www.ncbi.nlm.nih.gov/pubmed/38683655 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e50297 %T Nursing Students’ Attitudes Toward Technology: Multicenter Cross-Sectional Study %A Dallora,Ana Luiza %A Andersson,Ewa Kazimiera %A Gregory Palm,Bruna %A Bohman,Doris %A Björling,Gunilla %A Marcinowicz,Ludmiła %A Stjernberg,Louise %A Anderberg,Peter %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 371 41, Sweden, 46 073 422 3667, ana.luiza.moraes@bth.se %K nursing education %K technophilia %K eHealth %K technology anxiety %K technology enthusiasm %K mobile phone %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students’ attitudes toward technology could be investigated to assess their needs regarding this proficiency. Objective: This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. Methods: Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences. Results: In total, 646 students answered the questionnaire—342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students’ technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=−0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=−0.196; ρSwedish=−0.262; ρPolish=−0.133) and with the perceived skill in using computer devices (P<.001; ρall=−0.209; ρSwedish=−0.347; ρPolish=−0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=−0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). Conclusions: This study highlights nursing students’ techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care’s increasing reliance on technology, integrating health technology–related topics into education is crucial for future professionals to address health care challenges effectively. International Registered Report Identifier (IRRID): RR2-10.2196/14643 %M 38683660 %R 10.2196/50297 %U https://mededu.jmir.org/2024/1/e50297 %U https://doi.org/10.2196/50297 %U http://www.ncbi.nlm.nih.gov/pubmed/38683660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52189 %T Assessing Electronic Health Literacy in Individuals With the Post–COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study %A Marsall,Matthias %A Dinse,Hannah %A Schröder,Julia %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, 49 228 287 ext 11595, matthias.marsall@ukbonn.de %K eHealth literacy %K eHEALS %K factor analysis %K measurement invariance %K psychometric properties %K infodemic %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post–COVID-19 condition. This is particularly important as people with the post–COVID-19 condition are frequently affected by false information from the internet. Objective: The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post–COVID-19 condition. Methods: A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status– and internet use–related variables, sociodemographic data, and (post)–COVID-19–related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed. Results: In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker–Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86). Conclusions: The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post–COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post–COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS. %M 38662429 %R 10.2196/52189 %U https://formative.jmir.org/2024/1/e52189 %U https://doi.org/10.2196/52189 %U http://www.ncbi.nlm.nih.gov/pubmed/38662429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54478 %T The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial %A Lemmer,Diana %A Moessner,Markus %A Arnaud,Nicolas %A Baumeister,Harald %A Mutter,Agnes %A Klemm,Sarah-Lena %A König,Elisa %A Plener,Paul %A Rummel-Kluge,Christine %A Thomasius,Rainer %A Kaess,Michael %A Bauer,Stephanie %+ Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany, 49 6221 56 7345, stephanie.bauer@med.uni-heidelberg.de %K help seeking %K mental health %K stigma %K mental health literacy %K psychoeducation %K web-based experiment %K web-based randomized controlled trial %K microinterventions %K video-based interventions %D 2024 %7 24.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 %M 38656779 %R 10.2196/54478 %U https://www.jmir.org/2024/1/e54478 %U https://doi.org/10.2196/54478 %U http://www.ncbi.nlm.nih.gov/pubmed/38656779 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53614 %T Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study %A Smith,Sharissa M %A Bais,Babette %A Ismaili M'hamdi,Hafez %A Schermer,Maartje HN %A Steegers-Theunissen,Régine PM %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 CD, Netherlands, 31 10704 ext 0704, r.steegers@erasmusmc.nl %K preconception care %K mHealth %K mobile health %K pregnancy preparation %K nudge %K health inequality %K socioeconomic status %K lifestyle %K women %K pregnancy %K pregnant women %K pregnant %K socioeconomic %K pilot feasibility study %K mHealth app %K mHealth application %K app %K application %K risk factor %K nutrition %K stress %K chronic stress %K health literacy %K usability %K user satisfaction %K user %K users %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion “living in a deprived neighborhood” was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 %M 38648092 %R 10.2196/53614 %U https://humanfactors.jmir.org/2024/1/e53614 %U https://doi.org/10.2196/53614 %U http://www.ncbi.nlm.nih.gov/pubmed/38648092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47278 %T Patients’ Experiences With Digitalization in the Health Care System: Qualitative Interview Study %A Gybel Jensen,Christian %A Gybel Jensen,Frederik %A Loft,Mia Ingerslev %+ Department of Neurology, Rigshospitalet, Inge Lehmanns Vej 8, Copenhagen, Denmark, 45 35457076, belle.mia.ingerslev.loft@regionh.dk %K digitalization %K digital health %K eHealth %K digital health literacy %K digital practices %K patient experiences %K digital health services %K inequity in health %K qualitative research %K interview %K implementation %K tool %K neurology %K digital tool %K communication %K mobile phone %D 2024 %7 11.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients’ digital practices and experiences with digital health services. Objective: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? Methods: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. Results: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Conclusions: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged. %M 38602748 %R 10.2196/47278 %U https://www.jmir.org/2024/1/e47278 %U https://doi.org/10.2196/47278 %U http://www.ncbi.nlm.nih.gov/pubmed/38602748 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48783 %T Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey %A Choi,Soyoung %+ Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 272 Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 2173332573, soyoung@illinois.edu %K college students %K personal health data %K self-tracking %K eHealth literacy %K well-being %K tracking %K students %K disability %K cross-sectional survey %K pediatric care %K adult care %K smartphone health app %K application %K literacy %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. Objective: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. Methods: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. Results: More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=–5.97, P<.001) and perceived efficacy (t411=–4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (β=3.81, P<.001), self-tracking health practices (β=2.22, P=.03), and eHealth literacy (β=24.29, P<.001). Conclusions: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students. %M 38598285 %R 10.2196/48783 %U https://formative.jmir.org/2024/1/e48783 %U https://doi.org/10.2196/48783 %U http://www.ncbi.nlm.nih.gov/pubmed/38598285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47017 %T The Challenges in Using eHealth Decision Resources for Surrogate Decision-Making in the Intensive Care Unit %A Sun,Wan-Na %A Kao,Chi-Yin %+ Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5843, chiyinkao@mail.ncku.edu.tw %K decision-making %K eHealth %K intensive care unit %K literacy %K surrogate %K mobile phone %D 2024 %7 1.4.2024 %9 Viewpoint %J J Med Internet Res %G English %X The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This paper provides a comprehensive overview of eHealth. The challenges of applying eHealth tools, including economic disparities and information inaccuracies are addressed. This study then introduces eHealth literacy and the assessment tools to evaluate users’ capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate’s lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Tailoring communication strategies and providing diverse materials are essential for effective eHealth decision resources in the ICU setting. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy. %M 38557504 %R 10.2196/47017 %U https://www.jmir.org/2024/1/e47017 %U https://doi.org/10.2196/47017 %U http://www.ncbi.nlm.nih.gov/pubmed/38557504 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e55737 %T Measuring the Digital Competence of Health Professionals: Scoping Review %A Mainz,Anne %A Nitsche,Julia %A Weirauch,Vera %A Meister,Sven %+ Health Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstraße 11, Witten, 58448, Germany, 49 2302 926 78627, anne.mainz@uni-wh.de %K digital competence %K digital literacy %K digital health %K health care %K health care professional %K health care professionals %K scoping review %D 2024 %7 29.3.2024 %9 Review %J JMIR Med Educ %G English %X Background: Digital competence is listed as one of the key competences for lifelong learning and is increasing in importance not only in private life but also in professional life. There is consensus within the health care sector that digital competence (or digital literacy) is needed in various professional fields. However, it is still unclear what exactly the digital competence of health professionals should include and how it can be measured. Objective: This scoping review aims to provide an overview of the common definitions of digital literacy in scientific literature in the field of health care and the existing measurement instruments. Methods: Peer-reviewed scientific papers from the last 10 years (2013-2023) in English or German that deal with the digital competence of health care workers in both outpatient and inpatient care were included. The databases ScienceDirect, Scopus, PubMed, EBSCOhost, MEDLINE, OpenAIRE, ERIC, OAIster, Cochrane Library, CAMbase, APA PsycNet, and Psyndex were searched for literature. The review follows the JBI methodology for scoping reviews, and the description of the results is based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: The initial search identified 1682 papers, of which 46 (2.73%) were included in the synthesis. The review results show that there is a strong focus on technical skills and knowledge with regard to both the definitions of digital competence and the measurement tools. A wide range of competences were identified within the analyzed works and integrated into a validated competence model in the areas of technical, methodological, social, and personal competences. The measurement instruments mainly used self-assessment of skills and knowledge as an indicator of competence and differed greatly in their statistical quality. Conclusions: The identified multitude of subcompetences illustrates the complexity of digital competence in health care, and existing measuring instruments are not yet able to reflect this complexity. %M 38551628 %R 10.2196/55737 %U https://mededu.jmir.org/2024/1/e55737 %U https://doi.org/10.2196/55737 %U http://www.ncbi.nlm.nih.gov/pubmed/38551628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46971 %T The Political Economy of Digital Health Equity: Structural Analysis %A Shaw,James %A Glover,Wiljeana %+ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada, 1 4169780315, jay.shaw@wchospital.ca %K digital health equity %K health equity %K health policy %K telemedicine %K digital care %K political economy %K race %K ethnicity %K socioeconomic %K policy %D 2024 %7 26.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity. %M 38530341 %R 10.2196/46971 %U https://www.jmir.org/2024/1/e46971 %U https://doi.org/10.2196/46971 %U http://www.ncbi.nlm.nih.gov/pubmed/38530341 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e51511 %T Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey %A Linggonegoro,Danny %A Williams,Kathryn %A Hlobik,Madeline %A Huang,Jennifer %+ Dermatology Section, Division of Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 6173556117, jennifer.huang@childrens.harvard.edu %K teledermatology %K telemedicine %K telehealth %K health care research %K health care disparities %K digital health literacy %K technology access %K access %K accessibility %K health literacy %K digital literacy %K disparities %K disparity %K equity %K inequity %K inequities %K dermatology %K dermatological %K skin %K cross-sectional %K survey %K surveys %K national %K HINTS %K digital divide %D 2024 %7 22.3.2024 %9 Research Letter %J JMIR Dermatol %G English %X Certain sociodemographic factors are associated with low technology access and digital healthy literacy. %M 38517468 %R 10.2196/51511 %U https://derma.jmir.org/2024/1/e51511 %U https://doi.org/10.2196/51511 %U http://www.ncbi.nlm.nih.gov/pubmed/38517468 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54807 %T The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study %A Hölgyesi,Áron %A Luczay,Andrea %A Tóth-Heyn,Péter %A Muzslay,Eszter %A Világos,Eszter %A Szabó,Attila J %A Baji,Petra %A Kovács,Levente %A Gulácsi,László %A Zrubka,Zsombor %A Péntek,Márta %+ Health Economics Research Center, University Research and Innovation Center, Óbuda University, Bécsi St. 96/B, Budapest, 1034, Hungary, 36 16665603, pentek.marta@uni-obuda.hu %K electronic health literacy %K parents %K caregivers %K diabetes mellitus %K child %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents’ skills to deal with electronic health information sources. Objective: We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children’s outcomes. Methods: A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents’ electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children’s treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. Results: Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents’ average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children’s treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=−0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children’s HbA1c (r=−0.143; P=.08), PedsQL Diab (r=−0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=−0.13; P=.12). Regression analysis revealed significant associations of the child’s HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=−0.66; P=.03; pump + sensor: β=−0.93; P=.007), and parents’ self-efficacy (PSESDM; β=−0.08; P=.001). Conclusions: Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents’ diabetes management attitude but not with the child’s glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged. %M 38506893 %R 10.2196/54807 %U https://pediatrics.jmir.org/2024/1/e54807 %U https://doi.org/10.2196/54807 %U http://www.ncbi.nlm.nih.gov/pubmed/38506893 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50898 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %A Bindhu,Shwetha %A Nattam,Anunita %A Xu,Catherine %A Vithala,Tripura %A Grant,Tiffany %A Dariotis,Jacinda K %A Liu,Hexuan %A Wu,Danny T Y %+ College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH, 45267, United States, 1 5623916509, wutz@ucmail.uc.edu %K health literacy %K social determinants of health %K SDoH %K social determinants %K systematic review %K patient education %K health education %K health information %K information needs %K information comprehension %K patient counseling %K barriers to care %K language proficiency %D 2024 %7 20.3.2024 %9 Review %J Online J Public Health Inform %G English %X Background: Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. Objective: This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. Methods: The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. Results: The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. Conclusions: The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients. %M 38506914 %R 10.2196/50898 %U https://ojphi.jmir.org/2024/1/e50898 %U https://doi.org/10.2196/50898 %U http://www.ncbi.nlm.nih.gov/pubmed/38506914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48977 %T Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study %A Sinha,Jayati %A Serin,Nuket %+ Department of Marketing & Logistics, College of Business, Florida International University, 11200 SW 8th Street, Miami, FL, 33146, United States, 1 3053487573, jsinha@fiu.edu %K digital natives %K digital immigrants %K online health information seeking %K preventative health actions %K mobile phone %D 2024 %7 11.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI). Objective: This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions. Methods: A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions. Results: The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03). Conclusions: To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life. %M 38466985 %R 10.2196/48977 %U https://www.jmir.org/2024/1/e48977 %U https://doi.org/10.2196/48977 %U http://www.ncbi.nlm.nih.gov/pubmed/38466985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54107 %T Generation Z’s Health Information Avoidance Behavior: Insights From Focus Group Discussions %A Jia,Chenjin %A Li,Pengcheng %+ School of Communication, Universiti Sains Malaysia, 11800 USM, Penang, Gelugor, Malaysia, 60 174564739, DaPeng0605@outlook.com %K information avoidance %K health information %K Generation Z %K information overload %K planned risk information avoidance model %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Younger generations actively use social media to access health information. However, research shows that they also avoid obtaining health information online at times when confronted with uncertainty. Objective: This study aims to examine the phenomenon of health information avoidance among Generation Z, a representative cohort of active web users in this era. Methods: Drawing on the planned risk information avoidance model, we adopted a qualitative approach to explore the factors related to information avoidance within the context of health and risk communication. The researchers recruited 38 participants aged 16 to 25 years for the focus group discussion sessions. Results: In this study, we sought to perform a deductive qualitative analysis of the focus group interview content with open, focused, and theoretical coding. Our findings support several key components of the planned risk information avoidance model while highlighting the underlying influence of cognition on emotions. Specifically, socioculturally, group identity and social norms among peers lead some to avoid health information. Cognitively, mixed levels of risk perception, conflicting values, information overload, and low credibility of information sources elicited their information avoidance behaviors. Affectively, negative emotions such as anxiety, frustration, and the desire to stay positive contributed to avoidance. Conclusions: This study has implications for understanding young users’ information avoidance behaviors in both academia and practice. %M 38457223 %R 10.2196/54107 %U https://www.jmir.org/2024/1/e54107 %U https://doi.org/10.2196/54107 %U http://www.ncbi.nlm.nih.gov/pubmed/38457223 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50163 %T Readability and Health Literacy Scores for ChatGPT-Generated Dermatology Public Education Materials: Cross-Sectional Analysis of Sunscreen and Melanoma Questions %A Roster,Katie %A Kann,Rebecca B %A Farabi,Banu %A Gronbeck,Christian %A Brownstone,Nicholas %A Lipner,Shari R %+ Department of Dermatology, Weill Cornell Medicine, 1305 York Ave 9th Floor, New York, NY, 10021, United States, 1 646 962 3376, shl9032@med.cornell.edu %K ChatGPT %K artificial intelligence %K AI %K LLM %K LLMs %K large language model %K language model %K language models %K generative %K NLP %K natural language processing %K health disparities %K health literacy %K readability %K disparities %K disparity %K dermatology %K health information %K comprehensible %K comprehensibility %K understandability %K patient education %K public education %K health education %K online information %D 2024 %7 6.3.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 38446502 %R 10.2196/50163 %U https://derma.jmir.org/2024/1/e50163 %U https://doi.org/10.2196/50163 %U http://www.ncbi.nlm.nih.gov/pubmed/38446502 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48393 %T Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine %A Grosjean,Julien %A Benis,Arriel %A Dufour,Jean-Charles %A Lejeune,Émeline %A Disson,Flavien %A Dahamna,Badisse %A Cieslik,Hélène %A Léguillon,Romain %A Faure,Matthieu %A Dufour,Frank %A Staccini,Pascal %A Darmoni,Stéfan Jacques %+ Department of Digital Health, Rouen University Hospital, 1, rue de Germont, Rouen, 76031, France, 33 232885616, julien.grosjean@chu-rouen.fr %K digital health %K medical informatics %K medical education %K search engine %K knowledge management %K semantic web %K language %K teaching %K vocabulary %K controlled %K students %K educational personnel %K French %K curriculum %D 2024 %7 4.3.2024 %9 Tutorial %J JMIR Med Educ %G English %X Background: Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals. Objective: This study’s primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals. Methods: First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users. Results: Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal. Conclusions: CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care–related community. It focuses on making resources “findable,” “accessible,” “interoperable,” and “reusable” by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy. %M 38437007 %R 10.2196/48393 %U https://mededu.jmir.org/2024/1/e48393 %U https://doi.org/10.2196/48393 %U http://www.ncbi.nlm.nih.gov/pubmed/38437007 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51268 %T The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis %A Yeo,GeckHong %A Reich,Stephanie M %A Liaw,Nicole A %A Chia,Elizabeth Yee Min %+ School of Education, University of California, Irvine, 3454 Education, Irvine, CA, 92697, United States, 1 (949) 824 5970, smreich@uci.edu %K review and meta-analysis %K digital mental health literacy %K digital mental health interventions %K mental health functioning %D 2024 %7 29.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. Objective: This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. Methods: We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. Results: Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI −0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. Conclusions: For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995 %M 38421687 %R 10.2196/51268 %U https://www.jmir.org/2024/1/e51268 %U https://doi.org/10.2196/51268 %U http://www.ncbi.nlm.nih.gov/pubmed/38421687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48685 %T Digital Health Literacy of the Population in Germany and Its Association With Physical Health, Mental Health, Life Satisfaction, and Health Behaviors: Nationally Representative Survey Study %A König,Lars %A Kuhlmey,Adelheid %A Suhr,Ralf %+ Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30419549262, lars.koenig@charite.de %K digital health %K digital health literacy %K eHealth %K eHealth literacy %K health behaviors %K health literacy %K life satisfaction %K mental health %K physical health %K representative survey %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital health literacy, also known as eHealth literacy, describes the ability to seek, find, understand, and apply health information from the internet to address health problems. The World Health Organization calls for actions to improve digital health literacy. To develop target group–specific digital health literacy interventions, it is necessary to know the digital health literacy of the general population and relevant subgroups. Objective: This study aims to representatively assess the digital health literacy of the population in Germany and relevant subgroups. The results are meant to facilitate the development of target group–specific digital health literacy interventions. Additionally, this study further explores the associations between digital health literacy and physical health, mental health, life satisfaction, and diverse health behaviors. Methods: Study participants were drawn from a representative panel of the German-speaking population with internet access. To further increase the representativeness of the sample, survey weights were calculated using an iterative proportional fitting procedure. Participants answered a series of questionnaires regarding their digital health literacy, physical health, mental health, life satisfaction, and diverse health behaviors. Two-sided independent sample t tests were conducted to determine the significant differences between societal subgroups. Pearson correlation coefficients were calculated to explore the correlates of digital health literacy. Results: Digital health literacy is unevenly distributed within German society. The results of this study suggest that people with a low level of formal education and people with a low social status would benefit from digital health literacy interventions that address their competencies in the domains of information seeking and information appraisal. Furthermore, the results suggest that older people would likely benefit from digital health literacy interventions that address their competencies in the domains of information seeking and also information appraisal. Regarding sex, this study suggests that men might benefit from digital health literacy interventions that specifically address their competencies in the domain of information seeking. Furthermore, digital health literacy is weakly positively correlated with physical health, mental health, life satisfaction, exercise routines, fruit consumption, and vegetable consumption. Conclusions: Overall, the results of this study demonstrate that digital health literacy is associated with diverse health outcomes and behaviors. Furthermore, the results provide a starting point for the development of target group–specific digital health literacy interventions. %M 38381497 %R 10.2196/48685 %U https://publichealth.jmir.org/2024/1/e48685 %U https://doi.org/10.2196/48685 %U http://www.ncbi.nlm.nih.gov/pubmed/38381497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43770 %T Predictors of Mental Health Literacy in a Sample of Health Care Major Students: Pilot Evaluation Study %A Tohme,Pia %A Abi Fadel,Nour %A Yaktine,Nour %A Abi-Habib,Rudy %+ Department of Social and Education Sciences, Lebanese American University, Beirut Campus, Chouran, Beirut, 5056, Lebanon, 961 01786456 ext 2733, rudy.abihabib@lau.edu.lb %K awareness %K COVID-19 %K digital health literacy %K digital health %K disorder %K empathy %K health literacy %K literacy %K mental health literacy %K mental health %K mentalizing %K questionnaire %K students %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The numerous mental health awareness campaigns during the COVID-19 pandemic have shifted our understanding and perception of mental health. Objective: The purpose of this study is to evaluate predictors of mental health literacy (MHL), that is, one’s knowledge and beliefs about mental disorders. We evaluate whether digital health literacy, empathy, and mentalizing contribute to MHL. Methods: Our sample consisted of 89 health care major students, aged between 17 and 32 years, studying at a university in Lebanon. The Mental Health Literacy Scale for Healthcare Students (MHLS-HS), the eHealth Literacy Questionnaire (eHLQ), the Basic Empathy Scale (BES), and the Reflective Functioning Questionnaire-8 (RFQ-8) were used. Results: Multiple regression analyses revealed that the Engagement in Own Health subscale of digital health literacy constituted a predictor of MHL. While empathy and mentalizing did not directly predict MHL, they were found to predict components of MHL. Conclusions: This is the first study to evaluate digital health literacy, empathy, and mentalizing as predictors of MHL in Lebanon, a country where mental health is still considered taboo. Moreover, this pilot study is the first to provide some support for the predictive role of some digital health literacy subscales on MHL in light of the rise of the digital era following the COVID-19 pandemic. %M 38329801 %R 10.2196/43770 %U https://formative.jmir.org/2024/1/e43770 %U https://doi.org/10.2196/43770 %U http://www.ncbi.nlm.nih.gov/pubmed/38329801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50211 %T Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study %A Alsaad,Ebtihal %A AlDossary,Sharifah %+ Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Al Haras Al Watani St, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, Riyadh, PO Box 3660/ 11481, Saudi Arabia, 966 114299999, ebtihalalsaad@gmail.com %K misinformation %K education %K WhatsApp %K intervention %K pre-postintervention design %K health literacy %K educational %K video %K videos %K consumer %K consumers %K patient education %K survey %K surveys %K web-based information %K health information %K reliability %K accuracy %K reliable %K social media %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation can adversely affect individuals’ quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. Objective: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. Methods: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants’ ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. Results: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants’ abilities to identify misinformation in WhatsApp messages (z=–6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the “forwarded” label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). Conclusions: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants’ abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions. %M 38231563 %R 10.2196/50211 %U https://formative.jmir.org/2024/1/e50211 %U https://doi.org/10.2196/50211 %U http://www.ncbi.nlm.nih.gov/pubmed/38231563 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46656 %T The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data %A Shaw Jr,George %A Castro,Bianca A %A Gunn,Laura H %A Norris,Keith %A Thorpe Jr,Roland J %+ Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 7045620021, gshaw11@charlotte.edu %K accessibility %K eHealth literacy %K mHealth %K multivariable logistic regression %K obesity %K smartphones %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor’s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. %M 38198196 %R 10.2196/46656 %U https://mhealth.jmir.org/2024/1/e46656 %U https://doi.org/10.2196/46656 %U http://www.ncbi.nlm.nih.gov/pubmed/38198196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40172 %T The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China %A Chen,Weichao %A Ding,Mengjun %A Wang,Xiaoyan %+ Department of Editing and Publishing, Hunan Normal University, 36 Lushan Road, Changsha, 410081, China, 86 15116130338, weichaoch2018@163.com %K older adults %K internet use %K mental health %K influence mechanism %K participation in voluntary activities %K subjective age %K mobile phone %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults’ internet use may have a health effect. Objective: This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results. Methods: Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables. Results: It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, β=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults. Conclusions: Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults. %M 38113096 %R 10.2196/40172 %U https://www.jmir.org/2023/1/e40172 %U https://doi.org/10.2196/40172 %U http://www.ncbi.nlm.nih.gov/pubmed/38113096 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51616 %T Everyday Digital Literacy Questionnaire for Older Adults: Instrument Development and Validation Study %A Choi,JiYeon %A Choi,Seongmi %A Song,Kijun %A Baek,Jiwon %A Kim,Heejung %A Choi,Mona %A Kim,Yesol %A Chu,Sang Hui %A Shin,Jiyoung %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3323, jyshin214@yuhs.ac %K aging %K older adults %K digital literacy %K instrument %K validation %K psychometrics %K European Commission’s Digital Competence framework %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs. Objective: The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea. Methods: The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed. Results: Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included “information and communication” (9 items), “content creation and management” (4 items), and “safety and security” (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults. Conclusions: In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society. %M 38095999 %R 10.2196/51616 %U https://www.jmir.org/2023/1/e51616 %U https://doi.org/10.2196/51616 %U http://www.ncbi.nlm.nih.gov/pubmed/38095999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48838 %T Structural Validation and Measurement Invariance Testing of the Chinese Version of the eHealth Literacy Scale Among Undergraduates: Cross-Sectional Study %A Long,Chen %A Zheng,Lin %A Liu,Runhua %A Duan,Zhongxian %+ School of Public Management, Guizhou University, No. 2708, South Section of Huaxi Avenue, Huaxi District, Guiyang, 550025, China, 86 187 9883 8878, zxduan@gzu.edu.cn %K eHealth literacy %K eHEALS %K factor structure %K measurement invariance %K undergraduates %K health literacy %K cross-sectional survey %K digital health literacy %K measurement %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) was introduced in China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention, although its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multigroup measurement properties. Objective: This study aimed to evaluate the Chinese version of the eHEALS in terms of its measurement properties. Methods: A cross-sectional survey was conducted in a university setting in China. Item statistics were checked for response distributions and floor and ceiling effects. Internal consistency reliability was confirmed with Cronbach α, split-half reliability, Cronbach α if an item was deleted, and item-total correlation. A total of 5 representative eHEALS factor structures were examined and contrasted using confirmatory factor analysis. The study used the item-level content validity index (I-CVI) and the average of the I-CVI scores of all items on the scale to assess the content validity of the dominance model. Furthermore, the validated dominance model was subsequently used to evaluate the relevance and representation of elements in the instrument and to assess measurement invariance across genders. Results: A total of 972 respondents were identified, with a Cronbach α of .92, split-half reliability of 0.88, and item-total score correlation coefficients ranging from 0.715 to 0.781. Cronbach α if an item was deleted showed that all items should be retained. Acceptable content validity was supported by I-CVIs ≥0.80. The confirmatory factor analysis confirmed that the 3-factor model was acceptable. The measurement model met all relevant fit indices: average variance extracted from 0.663 to 0.680, composite reliability from 0.810 to 0.857, chi-square divided by the df of 4.768, root mean square error of approximation of 0.062, standardized root mean squared residual of 0.020, comparative fit index (CFI) of 0.987, and Tucker-Lewis index of 0.979. In addition, the scale demonstrated error variance invariance (Δnormed fit index=−0.016, Δincremental fit index=−0.012, ΔTucker-Lewis index=0.005, Δcomparative fit index=−0.012, Δrelative fit index=0.005, and Δroot mean square error of approximation=0.005). Conclusions: A 3-factor model of the Chinese version of the eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender. %M 37990370 %R 10.2196/48838 %U https://www.jmir.org/2023/1/e48838 %U https://doi.org/10.2196/48838 %U http://www.ncbi.nlm.nih.gov/pubmed/37990370 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e48981 %T The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study %A Ramjee,Serena %A Mohamedthani,Hanen %A Patel,Aditya Umeshkumar %A Goiriz,Rebeca %A Harwood,Catherine A %A Osborne,Richard H %A Cheng,Christina %A Hasan,Zeeshaan-ul %+ Barts and the London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner St, London, E1 2AD, United Kingdom, 44 02078822239, serena.ramjee1@nhs.net %K dermatology %K health literacy %K digital health literacy %K digital literacy %K skin %K chronic %K cluster analysis %K innovation %K eHealth literacy %K dermatologists %K telehealth %K dermatologist %K telemedicine %K remote care %K service %K services %K quality improvement %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. Objective: This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients’ digital health literacy requirements. Methods: We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. Results: The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. Conclusions: By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services. %M 38064259 %R 10.2196/48981 %U https://derma.jmir.org/2023/1/e48981 %U https://doi.org/10.2196/48981 %U http://www.ncbi.nlm.nih.gov/pubmed/38064259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46336 %T The Effectiveness of Publicly Available Web-Based Interventions in Promoting Health App Use, Digital Health Literacy, and Media Literacy: Pre-Post Evaluation Study %A König,Lars %A Suhr,Ralf %+ Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30419549262, lars.koenig@charite.de %K digital health literacy %K e-learning %K health apps %K health education %K health literacy %K media literacy %K mHealth %K mobile health %K serious games %K user experience %K web-based intervention %D 2023 %7 4.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: According to the World Health Organization, implementing mobile health (mHealth) technologies can increase access to quality health services worldwide. mHealth apps for smartphones, also known as health apps, are a central component of mHealth, and they are already used in diverse medical contexts. To benefit from health apps, potential users need specific skills that enable them to use such apps in a responsible and constructive manner. Objective: This study aimed to evaluate the effectiveness of the free and widely used web-based intervention, The APPocalypse?. Besides providing knowledge about health apps, the web-based intervention was designed to promote digital health and media literacy by teaching skills that enable users to distinguish between trustworthy and less trustworthy health apps. It was hypothesized that after completing the web-based intervention, participants’ knowledge in the domain of health apps, their digital health literacy, and their media literacy would be higher than it was before completing the web-based intervention. Methods: The study was divided into 3 parts. During part 1, participants (n=365; 181 female, 181 male, and 3 diverse; mean age 17.74, SD 1.391 years) provided demographic information and answered the pre- and postmeasurements. The measurements included questionnaires about participants’ knowledge in the domain of health apps, digital health literacy, and media literacy. During part 2, participants had 1 week to complete the web-based intervention. During part 3, participants answered the pre- and postmeasurements again. Furthermore, they answered educational quality and user experience questionnaires. Bayesian paired samples 2-tailed t tests were conducted to test the hypotheses. Results: Overall, the results support the hypotheses. After completing the web-based intervention, participants demonstrated more elaborate knowledge in the domain of health apps. Specifically, they displayed higher competencies in the domains of subjective (Bayes factor10 [BF10]=1.475×1079; effect size δ=–1.327) and objective health app knowledge (BF10=8.162×1080; effect size δ=–1.350). Furthermore, participants demonstrated higher digital health literacy. Specifically, they displayed higher competencies in the domains of information appraisal (BF10=3.413×1043; effect size δ=–0.870), information searching (BF10=3.324×1023; effect size δ=–0.604), evaluating reliability (BF10=3.081×1035; effect size δ=–0.766), and determining relevance (BF10=3.451×1024; effect size δ=–0.618). Regarding media literacy, the results were mixed. Participants displayed higher competencies in the domain of technology literacy beliefs (BF10=1.533×1021; effect size δ=–0.570). In the domain of technology control beliefs, their competencies did not seem to improve (BF10=0.109; effect size δ=–0.058). In comparison to relevant benchmarks, the web-based intervention offers exceptional educational quality and a superior user experience. Conclusions: The free web-based intervention The APPocalypse? might promote the constructive use of health apps, digital health literacy, and media literacy. Therefore, it may contribute to achieving the health-related United Nations Sustainable Development Goals. %M 38048146 %R 10.2196/46336 %U https://www.jmir.org/2023/1/e46336 %U https://doi.org/10.2196/46336 %U http://www.ncbi.nlm.nih.gov/pubmed/38048146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e52877 %T Authors’ Reply: “The Problem of Investigating Causal Relationships Between Cognitive and Evaluative Variables” %A Guetz,Bernhard %A Bidmon,Sonja %+ Carinthia University of Applied Sciences, Europastraße 4, Villach & Klagenfurt, 9524, Austria, 43 5905002453, guetz@fh-kaernten.at %K social influence %K physician rating websites %K patient satisfaction %K eHealth literacy %D 2023 %7 22.11.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37991815 %R 10.2196/52877 %U https://www.jmir.org/2023/1/e52877 %U https://doi.org/10.2196/52877 %U http://www.ncbi.nlm.nih.gov/pubmed/37991815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45570 %T The Problem of Investigating Causal Relationships Between Cognitive and Evaluative Variables %A Konerding,Uwe %+ Trimberg Research Academy, University of Bamberg, Otto-Friedrich-Universität Bamberg, Bamberg, D-96045, Germany, 49 951 863 3098, uwe.konerding@uni-bamberg.de %K social influence %K physician rating websites %K patient satisfaction %K eHealth literacy %D 2023 %7 22.11.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37991832 %R 10.2196/45570 %U https://www.jmir.org/2023/1/e45570 %U https://doi.org/10.2196/45570 %U http://www.ncbi.nlm.nih.gov/pubmed/37991832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51541 %T Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial %A Barksdale,Shanikque %A Stark Taylor,Shannon %A Criss,Shaniece %A Kemper,Karen %A Friedman,Daniela B. %A Thompson,Wanda %A Donelle,Lorie %A MacGilvray,Phyllis %A Natafgi,Nabil %+ Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery Bldg. Suite 349, Columbia, SC, 29208, United States, 1 803 777 8133, nnatafgi@mailbox.sc.edu %K digital health %K family medicine %K health literacy %K medical residents %K patient engagement %K patient-centered %K residency program %K teach-back %K telehealth %K telemedicine %K virtual care %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients’ understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. Objective: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. Methods: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop’s videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. Results: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents’ confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. Conclusions: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers’ concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers’ ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform. %M 37971799 %R 10.2196/51541 %U https://formative.jmir.org/2023/1/e51541 %U https://doi.org/10.2196/51541 %U http://www.ncbi.nlm.nih.gov/pubmed/37971799 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e50345 %T Gluu Essentials Digital Skills Training for Middle-Aged and Older Adults That Makes Skills Stick: Results of a Pre-Post Intervention Study %A Seaton,Cherisse L %A Rush,Kathy L %A Li,Eric Ping Hung %A Hasan,Mohammad Khalad %A Fawcus,Linda %+ School of Nursing, University of British Columbia, 1147 Research Rd, Kelowna, BC, V1V 1V7, Canada, 1 2508078652, Cherisse.Seaton@ubc.ca %K digital literacy %K digital skills %K older adults %K mobile device proficiency %K online %K mobile phone %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied. Objective: The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ≥50 years) and to gather participants’ recommendations for lifelong digital skills promotion. Methods: The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support. Results: A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants’ recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access. Conclusions: The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults. %M 37948115 %R 10.2196/50345 %U https://aging.jmir.org/2023/1/e50345 %U https://doi.org/10.2196/50345 %U http://www.ncbi.nlm.nih.gov/pubmed/37948115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47595 %T Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study %A Jiao,Wen %A Chang,Angela %A Ho,Mary %A Lu,Qianfeng %A Liu,Matthew Tingchi %A Schulz,Peter Johannes %+ Department of Communication, Faculty of Social Sciences, University of Macau, E21-2056, Avenida da Universidade, Taipa, Macao, China, 853 8822 8991, wychang@um.edu.mo %K health information seeking %K digital health literacy %K health empowerment %K Generation Z %K digitally savvy %D 2023 %7 30.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research. Objective: First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health. Methods: The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results. Results: When compared with previous generations, Generation Z respondents (995/1862, 53.44%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: β=.192, P<.001; older population: β=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: β=.070, P=.002; older population: β=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall. Conclusions: This study examined and compared the health information–seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors. %M 37902832 %R 10.2196/47595 %U https://www.jmir.org/2023/1/e47595 %U https://doi.org/10.2196/47595 %U http://www.ncbi.nlm.nih.gov/pubmed/37902832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48143 %T Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis %A Engineer,Margi %A Kot,Sushant %A Dixon,Emma %+ Computer Science Department, Clemson University, 105 Sikes Hall, Clemson, SC, 29634, United States, 1 (864) 656 3311, mengine@g.clemson.edu %K natural language processing %K consumer health information %K readability %K Alzheimer disease and related dementias %K caregivers %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. Objective: In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. Methods: We assessed the text’s readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. Results: The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. Conclusions: Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia. %M 37878351 %R 10.2196/48143 %U https://formative.jmir.org/2023/1/e48143 %U https://doi.org/10.2196/48143 %U http://www.ncbi.nlm.nih.gov/pubmed/37878351 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47556 %T Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study %A Xu,Richard Huan %A Chan,Ho Hin %A Shi,Lushaobo %A Li,Ting %A Wang,Dong %+ School of Health Management, Southern Medical University, Shatai Nan Road, Guangzhou, 510515, China, 86 61647576, dongw96@smu.edu.cn %K coronaphobia %K eHealth literacy %K Bayesian statistics %K structural equation modeling %K mediating effect %K mental health %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people’s ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown. Objective: This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults. Methods: The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated. Results: A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from −0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean −0.0016, 95% HDI −0.0022 to −0.0011), depression (posterior mean −0.006, 95% HDI −0.0079 to −0.004), stigma (posterior mean −0.0052, 95% HDI −0.0068 to −0.0036), and irritability (posterior mean −0.0037, 95% HDI −0.0052 to −0.0022). The moderating effects of eHL varied across the rural and urban subsamples. Conclusions: Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19–related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic. %M 37773621 %R 10.2196/47556 %U https://publichealth.jmir.org/2023/1/e47556 %U https://doi.org/10.2196/47556 %U http://www.ncbi.nlm.nih.gov/pubmed/37773621 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45484 %T User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study %A Chen,Nai-Jung %A Huang,Chiu-Mieh %A Fan,Ching-Chih %A Lu,Li-Ting %A Lin,Fen-He %A Liao,Jung-Yu %A Guo,Jong-Long %+ Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, No. 162, Sec. 1, Heping East Road, Taipei, 106, Taiwan, 886 2 7749 1737, jonglong@ntnu.edu.tw %K chronic kidney disease %K chatbot %K health education %K push notification %K users’ evaluation %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. Objective: The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants’ user experiences will form the basis for program design improvements. Methods: Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Results: Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. Conclusions: The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users’ evaluation is satisfactory. Trial Registration: ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517 %M 37725429 %R 10.2196/45484 %U https://formative.jmir.org/2023/1/e45484 %U https://doi.org/10.2196/45484 %U http://www.ncbi.nlm.nih.gov/pubmed/37725429 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46002 %T Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project %A Tewary,Sweta %A Cook,Nicole %A Dezine,Marie %A Shnayder,Oksana %A Pandya,Naushira %+ Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL, 33314, United States, 1 954 262 4015, st813@nova.edu %K COVID-19 %K telehealth %K older adults %K isolation %K health education %K mental wellness %K telemedicine %K health literacy %K digital health %K mental health %K social isolation %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University’s South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15%), to connect with friends and family (n=10, 26%), and to connect with faith communities (n=3, 8%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. %M 37695647 %R 10.2196/46002 %U https://formative.jmir.org/2023/1/e46002 %U https://doi.org/10.2196/46002 %U http://www.ncbi.nlm.nih.gov/pubmed/37695647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45224 %T Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study %A O'Brien,Niki %A Li,Edmond %A Chaibva,Cynthia N %A Gomez Bravo,Raquel %A Kovacevic,Lana %A Kwame Ayisi-Boateng,Nana %A Lounsbury,Olivia %A Nwabufo,Ngnedjou Francoise F %A Senkyire,Ephraim Kumi %A Serafini,Alice %A Surafel Abay,Eleleta %A van de Vijver,Steven %A Wanjala,Mercy %A Wangari,Marie-Claire %A Moosa,Shabir %A Neves,Ana Luisa %+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Hospital, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk %K digital health %K digital health technology %K telemedicine %K remote care %K primary care %K primary health carel PHC %K COVID-19 %K global health %K sub-Saharan Africa %K eHealth %D 2023 %7 7.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers’ contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. %M 37676721 %R 10.2196/45224 %U https://www.jmir.org/2023/1/e45224 %U https://doi.org/10.2196/45224 %U http://www.ncbi.nlm.nih.gov/pubmed/37676721 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48630 %T Health Information on Pre-Exposure Prophylaxis From Search Engines and Twitter: Readability Analysis %A Park,Albert %A Sayed,Fatima %A Robinson,Patrick %A Elopre,Latesha %A Ge,Yaorong %A Li,Shaoyu %A Grov,Christian %A Sullivan,Patrick Sean %+ Department of Software and Information Systems, University of North Carolina Charlotte, 9201 University City Blvd, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 704 687 8668, al.park@charlotte.edu %K pre-exposure prophylaxis %K PrEP %K health literacy %K health education materials %K readability %K prophylaxis %K health information %K electronic health education %K HIV %K infection %K Twitter %D 2023 %7 4.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication. Objective: We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience. Methods: Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons. Results: A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level. Conclusions: Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States. %M 37665621 %R 10.2196/48630 %U https://publichealth.jmir.org/2023/1/e48630 %U https://doi.org/10.2196/48630 %U http://www.ncbi.nlm.nih.gov/pubmed/37665621 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e46819 %T Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study %A Livesay,Karen %A Petersen,Sacha %A Walter,Ruby %A Zhao,Lin %A Butler-Henderson,Kerryn %A Abdolkhani,Robab %+ School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, 289 McKimmies Rd, Bundoora, Melbourne, 3083, Australia, 61 98098654, robab.abdolkhani@rmit.edu.au %K nursing informatics %K digital health %K COVID-19 pandemic %K workforce %K sociotechnical approach %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. Objective: This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. Methods: Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. Results: Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses’ lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. Conclusions: Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce. %M 37585256 %R 10.2196/46819 %U https://nursing.jmir.org/2023/1/e46819 %U https://doi.org/10.2196/46819 %U http://www.ncbi.nlm.nih.gov/pubmed/37585256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46841 %T The Effectiveness of Improving Infectious Disease–Specific Health Literacy Among Residents: WeChat-Based Health Education Intervention Program %A Zhao,Yusui %A Xu,Shuiyang %A Zhang,Xuehai %A Wang,Lei %A Huang,Yu %A Wu,Shuxian %A Wu,Qingqing %+ Zhejiang Provincial Center for Disease Control and Prevention, Department of Health Education, 3399 Binsheng Road, Hanghzhou, 310051, China, 86 0571 87118439, qqwu@cdc.zj.cn %K effectiveness %K health education %K infectious disease-specific health literacy %K intervention %K WeChat %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Infectious disease–specific health literacy (IDSHL) has become an important determinant of infectious disease incidence. It can not only reduce the incidence of re-emerging infectious diseases, but also effectively prevent the emergence of new infectious diseases such as COVID-19. WeChat, as a new media, has been proven to greatly reduce the chance of infectious diseases spreading from person to person, especially in case of respiratory infections. However, there is currently no concrete health education invention program to improve IDSHL using a WeChat public account. Objective: The aims of this study were as follows: (1) to determine the IDSHL of the population in Zhejiang, China; (2) to develop a health education program for the improvement of IDSHL using a WeChat public account; and (3) to evaluate the effectiveness of the health education program that was implemented in the prevention of infectious disease outbreaks. Methods: We used a standardized questionnaire, which consisted of 28 closed-ended questions, to measure the level and score of IDSHL before and after intervention. A multiple-stage stratified random sampling technique was used to select study participants from Zhejiang province in China, who were further divided randomly into 2 groups: the intervention and control groups. From July 2014 to January 2015, a WeChat-based health education intervention program was carried out on the intervention group. Standard descriptive statistics and chi-square and t tests were conducted to analyze the data. Results: A total of 3001 residents participated in the baseline survey of this study. At baseline, participant IDSHL rates were 73.29% and 72.12% for the intervention and control groups, respectively (Χ21=0.5; P=.50). After 7 months of intervention, 9.90% (297/3001) of participants dropped out of the study. Of the lost participants, 119 were from the intervention group and 178 were from the control group. There were significant differences between follow-up and lost participants with respect to age (P=.04), marital status (P=.02) and occupations (P=.002). After intervention, the intervention group scores in the different domains were higher than those in the control group (infectious disease–related knowledge, prevention, management, or treatment, identification of pathogens and infection sources, and cognitive ability). There were significant improvements in the IDSHL of participants in both the intervention and control groups (Χ21=135.9; P<.001 vs Χ21=9.1; P=.003), and there was a greater change in the IDSHL among the intervention group participants than among the control group participants (1230/1359, 90.51% vs 1038/1359, 77.17%). Conclusions: The health education intervention program using a WeChat public account proved to be an effective, feasible, and well-accepted means to improve the IDSHL of the general population. In the future, this health education intervention program can be used as a reference for prevention and treatment of infectious diseases. %M 37556189 %R 10.2196/46841 %U https://formative.jmir.org/2023/1/e46841 %U https://doi.org/10.2196/46841 %U http://www.ncbi.nlm.nih.gov/pubmed/37556189 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46649 %T Digital Outpatient Services for Adults: Development of an Intervention and Protocol for a Multicenter Non–Randomized Controlled Trial %A Holmen,Heidi %A Holm,Are Martin %A Kilvær,Thomas Karsten %A Ljoså,Tone Marte %A Granan,Lars-Petter %A Ekholdt,Christopher %A Larsen,Lotte Sandberg %A Fosse,Erik %+ Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, 47 91 50 27 70, heidho@ous-hf.no %K cancer %K complex pain %K digital solution %K epilepsy %K health literacy %K interstitial lung disease %K mHealth %K outpatient %K patient-reported outcome measures %K remote monitoring %K self-monitoring %D 2023 %7 10.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted. Objective: This article aims to describe the “digital outpatient service” intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention. Methods: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers’ dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non–randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis. Results: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023. Conclusions: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care. Trial Registration: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869 International Registered Report Identifier (IRRID): DERR1-10.2196/46649 %M 37428533 %R 10.2196/46649 %U https://www.researchprotocols.org/2023/1/e46649 %U https://doi.org/10.2196/46649 %U http://www.ncbi.nlm.nih.gov/pubmed/37428533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48166 %T Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis %A Dong,Qian %A Liu,Ting %A Liu,Ran %A Yang,Hongxia %A Liu,Cuiping %+ School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Changcheng Road, Taian, Shandong Province, 271016, China, 86 13854218960, lcping0926@126.com %K digital health literacy interventions %K older adults %K eHealth literacy efficacy %K knowledge %K self-efficacy %K skills %D 2023 %7 28.6.2023 %9 Review %J J Med Internet Res %G English %X Background: In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults. DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people. Objective: The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults. Methods: English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses. Results: A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI –0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review. Conclusions: DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204 %M 37379077 %R 10.2196/48166 %U https://www.jmir.org/2023/1/e48166 %U https://doi.org/10.2196/48166 %U http://www.ncbi.nlm.nih.gov/pubmed/37379077 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40425 %T The Use of Digital Health by South Asian Communities: Scoping Review %A Aldosari,Nasser %A Ahmed,Saima %A McDermott,Jane %A Stanmore,Emma %+ School of Health Sciences, University of Manchester, Oxford St, Manchester, M11 3DF, United Kingdom, 44 7580503020, nmdhaa@gmail.com %K South Asians %K Asia %K digital health %K eHealth %K mHealth %K mobile health %K aging %K ethnicity %K ethnic %K culturally sensitive %K cultural sensitivity %K inequality %K inequalities %K disparity %K disparities %K physical activity %K exercise %K immigrant %K scoping review %K experience %K attitude %K barrier %K facilitator %K opinion %K adoption %K digital divide %K accessibility %K minority %K mobile phone %D 2023 %7 12.6.2023 %9 Review %J J Med Internet Res %G English %X Background: South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. Objective: The aim of the review is to identify South Asian individuals’ experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services. Methods: The Arksey and O’Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review. Results: Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians. Conclusions: Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups’ access to health care services to support individual health needs, and consequently enhance health status. %M 37307045 %R 10.2196/40425 %U https://www.jmir.org/2023/1/e40425 %U https://doi.org/10.2196/40425 %U http://www.ncbi.nlm.nih.gov/pubmed/37307045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44602 %T Performance-Based Measurement of eHealth Literacy: Systematic Scoping Review %A Crocker,Bradley %A Feng,Olivia %A Duncan,Lindsay R %+ Department of Kinesiology & Physical Education, McGill University, 475 Pine Ave W, Montreal, QC, H2W 1S4, Canada, 1 514 398 4184 ext 00919, bradley.crocker@mail.mcgill.ca %K eHealth literacy %K measurement %K performance-based %K eHealth Literacy Scale %K eHEALS %K scoping review %K review method %K health literacy %K library science %K librarian %K search strategy %D 2023 %7 2.6.2023 %9 Review %J J Med Internet Res %G English %X Background: eHealth literacy describes the ability to locate, comprehend, evaluate, and apply web-based health information to a health problem. In studies of eHealth literacy, researchers have primarily assessed participants’ perceived eHealth literacy using a short self-report instrument, for which ample research has shown little to no association with actual performed eHealth-related skills. Performance-based measures of eHealth literacy may be more effective at assessing actual eHealth skills, yet such measures seem to be scarcer in the literature. Objective: The primary purpose of this study was to identify tools that currently exist to measure eHealth literacy based on objective performance. A secondary purpose of this study was to characterize the prevalence of performance-based measurement of eHealth literacy in the literature compared with subjective measurement. Methods: We conducted a systematic scoping review of the literature, aligning with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, in 3 stages: conducting the search, screening articles, and extracting data into a summary table. The summary table includes terminology for eHealth literacy, description of participants, instrument design, health topics used, and a brief note on the evidence of validity for each performance-based measurement tool. A total of 1444 unique articles retrieved from 6 relevant databases (MEDLINE; PsycINFO; CINAHL; Library and Information Science Abstracts [LISA]; Library, Information Science & Technology Abstracts [LISTA]; and Education Resources Information Center [ERIC]) were considered for inclusion, of which 313 (21.68%) included a measure of eHealth literacy. Results: Among the 313 articles that included a measure of eHealth literacy, we identified 33 (10.5%) that reported on 29 unique performance-based eHealth literacy measurement tools. The types of tools ranged from having participants answer health-related questions using the internet, having participants engage in simulated internet tasks, and having participants evaluate website quality to quizzing participants on their knowledge of health and the web-based health information–seeking process. In addition, among the 313 articles, we identified 280 (89.5%) that measured eHealth literacy using only a self-rating tool. Conclusions: This study is the first research synthesis looking specifically at performance-based measures of eHealth literacy and may direct researchers toward existing performance-based measurement tools to be applied in future projects. We discuss some of the key benefits and drawbacks of different approaches to performance-based measurement of eHealth literacy. Researchers with an interest in gauging participants’ actual eHealth literacy (as opposed to perceived eHealth literacy) should make efforts to incorporate tools such as those identified in this systematic scoping review. %M 37266975 %R 10.2196/44602 %U https://www.jmir.org/2023/1/e44602 %U https://doi.org/10.2196/44602 %U http://www.ncbi.nlm.nih.gov/pubmed/37266975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46537 %T Global Trends in Social Prescribing: Web-Based Crawling Approach %A Lee,Hocheol %A Koh,Sang Baek %A Jo,Heui Sug %A Lee,Tae Ho %A Nam,Hae Kweun %A Zhao,Bo %A Lim,Subeen %A Lim,Joo Aeh %A Lee,Ho Hee %A Hwang,Yu Seong %A Kim,Dong Hyun %A Nam,Eun Woo %+ Department of Health Administration, Software Digital Healthcare Convergence College, Yonsei University, Changjogwan 412Ho, Yonseidae-gil 1, Wonju, 26493, Republic of Korea, 82 010 3867 9569, ewnam@yonsei.ac.kr %K social prescribing %K social loneliness %K National Health Service %K aging population %K web crawling %K sustainable model %K Google Trend %K web-based data %K NPI %K health care model %K primary care %K digital health intervention %K implementation %K health care professional %D 2023 %7 22.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing—a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. Objective: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. Methods: Google’s searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. Results: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing–related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased “Healthy” terms from 2020, “gardening” prominence in “Program,” “community” growth across categories, and “Target” term spikes in 2021. Conclusions: This study’s discussion highlights four key aspects: (1) the “Healthy” category trends emphasize mental health, cancer, and sleep; (2) the “Program” category prioritizes gardening, community, home-schooling, and digital initiatives; (3) “Governance” underscores the significance of community resources in social prescribing implementation; and (4) “Target” focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships. %M 37086427 %R 10.2196/46537 %U https://www.jmir.org/2023/1/e46537 %U https://doi.org/10.2196/46537 %U http://www.ncbi.nlm.nih.gov/pubmed/37086427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39808 %T The Chinese Version of the Patient Education Materials Assessment Tool for Printable Materials: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %A Dong,Zhaogang %A Xing,Zhaoquan %A Wang,Ding %A Cao,Xiangting %+ School of Foreign Studies, Nantong University, No. 9, Seyuan Rd., Chongchuan District, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K actionability %K adaptation %K Chinese version of the PEMAT-P %K comprehensibility %K health education materials translation %K validation %D 2023 %7 18.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing people with understandable and actionable health information can considerably promote healthy behaviors and outcomes. To this end, some valid and reliable scales assessing the patient-friendliness of health education materials, like the PEMAT-P (Patient Education Materials Assessment Tool for printable materials), have been well developed in English-speaking countries. However, the English version of the PEMAT-P has not been translated and adapted into simplified Chinese and validated in mainland China. Objective: This study sought to translate the PEMAT-P tool into a simplified Chinese (Mandarin) version (C-PEMAT-P, a Chinese version of the Patient Education Materials Assessment Tool for printable materials) and verify its validity and reliability for assessing the comprehensibility and actionability of health education resources written in simplified Chinese. As a result, the validated C-PEMAT-P could be used to guide health researchers and educators to design more comprehensible and actionable materials for more tailored and targeted health education and interventions. Methods: We translated the PEMAT-P into simplified Chinese in the following three steps: (1) forward-translating the PEMAT-P into simplified Chinese, (2) back-translating the simplified Chinese version into English, and (3) testing translation equivalence linguistically and culturally by examining the original English version of the PEMAT-P and the back-translated English version of the tool. Any discrepancies between the original English tool and the back-translated English tool were resolved through a panel discussion among the research team of all authors to produce a revised forward-translated Chinese version (C-PEMAT-P). We then evaluated the clarity of construction and wording as well as the content relevance of the C-PEMAT-P using a 4-point ordinal scale to determine its content validity. After that, 2 native Chinese speakers (health educators) used the C-PEMAT-P to rate 15 health education handouts concerning air pollution and health to validate their reliability. We calculated the Cohen coefficient and Cronbach α to determine the interrater agreement and internal consistency of the C-PEMAT-P, respectively. Results: We finalized the translated Chinese tool after discussing the differences between the 2 English versions (original and back-translated) of the PEMAT-P, producing the final Chinese version of the PEMAT-P (C-PEMAT-P). The content validity index of the C-PEMAT-P version was 0.969, the Cohen coefficient for the interrater scoring agreement was 0.928, and the Cronbach α for internal consistency was .897. These values indicated the high validity and reliability of the C-PEMAT-P. Conclusions: The C-PEMAT-P has been proven valid and reliable. It is the first Chinese scale for assessing the comprehensibility and actionability of Chinese health education materials. It can be used as an assessment tool to evaluate health education materials currently available and a guide to help health researchers and educators design more comprehensible and actionable materials for more tailored and targeted health education and interventions. %M 37200085 %R 10.2196/39808 %U https://www.jmir.org/2023/1/e39808 %U https://doi.org/10.2196/39808 %U http://www.ncbi.nlm.nih.gov/pubmed/37200085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44501 %T Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study %A Cheng,Jessica %A Arora,Vineet M %A Kappel,Nicole %A Vollbrecht,Hanna %A Meltzer,David O %A Press,Valerie %+ General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 773 702 5170, vpress@bsd.uchicago.edu %K health literacy %K eHealth literacy %K telehealth %K transitions of care, digital divide %K telemedicine %K technology use %K video consultation %K urban population %K digital health literacy %K patient care %D 2023 %7 12.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients. Objective: The aim of this study is to evaluate video capabilities, eHealth literacy, and engagement with video telehealth among hospitalized patients. Methods: The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed self-reported rates of audio versus video telehealth usage as well as the participants’ self-reported willingness to use video telehealth for future health care visits. We used a multivariable binary logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race or ethnicity, educational level, eHL literacy scale (eHEALS), health literacy (brief health literacy screen), technology access, internet access, and video capability. Results: Of the 297 enrolled participants, median age was 58 years, most (n=185, 62%) identified as Black, half (n=149, 50%) were female, one-quarter (n=66, 22%) lacked home internet access, and one-third (n=102, 34%) had inadequate eHL. Conclusions: Patients with low eHL reported greater participation in audio-only telehealth over video telehealth, of which the former may lose its flexible pandemic reimbursement policy. This may widen the existing health disparities as older adults and patients with low eHL face challenges in accessing video telehealth services. Low eHL is associated with lack of web-based skills, lower rates of video telehealth usage, and lower willingness to use video technology. The study results raise the question of how to improve video capability among patients who, despite having access to smartphones and laptops, face challenges in using telehealth optimally. %M 37171854 %R 10.2196/44501 %U https://formative.jmir.org/2023/1/e44501 %U https://doi.org/10.2196/44501 %U http://www.ncbi.nlm.nih.gov/pubmed/37171854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40914 %T Using Animated Videos to Promote the Accessibility and Understandability of Package Leaflets: Retrospective Observational Study Evaluating the First Year of Implementation %A van den Berg,Liselot N %A Chavannes,Niels H %A Aardoom,Jiska J %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 71 526 57 61, L.N.van_den_Berg@lumc.nl %K package leaflet %K health literacy %K implementation %K online library %K animated videos %K accessibility %K understandability %K comprehension %K eHealth %K medication %K health communication %D 2023 %7 4.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The medication package leaflet is the most used and trusted source of information in the home situation but is often incomprehensible for individuals, especially for those with limited health literacy. The platform “Watchyourmeds” comprises a web-based library with over 10,000 animated videos that explain the most essential information from the package leaflet in an unambiguous and simple manner to increase the accessibility and understandability of package leaflets. Objective: This study aimed to investigate Watchyourmeds in the Netherlands from a user perspective during the first year of implementation by investigating (1) usage data, (2) self-reported user experiences, and (3) the preliminary and potential impact on medication knowledge. Methods: This was a retrospective observational study. The first aim was investigated by examining objective user data from 1815 pharmacies from the first year of implementation of Watchyourmeds. User experiences (second aim) were investigated by examining individuals’ completed self-report questionnaires (n=4926) that they received after completing a video. The preliminary and potential impact on medication knowledge (third aim) was investigated by examining users’ self-report questionnaire data (n=67) that assessed their medication knowledge about their prescribed medication. Results: Nearly 1.8 million videos have been distributed to users by over 1400 pharmacies, with monthly numbers increasing to 280,000 in the last month of the implementation year. Most users (4444/4805, 92.5%) indicated to have fully understood the information presented in the videos. Female users reported more often to have fully understood the information than male users (χ24=11.5, P=.02). Most users (3662/4805, 76.2%) said that they did not think any information was missing in the video. Users with a lower educational level stated more often (1104/1290, 85.6%) than those with a middle (984/1230, 80%) or higher (964/1229, 78.4%) educational level that they did not seem to be missing any information in the videos (χ212=70.6, P<.001). A total of 84% (4142/4926) of the users stated that they would like to use Watchyourmeds more often and for all their medication, or would like to use it most of the time. Male users and older users stated more often that they would use Watchyourmeds again for other medication than the female (χ23=25.0, P<.001) and younger users (χ23=38.1, P<.001), respectively. Almost 88% (4318/4926) of the users would recommend the web-based library to friends, family, or acquaintances. Regarding the third aim, results showed that 73.8% (293/397) of the questions assessing users’ medication knowledge were answered correctly. Conclusions: The results of this study suggest that a web-based library with animated videos is a valuable and acceptable addition to stand-alone package leaflets to increase the understanding and accessibility of medication information. %M 37140968 %R 10.2196/40914 %U https://www.jmir.org/2023/1/e40914 %U https://doi.org/10.2196/40914 %U http://www.ncbi.nlm.nih.gov/pubmed/37140968 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40004 %T Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study %A Brainin,Esther %A Neter,Efrat %+ Ruppin Academic Center, Department of Behavioral Sciences, Faculty of Community and Social Sciences, Emek Hefer, Emek Hefer District, 4025000, Israel, 972 98983015, estherb@ruppin.ac.il %K eHealth %K health %K internet %K structuration theory %K agency %K digital divide %K age %K gender %K education %K information %K health condition %K self-rated health %K SRH %K health care services %K surrogate %K older adults %K users %K patient %K Giddens %K Archer %K Bourdieu %K capital %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults’ agential adoption of eHealth practices despite their advanced age. Objective: This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. Methods: We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. Results: We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. Conclusions: Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones’ circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today’s patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients. %M 37121572 %R 10.2196/40004 %U https://aging.jmir.org/2023/1/e40004 %U https://doi.org/10.2196/40004 %U http://www.ncbi.nlm.nih.gov/pubmed/37121572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43002 %T The Chinese Version of the Breast Cancer Literacy Assessment Tool: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K breast cancer literacy assessment tool %K translation %K adaptation %K psychometric evaluation %K validity %K reliability %K breast cancer %K cancer %K tool %K women %K prevention %K detection %K intervention %K assessment %K education %K breast cancer literacy %K assessment tool %K cancer awareness %K health literacy %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer among Chinese women, with an age-standardized prevalence of 21.6 cases per 100,000 women. Limited cancer health literacy reduces females’ ability to engage in cancer prevention and detection. It is necessary to assess Chinese women’s breast cancer literacy to deliver targeted interventions and effective education. However, there is no Breast Cancer Literacy Assessment Tool (B-CLAT) available in China currently. Objective: This study aimed to translate and linguistically and culturally adapt the B-CLAT into a simplified-Chinese version (C-B-CLAT), and then validate its psychometric properties by administering it to Chinese college students. Methods: First, we translated the B-CLAT into a simplified-Chinese version and verified its validity and reliability using rigorous translation and validation guidelines proposed in previous studies. We then evaluated the psychometric properties among 50 female participants with a mean age of 19.62 (SD 1.31) years recruited from Nantong University, China. Results: Items 1, 6, 8, 9, 10, 16, 17, 20, 21, 22, 23, 24, 25, 26, 29, and 30 were deleted to increase the relevant subscale internal consistency. Items 3, 12, 13, 14, 18, 20, 27, and 31 were deleted due to their Cronbach α being lower than .5 in the test-retest analysis. After deletion, the internal consistency of the entire scale was fair with α=.607. The prevention and control subscale had the highest internal consistency with α=.730, followed by the screening and knowledge subscale with α=.509, while the awareness subscale had the lowest internal consistency with α=.224. The intraclass correlation coefficient for the C-B-CLAT (items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34) was fair to excellent (odds ratio [OR] 0.88, 95% CI 0.503-0.808). The values of Cronbach α for items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34 ranged from .499 to .806, and the α value for the C-B-CLAT was .607. This indicates fair test-retest reliability. The mean difference in the C-B-CLAT scores between stage 1 and stage 2 was 0.47 (OR 0.67, 95% CI −0.53 to 1.47), which was not significantly different from zero (t48=0.945; P=.35). This result implies that the C-B-CLAT produced the same scores at stage 1 and stage 2 on average, thus showing good agreement in the C-B-CLAT scores between stage 1 and stage 2. The SD of the difference was 3.48. The 95% limits of agreement were −6.34 to 7.28. Conclusions: We developed a simplified-Chinese version of the B-CLAT through translation and adaptation. Psychometric properties testing has proven this version valid and reliable for assessing breast cancer literacy among Chinese college students. %M 37074784 %R 10.2196/43002 %U https://formative.jmir.org/2023/1/e43002 %U https://doi.org/10.2196/43002 %U http://www.ncbi.nlm.nih.gov/pubmed/37074784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42868 %T Factors Associated With Limited Digital Health Literacy Among Chinese Male Populations: Cross-sectional Study %A Xing,Zhaoquan %A Ji,Meng %A Dong,Zhaogang %A Xu,Xiaofei %A Shan,Yi %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K factor %K older age %K lower education attainment %K lower functional, communicative, and critical health literacy %K weaker belief and self-confidence %K limited eHealth literacy %K Chinese population %K logistic regression %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth resources and interventions promise to promote favorable behavior change, self-efficacy, and knowledge acquisition, thereby improving health literacy. However, individuals with limited eHealth literacy may find it difficult to identify, understand, and benefit from eHealth use. It is necessary to identify the self-assessed eHealth literacy of those who use eHealth resources to classify their eHealth literacy levels and to determine the demographic characteristics associated with higher and lower eHealth literacy skills. Objective: This study aimed to identify notable factors closely associated with limited eHealth literacy among Chinese male populations to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We hypothesized that participants’ eHealth literacy status was associated with various demographic characteristics. Therefore, we elicited the following information in the questionnaire: age and education, self-assessed disease knowledge, 3 well-developed health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, eHealth Literacy Scale, and General Health Numeracy Test), and the 6 Internal items on health beliefs and self-confidence in the Multidimensional Health Locus of Control Scales. Using randomized sampling, we recruited survey participants from Qilu Hospital of Shandong University, China. After validating the data collected through a web-based questionnaire survey via wenjuanxing, we coded all valid data according to predefined coding schemes of Likert scales with different point (score) ranges. We then calculated the total scores of the subsections of the scales or the entire scale. Finally, we used logistic regression modeling to associate the scores of the eHealth Literacy Scale with the scores of the All Aspects of Health Literacy Scale, the General Health Numeracy Test-6, and age and education to ascertain factors considerably associated with limited eHealth literacy among Chinese male populations. Results: All data from the 543 returned questionnaires were valid according to the validation criteria. By interpreting these descriptive statistics, we found that 4 factors were significantly correlated with participants’ limited eHealth literacy: older age, lower education attainment, lower levels of all aspects of health literacy (functional, communicative, and critical), and weaker beliefs and self-confidence in internal drivers and strengths to stay healthy. Conclusions: By applying logistic regression modeling, we ascertained 4 factors that were significantly correlated with limited eHealth literacy among Chinese male populations. These relevant factors identified can inform stakeholders engaging in clinical practice, health education, medical research, and health policy making. %M 37074760 %R 10.2196/42868 %U https://formative.jmir.org/2023/1/e42868 %U https://doi.org/10.2196/42868 %U http://www.ncbi.nlm.nih.gov/pubmed/37074760 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e38377 %T A Web Tool to Help Counter the Spread of Misinformation and Fake News: Pre-Post Study Among Medical Students to Increase Digital Health Literacy %A Moretti,Valentina %A Brunelli,Laura %A Conte,Alessandro %A Valdi,Giulia %A Guelfi,Maria Renza %A Masoni,Marco %A Anelli,Filippo %A Arnoldo,Luca %+ Dipartimento di Area Medica, Università degli Studi di Udine, via Colugna 50, Udine, 33100, Italy, 39 0432554768, laura.brunelli@uniud.it %K infodemic %K fake news %K education %K digital health literacy %K medical education %K medical student %K health information %K social media %K health literacy %K online learning %K digital education %K COVID-19 %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic was accompanied by the spread of uncontrolled health information and fake news, which also quickly became an infodemic. Emergency communication is a challenge for public health institutions to engage the public during disease outbreaks. Health professionals need a high level of digital health literacy (DHL) to cope with difficulties; therefore, efforts should be made to address this issue starting from undergraduate medical students. Objective: The aim of this study was to investigate the DHL skills of Italian medical students and the effectiveness of an informatics course offered by the University of Florence (Italy). This course focuses on assessing the quality of medical information using the “dottoremaeveroche” (DMEVC) web resource offered by the Italian National Federation of Orders of Surgeons and Dentists, and on health information management. Methods: A pre-post study was conducted at the University of Florence between November and December 2020. First-year medical students participated in a web-based survey before and after attending the informatics course. The DHL level was self-assessed using the eHealth Literacy Scale for Italy (IT-eHEALS) tool and questions about the features and quality of the resources. All responses were rated on a 5-point Likert scale. Change in the perception of skills was assessed using the Wilcoxon test. Results: A total of 341 students participated in the survey at the beginning of the informatics course (women: n=211, 61.9%; mean age 19.8, SD 2.0) and 217 of them (64.2%) completed the survey at the end of the course. At the first assessment, the DHL level was moderate, with a mean total score of the IT-eHEALS of 2.9 (SD 0.9). Students felt confident about finding health-related information on the internet (mean score of 3.4, SD 1.1), whereas they doubted the usefulness of the information they received (mean score of 2.0, SD 1.0). All scores improved significantly in the second assessment. The overall mean score of the IT-eHEALS significantly increased (P<.001) to 4.2 (SD 0.6). The item with the highest score related to recognizing the quality of health information (mean score of 4.5, SD 0.7), whereas confidence in the practical application of the information received remained the lowest (mean of 3.7, SD 1.1) despite improvement. Almost all students (94.5%) valued the DMEVC as an educational tool. Conclusions: The DMEVC tool was effective in improving medical students’ DHL skills. Effective tools and resources such as the DMEVC website should be used in public health communication to facilitate access to validated evidence and understanding of health recommendations. %M 36996010 %R 10.2196/38377 %U https://mededu.jmir.org/2023/1/e38377 %U https://doi.org/10.2196/38377 %U http://www.ncbi.nlm.nih.gov/pubmed/36996010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41394 %T The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study %A Ishizuka-Inoue,Mami %A Shimoura,Kanako %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K infodemic %K COVID-19 %K health literacy %K fear of COVID-19 %K cross-sectional study %K behavior %K age group %K misinformation %K influence %K prevention %K disease %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants’ characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. %M 37011226 %R 10.2196/41394 %U https://formative.jmir.org/2023/1/e41394 %U https://doi.org/10.2196/41394 %U http://www.ncbi.nlm.nih.gov/pubmed/37011226 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e42609 %T Use of Social Media for Patient Education in Dermatology: Narrative Review %A Wojtara,Magda Sara %+ Department of Human Genetics, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, United States, 1 248 962 3672, wojtaram@umich.edu %K dermatology %K health literacy %K innovation %K patient education %K social media %D 2023 %7 14.4.2023 %9 Review %J JMIR Dermatol %G English %X Background: Social media has rapidly become one of the main avenues for news and communication among those with access to technology. Nearly 60% or 4.7 billion people worldwide use social media. Different social media networks provide users with a barrage of posts, opinions, and transformations. With this noticeable uptick in physician and patient education usage of social media, exploration of the impacts of social media on patient education in dermatology is crucial. Objective: The goal of this narrative review was to evaluate existing peer-reviewed literature examining the use of social media for patient education in dermatology and to establish trends and implications. Additional attention was given to different social media sites, and potential differences in modalities of posts such as short-form videos on TikTok and Instagram Reels, long-form videos on YouTube, and infographics on Twitter, Instagram, and Facebook. Methods: PubMed, Access DermatologyDxRx, and Scopus searches of peer-reviewed publications were performed to discover articles with social media and patient education keywords in combination with other health care–relevant or dermatology-relevant keywords. Subsequently, the screening of these studies was performed by the author who has experience with education and research experience in health care, dermatology, social media, and telehealth. Ultimately, the selected articles were summarized through qualitative analysis of key points and presented for further discussion. Results: Through this narrative review, the researcher was able to identify several publications focusing on dermatology and social media. Some common subject areas included the use of social media for the promotion of private dermatology practices, residency programs, and research journals. So long as providers, such as dermatologists, take ethical considerations into account, these platforms can provide patients with curated educational content. In addition, several publications emphasized the use of social media as a form of patient education on dermatologic conditions but also as a source of misinformation. Conclusions: This narrative review illuminated the use of social media as a form of patient education for dermatology, with its applications addressed across many demographics and situations. As social media platforms continue to update their algorithms, content filters, and posts, social media may become a reputable form of patient education in dermatology. Future studies and innovations should continue to explore innovations in this space, the efficacy of different modalities of posts, and longitudinal differences in patient outcomes and health literacy. %M 37632938 %R 10.2196/42609 %U https://derma.jmir.org/2023/1/e42609 %U https://doi.org/10.2196/42609 %U http://www.ncbi.nlm.nih.gov/pubmed/37632938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43267 %T The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study %A Sjöström,Anna E %A Hajdarevic,Senada %A Hörnsten,Åsa %A Kristjánsdóttir,Ólöf %A Castor,Charlotte %A Isaksson,Ulf %+ Department of Nursing, Umeå University, Umeå, 90187, Sweden, 46 907865394, anna.e.sjostrom@umu.se %K cultural adaptation %K digital health %K eHealth %K eHLQ %K eHealth literacy %K health literacy %K validation %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers’ digital competencies—their “eHealth literacy.” The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. Objective: The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. Methods: We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori–defined factor structure (confirmatory factor analysis). Results: A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. Conclusions: The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations. %M 37043268 %R 10.2196/43267 %U https://www.jmir.org/2023/1/e43267 %U https://doi.org/10.2196/43267 %U http://www.ncbi.nlm.nih.gov/pubmed/37043268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41915 %T The Usage of Digital Health Technology Among Older Adults in Hong Kong and the Role of Technology Readiness and eHealth Literacy: Path Analysis %A Kim,Seungmo %A Chow,Bik Chu %A Park,Sanghyun %A Liu,Huaxuan %+ Department of Sport for All, Korea National Open University, Nanumgwan 507, 86 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea, 82 10 4817 4161, dslionspark@mail.knou.ac.kr %K older adults %K elderly %K digital health technology %K health technology %K digital health %K technology readiness %K eHealth literacy %K continuous usage intention %K usage intention %K intention-to-use %K attitude %K technology use %K elder %K digital literacy %K adoption %K acceptance %K readiness %K gerontology %K aging %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although digital health technologies (DHTs) help many people maintain a healthy life, including those of advanced age, these technologies are of little use to older adult populations if they are not being adopted in daily life. Thus, it is critical to identify ways to help older adults recognize and try new technologies and maintain their use of them to maximize the benefits of these technologies in a digital-based society. Objective: Our study aimed (1) to assess the current usage of DHT among older adults in Hong Kong and (2) to examine how high and low levels of eHealth literacy in this group affects the relationship between the Technology Readiness and Acceptance Model (TRAM) and attitudes and intention toward DHT. Methods: A total of 306 adults over 60 years of age in Hong Kong participated in this study. After conducting confirmatory factor analysis to validate the measurement model, the hypothesized model was tested using structural equation modeling. Results: Optimism was significantly related to perceived usefulness, while optimism, innovativeness, and discomfort were significantly associated with perceived ease of use. Both perceived usefulness and perceived ease of use were significantly linked to attitude toward the use of DHTs. Meanwhile, attitude significantly predicted usage intention. Additionally, the results revealed the differences in the relationships of the TRAM between participants with high and low levels of eHealth literacy. The influence of optimism and innovativeness on perceived ease of use was stronger for the higher-level group than for the lower-level group, and the influence of discomfort for the higher-level group was much weaker. Conclusions: The findings provided partial support for the impact of eHealth literacy on encouraging older adults to use DHT and obtain health benefits from it. This study also suggests providing assistance and guidelines for older adults to narrow the aging-related technology gap and to further explore the associations of eHealth literacy, the TRAM, and actual behaviors. %M 37043274 %R 10.2196/41915 %U https://www.jmir.org/2023/1/e41915 %U https://doi.org/10.2196/41915 %U http://www.ncbi.nlm.nih.gov/pubmed/37043274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35112 %T Developing a Digital Medication Adherence Intervention for and With Patients With Asthma and Low Health Literacy: Protocol for a Participatory Design Approach %A Faber,Jasper S %A Poot,Charlotte C %A Dekkers,Tessa %A Romero Herrera,Natalia %A Chavannes,Niels H %A Meijer,Eline %A Visch,V T %+ Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 640850881, j.s.faber@tudelft.nl %K participatory design %K low health literacy %K eHealth %K medication adherence %K asthma %K mHealth %K health literacy %K participatory medicine %K health care %K medication %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Current eHealth interventions are poorly adopted by people with low health literacy (LHL) as they often fail to meet their needs, skills, and preferences. A major reason for this poor adoption is the generic, one-size-fits-all approach taken by designers of these interventions, without addressing the needs, skills, and preferences of disadvantaged groups. Participatory design approaches are effective for developing interventions that fit the needs of specific target groups; yet, very little is known about the practical implications of executing a participatory design project for and with people with LHL. Objective: This study aimed to demonstrate the application of participatory design activities specifically selected to fit the needs and skills of people with LHL and how these were manifested within an overarching eHealth design process. In addition, the study aims to present reflections and implications of these activities that could support future designers to engage people with LHL in their design processes. Methods: We used the design process of a smart asthma inhaler for people with asthma and LHL to demonstrate participatory design activities. The study was framed under 5 stages of design thinking: empathize, define, ideate, prototype, and test within 2 major iteration cycles. We integrated 3 participatory design activities deemed specifically appropriate for people with LHL: co-constructing stories, experience prototype exhibition, and video prototype evaluation. Results: Co-constructing stories was found to deepen the understanding of the participant’s motivation to use or not to use maintenance medication. This understanding informed and facilitated the subsequent development of diverse preliminary prototypes of possible interventions. Discussing these prototypes in the experience prototype exhibition helped provoke reactions, thoughts, and feelings about the interventions, and potential scenarios of use. Through the video prototype evaluation, we were able to clearly communicate the goal and functionality of the final version of our intervention and gather appropriate responses from our participants. Conclusions: This study demonstrates a participatory design approach for and with patients with asthma and LHL. We demonstrated that careful consideration and selection of activities can result in participants that are engaged and feel understood. This paper provides insight into the practical implications of participatory activities with people with LHL and supports and inspires future designers to engage with this disadvantaged target group. %M 37043260 %R 10.2196/35112 %U https://formative.jmir.org/2023/1/e35112 %U https://doi.org/10.2196/35112 %U http://www.ncbi.nlm.nih.gov/pubmed/37043260 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43342 %T Assessing Patients’ Critical Health Literacy and Identifying Associated Factors: Cross-sectional Study %A Shan,Yi %A Ji,Meng %A Dong,Zhaogang %A Xing,Zhaoquan %A Xu,Xiaofei %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K critical health literacy %K Chinese patients %K latent class modeling %K limited critical health literacy %K associated factors %D 2023 %7 5.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have revealed that functional health literacy plays a less important role than communicative and critical health literacy (CRHL) and that communicative literacy and CRHL contribute more to better patient self-management. Although improving health literacy has been identified as an approach to fostering community involvement and empowerment, CRHL may be regarded as the neglected domain of health literacy, rarely achieving any focus or interventions that claim to be working toward this outcome. Considering this research background, close scholarly attention needs to be paid to CRHL and its associated factors. Objective: This study aimed to assess CRHL and identify essential factors closely associated with the status of CRHL among Chinese patients and to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We conducted this cross-sectional study, which lasted from April 8, 2022, to September 23, 2022, following the steps below. We first designed a 4-section survey questionnaire and then recruited Mandarin Chinese–speaking patients from Qilu Hospital of Shandong University, China, using randomized sampling. Subsequently, we administered the questionnaire via wenjuanxing, the most popular web-based survey platform in China, between July 20, 2022, and August 19, 2022. Finally, we used latent class modeling to analyze the valid data collected to classify the patient participants and identify the factors potentially associated with different CRHL levels. Results: All data in the 588 returned questionnaires were valid. On the basis of the collected data, we classified the patient participants into 3 latent classes of limited, moderate, and adequate CRHL and identified 4 factors associated with limited CRHL, including middle and old age, male sex, lower educational attainment, and low internal drive to maintain one’s health. Conclusions: Using latent class modeling, we identified 3 classes of CRHL and 4 factors associated with limited CRHL among the Chinese study participants. These literacy classes and the predicting factors ascertained in this study can provide some implications for clinical practice, health education, medical research, and health policy making. %M 37018027 %R 10.2196/43342 %U https://www.jmir.org/2023/1/e43342 %U https://doi.org/10.2196/43342 %U http://www.ncbi.nlm.nih.gov/pubmed/37018027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42782 %T Susceptibility to Breast Cancer Misinformation Among Chinese Patients: Cross-sectional Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %A Xu,Xiaofei %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Camperdown, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K susceptibility %K breast cancer misinformation %K Chinese patients %K logistic regression %K predicting factors %K cancer %K misinformation %K China %K breast cancer %K policy %K age %K gender %K education %K literacy %K clinical %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect. Objective: This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making. Methods: We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the “Internal” subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients. Results: All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between “knowing a lot” and “knowing some.” The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients’ health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients’ limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence. Conclusions: Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making. %M 37018020 %R 10.2196/42782 %U https://formative.jmir.org/2023/1/e42782 %U https://doi.org/10.2196/42782 %U http://www.ncbi.nlm.nih.gov/pubmed/37018020 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37673 %T An Interactive Communication Model for Self-Care—Regardless of Health Literacy: Protocol for a Quasi-Experimental Study %A Haesum,Lisa Korsbakke Emtekaer %A Hejlesen,Ole Kristian %A Udsen,Flemming Witt %+ Department of Nursing, University College of Northern Denmark, Selma Lagerløfs Vej 2, Aalborg, 9000, Denmark, 45 72691095, lkeh@ucn.dk %K health literacy %K interactive communication %K nursing %K quasi-experimental study %K economic evaluation %K economic %K cost %K rehabilitation %K primary care %K nurse %K communication %K health information %K patient education %K health resource %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clear dialogue-based (interactive) communication that ensures comprehension and recall becomes more important in patient-provider interactions, especially in relation to patients with chronic diseases, where self-management education and counseling are cornerstones in managing these diseases. If patients with chronic disease experience challenges in obtaining, understanding, and applying health-related information (necessary to make informed health decisions and sufficiently manage their health), clear communication and ensuring comprehension become even more critical in the patient-provider interactions. Furthermore, patient-provider communication has been proposed as a potential pathway through which health literacy might influence health outcomes, especially in individuals with chronic diseases. Hence, adjusting communication to the individual level of health literacy might have a positive influence on health outcomes. On this basis, the authors have developed a web-based interactive communication model that both seeks to accommodate health literacy by allowing tailored communication and ensure comprehension and recall between nurses and patients. Objective: This study seeks to examine the use of an IT solution that comprises an interactive communication model that seeks to accommodate health literacy in communication and ensure comprehension and recall between nurses and patients. Methods: A quasi-experimental control group study including full economic evaluation with 6-month follow-up. Based on power calculation, a total of 82 participants will be included. Participants are assigned either the interactive communication model (intervention) or usual nursing care. It will be assessed if the model influences the level of health literacy and participants experience a higher health-related quality of life. Further, cost-effectiveness will be evaluated. Overall, the statistical methods will follow an intention-to-treat principle. Results will be presented in accordance with the Transparent Reporting of Evaluations with Non-randomized Designs guidelines for nonrandomized designs as well as the Consolidated Health Economic Evaluation Reporting Standards. Results: This paper describes a protocol for a clustered quasi-experimental control study that seeks to evaluate the effectiveness of the interactive communicative model. Most studies in the field of health literacy are epidemiological studies that seek to address the effects of poor health literacy in populations and its potential impact on health inequity. A total of 82 participants, who receive community nursing will be included. The final trial day is May 1, 2022, with the first report of results in the final quarter of 2022. Conclusions: The results of the trial can create the base for conducting a large-scale study and inspire the conduction of more studies that seeks to create and evaluate interventions aimed at enhancing the level of health literacy and reducing the usage of health resources. Trial Registration: ClinicalTrials.gov NCT04929314; https://clinicaltrials.gov/ct2/show/NCT04929314 International Registered Report Identifier (IRRID): DERR1-10.2196/37673 %M 37000515 %R 10.2196/37673 %U https://www.researchprotocols.org/2023/1/e37673 %U https://doi.org/10.2196/37673 %U http://www.ncbi.nlm.nih.gov/pubmed/37000515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45482 %T Using Normative Language When Describing Scientific Findings: Randomized Controlled Trial of Effects on Trust and Credibility %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health - Bloomington, Indiana University Bloomington, 809 East 9th Street, Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K trust %K trust in science %K scientific communication %K meta-science %K RCT %D 2023 %7 30.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Scientists often make cognitive claims (eg, the results of their work) and normative claims (eg, what should be done based on those results). Yet, these types of statements contain very different information and implications. This randomized controlled trial sought to characterize the granular effects of using normative language in science communication. Objective: Our study examined whether viewing a social media post containing scientific claims about face masks for COVID-19 using both normative and cognitive language (intervention arm) would reduce perceptions of trust and credibility in science and scientists compared with an identical post using only cognitive language (control arm). We also examined whether effects were mediated by political orientation. Methods: This was a 2-arm, parallel group, randomized controlled trial. We aimed to recruit 1500 US adults (age 18+) from the Prolific platform who were representative of the US population census by cross sections of age, race/ethnicity, and gender. Participants were randomly assigned to view 1 of 2 images of a social media post about face masks to prevent COVID-19. The control image described the results of a real study (cognitive language), and the intervention image was identical, but also included recommendations from the same study about what people should do based on the results (normative language). Primary outcomes were trust in science and scientists (21-item scale) and 4 individual items related to trust and credibility; 9 additional covariates (eg, sociodemographics, political orientation) were measured and included in analyses. Results: From September 4, 2022, to September 6, 2022, 1526 individuals completed the study. For the sample as a whole (eg, without interaction terms), there was no evidence that a single exposure to normative language affected perceptions of trust or credibility in science or scientists. When including the interaction term (study arm × political orientation), there was some evidence of differential effects, such that individuals with liberal political orientation were more likely to trust scientific information from the social media post’s author if the post included normative language, and political conservatives were more likely to trust scientific information from the post’s author if the post included only cognitive language (β=0.05, 95% CI 0.00 to 0.10; P=.04). Conclusions: This study does not support the authors’ original hypotheses that single exposures to normative language can reduce perceptions of trust or credibility in science or scientists for all people. However, the secondary preregistered analyses indicate the possibility that political orientation may differentially mediate the effect of normative and cognitive language from scientists on people’s perceptions. We do not submit this paper as definitive evidence thereof but do believe that there is sufficient evidence to support additional research into this topic, which may have implications for effective scientific communication. Trial Registration: OSF Registries osf.io/kb3yh; https://osf.io/kb3yh International Registered Report Identifier (IRRID): RR2-10.2196/41747 %M 36995753 %R 10.2196/45482 %U https://www.jmir.org/2023/1/e45482 %U https://doi.org/10.2196/45482 %U http://www.ncbi.nlm.nih.gov/pubmed/36995753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39024 %T Health Literate Internet-Based Information-Seeking Processes: Theory-Based Development of a Conceptual Model %A Heiberger,Andrea %A Dresch,Carolin %A Schulz,Anja Alexandra %A Wirtz,Markus Antonius %+ Research Methods in Health Sciences, Faculty of Mathematics, Natural Sciences and Technology, University of Education Freiburg, Kunzenweg 21, Freiburg im Breisgau, 79117, Germany, 49 761 682624, andrea.heiberger@ph-freiburg.de %K health literacy %K internet-based search %K model development %K parents %K health information %K internet %K childhood %K allergy %K prevention %K pediatric %K online %K content %K information %D 2023 %7 23.3.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 36951897 %R 10.2196/39024 %U https://www.jmir.org/2023/1/e39024 %U https://doi.org/10.2196/39024 %U http://www.ncbi.nlm.nih.gov/pubmed/36951897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41867 %T Communicating Health Literacy on Prescription Medications on Social Media: In-depth Interviews With “Patient Influencers” %A Willis,Erin %A Friedel,Kate %A Heisten,Mark %A Pickett,Melissa %A Bhowmick,Amrita %+ University of Colorado Boulder, 478 UCB, 1511 University Ave., Boulder, CO, 80309, United States, 1 3034927161, erin.willis@colorado.edu %K social media %K social media influencer %K pharmaceutical advertising %K health literacy %D 2023 %7 13.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Historically, pharmaceutical companies have struggled with trust and brand reputation among key stakeholders and have adopted innovative marketing strategies to reach patients directly and rebuild those relationships. Social media influencers are a popular strategy to influence younger demographics, including Generation Z and millennials. It is common for social media influencers to work in paid partnerships with brands; this is a multibillion-dollar industry. Long have patients been active in online health communities and social media platforms such as Twitter and Instagram, but in recent years, pharmaceutical marketers have noticed the power of patient persuasion and begun to leverage “patient influencers” in brand campaigns. Objective: This study aimed to explore how patient influencers communicate health literacy on pharmaceutical medications on social media to their communities of followers. Methods: A total of 26 in-depth interviews were conducted with patient influencers using a snowball sampling technique. This study is part of a larger project using an interview guide that included a range of topics such as social media practices, logistics of being an influencer, considerations for brand partnerships, and views on the ethical nature of patient influencers. The constructs of the Health Belief Model were used in this study’s data analysis: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. This study was approved by the institutional review board of the University of Colorado and adhered to ethical standards in interview practice. Results: As patient influencers are a new phenomenon, it was our goal to identify how health literacy on prescription medications and pharmaceuticals is being communicated on social media. Using the constructs of the Health Belief Model to guide the analysis, 3 themes were identified: understanding disease through experience, staying informed on the science or field, and suggesting that physicians know best. Conclusions: Patients are actively exchanging health information on social media channels and connecting with other patients who share similar diagnoses. Patient influencers share their knowledge and experience in efforts to help other patients learn about disease self-management and improve their quality of life. Similar to traditional direct-to-consumer advertising, the phenomenon of patient influencers raises ethical questions that need more investigation. In a way, patient influencers are health education agents who may also share prescription medication or pharmaceutical information. They can break down complex health information based on expertise and experience and mitigate the loneliness and isolation that other patients may feel without the support of a community. %M 36912881 %R 10.2196/41867 %U https://www.jmir.org/2023/1/e41867 %U https://doi.org/10.2196/41867 %U http://www.ncbi.nlm.nih.gov/pubmed/36912881 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41615 %T Development and Internal Validation of the Digital Health Readiness Questionnaire: Prospective Single-Center Survey Study %A Scherrenberg,Martijn %A Falter,Maarten %A Kaihara,Toshiki %A Xu,Linqi %A van Leunen,Mayke %A Kemps,Hareld %A Kindermans,Hanne %A Dendale,Paul %+ Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, 3500, Belgium, 32 494 247 479, martijn.scherrenberg@telenet.be %K adherence %K assessment %K digital access %K digital divide %K digital health intervention %K digital health %K digital literacy %K digital skills %K health literacy %K participation %K telemedicine %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objective: The aim of the development of the Digital Health Readiness Questionnaire (DHRQ) was to create a short, usable, and freely accessible questionnaire that was designed from a clinical practice perspective. Methods: It was a prospective single-center survey study conducted in Jessa Hospital Hasselt in Belgium. The questionnaire was developed with a panel of field experts with questions in following 5 categories: digital usage, digital skills, digital literacy, digital health literacy, and digital learnability. All participants who were visiting the cardiology department as patients between February 1, 2022, and June 1, 2022, were eligible for participation. Cronbach α and confirmatory factor analysis were performed. Results: A total number of 315 participants were included in this survey study, of which 118 (37.5%) were female. The mean age of the participants was 62.6 (SD 15.1) years. Cronbach α analysis yielded a score of >.7 in all domains of the DHRQ, which indicates acceptable internal consistency. The fit indices of the confirmatory factor analysis showed a reasonably good fit: standardized root-mean-square residual=0.065, root-mean-square error of approximation=0.098 (95% CI 0.09-0.106), Tucker-Lewis fit index=0.895, and comparative fit index=0.912. Conclusions: The DHRQ was developed as an easy-to-use, short questionnaire to assess the digital readiness of patients in a routine clinical setting. Initial validation demonstrates good internal consistency, and future research will be needed to externally validate the questionnaire. The DHRQ has the potential to be implemented as a useful tool to gain insight into the patients who are treated in a care pathway, tailor digital care pathways to different patient populations, and offer those with low digital readiness but high learnability appropriate education programs in order to let them take part in the digital pathways. %M 36897627 %R 10.2196/41615 %U https://www.jmir.org/2023/1/e41615 %U https://doi.org/10.2196/41615 %U http://www.ncbi.nlm.nih.gov/pubmed/36897627 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44370 %T Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program %A Agyapong,Belinda %A Chishimba,Charles %A Wei,Yifeng %A da Luz Dias,Raquel %A Eboreime,Ejemai %A Msidi,Eleanor %A Abidi,Syed Sibte Raza %A Mutaka-Loongo,Maryn %A Mwansa,James %A Orji,Rita %A Zulu,John Mathias %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K burnout %K stress %K Zambia %K Africa %K teacher %K educator %K school %K anxiety %K wellness %K depression %K e-mental health %K intervention %K health literacy %K mental health %K depressive %K psychological issue %K psychological problem %K text message %K messaging %K decision-making %D 2023 %7 6.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. Objective: The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. Methods: This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. Results: The Wellness4Teachers email program is expected to improve the participating teachers’ mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program’s launch. Conclusions: The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program’s impact on subscribers’ mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. International Registered Report Identifier (IRRID): PRR1-10.2196/44370 %M 36877571 %R 10.2196/44370 %U https://www.researchprotocols.org/2023/1/e44370 %U https://doi.org/10.2196/44370 %U http://www.ncbi.nlm.nih.gov/pubmed/36877571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44741 %T Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan %A Mitsutake,Seigo %A Takahashi,Yoshimitsu %A Otsuki,Aki %A Umezawa,Jun %A Yaguchi-Saito,Akiko %A Saito,Junko %A Fujimori,Maiko %A Shimazu,Taichi %A , %+ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Tokyo, 173-0015, Japan, 81 339643241 ext 4229, mitsu@tmig.or.jp %K chronic diseases %K cross-sectional study %K eHealth literacy, health communication %K internet, social networking %D 2023 %7 2.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users. Objective: This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs. Methods: This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use. Results: The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use. Conclusions: For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information. %M 36862482 %R 10.2196/44741 %U https://www.jmir.org/2023/1/e44741 %U https://doi.org/10.2196/44741 %U http://www.ncbi.nlm.nih.gov/pubmed/36862482 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40645 %T Multiple Automated Health Literacy Assessments of Written Health Information: Development of the SHeLL (Sydney Health Literacy Lab) Health Literacy Editor v1 %A Ayre,Julie %A Bonner,Carissa %A Muscat,Danielle M %A Dunn,Adam G %A Harrison,Eliza %A Dalmazzo,Jason %A Mouwad,Dana %A Aslani,Parisa %A Shepherd,Heather L %A McCaffery,Kirsten J %+ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128B, Edward Ford Building (A27), Sydney, 2050, Australia, 61 29351 7789, julie.ayre@sydney.edu.au %K health literacy %K comprehension %K health education %K health communication %K medicine information %K readability %D 2023 %7 14.2.2023 %9 Viewpoint %J JMIR Form Res %G English %X Producing health information that people can easily understand is challenging and time-consuming. Existing guidance is often subjective and lacks specificity. With advances in software that reads and analyzes text, there is an opportunity to develop tools that provide objective, specific, and automated guidance on the complexity of health information. This paper outlines the development of the SHeLL (Sydney Health Literacy Lab) Health Literacy Editor, an automated tool to facilitate the implementation of health literacy guidelines for the production of easy-to-read written health information. Target users were any person or organization that develops consumer-facing education materials, with or without prior experience with health literacy concepts. Anticipated users included health professionals, staff, and government and nongovernment agencies. To develop this tool, existing health literacy and relevant writing guidelines were collated. Items amenable to programmable automated assessment were incorporated into the Editor. A set of natural language processing methods were also adapted for use in the SHeLL Editor, though the approach was primarily procedural (rule-based). As a result of this process, the Editor comprises 6 assessments: readability (school grade reading score calculated using the Simple Measure of Gobbledygook (SMOG)), complex language (percentage of the text that contains public health thesaurus entries, words that are uncommon in English, or acronyms), passive voice, text structure (eg, use of long paragraphs), lexical density and diversity, and person-centered language. These are presented as global scores, with additional, more specific feedback flagged in the text itself. Feedback is provided in real-time so that users can iteratively revise and improve the text. The design also includes a “text preparation” mode, which allows users to quickly make adjustments to ensure accurate calculation of readability. A hierarchy of assessments also helps users prioritize the most important feedback. Lastly, the Editor has a function that exports the analysis and revised text. The SHeLL Health Literacy Editor is a new tool that can help improve the quality and safety of written health information. It provides objective, immediate feedback on a range of factors, complementing readability with other less widely used but important objective assessments such as complex and person-centered language. It can be used as a scalable intervention to support the uptake of health literacy guidelines by health services and providers of health information. This early prototype can be further refined by expanding the thesaurus and leveraging new machine learning methods for assessing the complexity of the written text. User-testing with health professionals is needed before evaluating the Editor’s ability to improve the health literacy of written health information and evaluating its implementation into existing Australian health services. %M 36787164 %R 10.2196/40645 %U https://formative.jmir.org/2023/1/e40645 %U https://doi.org/10.2196/40645 %U http://www.ncbi.nlm.nih.gov/pubmed/36787164 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41809 %T Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study %A Vazquez,Christian Elias %A Xie,Bo %A Shiroma,Kristina %A Charness,Neil %+ School of Social Work, The University of Texas at Arlington, 211 S Cooper St, Arlington, TX, 76019, United States, 1 8052596963, christian.vazquez@uta.edu %K eHealth literacy %K digital literacy %K older adults %K eHealth %K aging %K web-based information %K health information %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults tend to have insufficient health literacy, which includes eHealth literacy—the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults’ low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults’ eHealth literacy. Objective: The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults’ learning with CL versus IL for eHealth literacy. Methods: Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy. Results: eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases). Conclusions: Older adults’ eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains. %M 36757773 %R 10.2196/41809 %U https://aging.jmir.org/2023/1/e41809 %U https://doi.org/10.2196/41809 %U http://www.ncbi.nlm.nih.gov/pubmed/36757773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41873 %T Promoting Digital Proficiency and Health Literacy in Middle-aged and Older Adults Through Mobile Devices With the Workshops for Online Technological Inclusion (OITO) Project: Experimental Study %A Quialheiro,Anna %A Miranda,André %A Garcia Jr,Miguel %A Carvalho,Adriana Camargo de %A Costa,Patrício %A Correia-Neves,Margarida %A Santos,Nadine Correia %+ Life and Health Sciences Research Institute, School of Medicine, University of Minho, Campus Gualtar, Braga, 4710-057, Portugal, 351 915398814, aquialheiro@med.uminho.pt %K digital proficiency %K health literacy %K older adults %K mobile devices %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition. Objective: The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers. Methods: The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarães, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale. Results: Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. Conclusions: The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period. %M 36753331 %R 10.2196/41873 %U https://formative.jmir.org/2023/1/e41873 %U https://doi.org/10.2196/41873 %U http://www.ncbi.nlm.nih.gov/pubmed/36753331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40778 %T The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis %A Kim,Keonhee %A Shin,Sangyoon %A Kim,Seungyeon %A Lee,Euni %+ Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 27408588, eunilee@snu.ac.kr %K eHealth literacy %K digital health literacy %K online health information %K health-related behaviors %K health-promoting behavior %K meta-analysis %D 2023 %7 30.1.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 36716080 %R 10.2196/40778 %U https://www.jmir.org/2023/1/e40778 %U https://doi.org/10.2196/40778 %U http://www.ncbi.nlm.nih.gov/pubmed/36716080 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40105 %T eHealth Literacy and Patient Portal Use and Attitudes: Cross-sectional Observational Study %A Deshpande,Nikita %A Arora,Vineet M %A Vollbrecht,Hanna %A Meltzer,David O %A Press,Valerie %+ Section of General Internal Medicine, Department of Medicine, University of Chicago, MC 2007, Rm B224, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 773 702 5170, vpress@bsd.uchicago.edu %K health literacy %K patient portal %K COVID-19 %K health technology %K inpatients %K digital health literacy %K awareness %K use %K engagement %K attitudes %K hospitalized patients %K access %K accessibility %K perception %K health care delivery %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Throughout the COVID-19 pandemic, patient portals have become more widely used tools of patient care delivery. However, not all individuals have equivalent access or ability to use patient portals. Objective: The aim of this study is to evaluate the relationships between eHealth literacy (eHL) and patient portal awareness, use, and attitudes among hospitalized patients. Methods: Inpatients completed patient portal surveys; eHL was assessed (eHealth Literacy Scale). Multivariable logistic regression analyses adjusted for age, self-reported race, gender, and educational attainment were completed with significance at P<.006 (Bonferroni correction). Results: Among 274 participants, most identified as Black (n=166, 61%) and female (n=140, 51%), mean age was 56.5 (SD 16.7) years, and 178 (65%) reported some college or higher educational attainment. One-quarter (n=79, 28%) had low eHL (mean 27, SD 9.5), which was associated with lower odds of portal access awareness (odds ratio 0.11, 95% CI 0.05-0.23; P<.001), having ever used portals (odds ratio 0.19, 95% CI 0.10-0.36; P<.001), less perceived usefulness of portals (odds ratio 0.20, 95% CI 0.10-0.38; P=.001), and lower likelihood of planning to use portals in the coming years (odds ratio 0.12, 95% CI 0.06-0.25; P<.001). As time through the COVID-19 pandemic passed, there was a trend toward increased perceived usefulness of patient portals (53% vs 62%, P=.08), but average eHL did not increase through time (P=.81). Conclusions: Low eHL was associated with less awareness, use, and perceived usefulness of portals. Perceived usefulness of portals likely increased through the COVID-19 pandemic, but patients’ eHL did not. Interventions tailored for patients with low eHL could ensure greater equity in health care delivery through the COVID-19 pandemic. %M 36705947 %R 10.2196/40105 %U https://humanfactors.jmir.org/2023/1/e40105 %U https://doi.org/10.2196/40105 %U http://www.ncbi.nlm.nih.gov/pubmed/36705947 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38346 %T Young People’s Trust in Cocreated Web-Based Resources to Promote Mental Health Literacy: Focus Group Study %A Ito-Jaeger,Sachiyo %A Perez Vallejos,Elvira %A Logathasan,Saruka %A Curran,Thomas %A Crawford,Paul %+ Faculty of Medicine and Health Sciences, University of Nottingham, Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1158231294, sachiyo.ito-jaeger@nottingham.ac.uk %K trust %K mental health %K web %K young people %K cocreation %K mental health literacy %K qualitative study %K thematic analysis %K trustworthy %K digital mental health %K internet %K digital health %K mobile phone %D 2023 %7 9.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust. Objective: The objective of this study was to explore young people’s trust-related concerns about and recommendations for the cocreated mental health website “What’s Up With Everyone” by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources. Methods: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts. Results: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators’ credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website. Conclusions: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators’ credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible. %M 36622752 %R 10.2196/38346 %U https://mental.jmir.org/2023/1/e38346 %U https://doi.org/10.2196/38346 %U http://www.ncbi.nlm.nih.gov/pubmed/36622752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e31903 %T An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study %A Denny,Mary Carter %A Ancer Leal,Andrea %A Montiel,Tahani Casameni %A Wynne,Keona J %A Edquilang,Gabrielle %A Vu,Kim Yen Thi %A Vahidy,Farhaan %A Savitz,Sean I %A Beauchamp,Jennifer ES %A Sharrief,Anjail %+ Department of Neurology, Georgetown University Medical Center, MedStar Health, 3800 Reservoir Road NW, PHC 7, Washington, DC, DC, 20007, United States, 1 202 444 8532, MaryCarter.Denny@medstar.net %K stroke %K stroke prevention %K health literacy %K stroke literacy %K patient education %K transition of care %K risk factors %K cardiac %K digital health %D 2023 %7 4.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy—an understanding of stroke symptoms, risk factors, and treatment—likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. Objective: We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. Methods: The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. Results: A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. Conclusions: An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0171952 %M 35972729 %R 10.2196/31903 %U https://formative.jmir.org/2023/1/e31903 %U https://doi.org/10.2196/31903 %U http://www.ncbi.nlm.nih.gov/pubmed/35972729 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40771 %T Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study %A Du,Yumeng %A Zhou,Qiru %A Cheng,Weibin %A Zhang,Zhang %A Hoelzer,Samantha %A Liang,Yizhi %A Xue,Hao %A Ma,Xiaochen %A Sylvia,Sean %A Tian,Junzhang %A Tang,Weiming %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No.466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 15920567132, weiming_tang@med.unc.edu %K telemedicine %K telehealth %K rural residents %K mixed methods %K China %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. %M 36563026 %R 10.2196/40771 %U https://publichealth.jmir.org/2022/12/e40771 %U https://doi.org/10.2196/40771 %U http://www.ncbi.nlm.nih.gov/pubmed/36563026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39220 %T Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale %A Montagni,Ilaria %A Pouymayou,Aude %A Pereira,Edwige %A Tzourio,Christophe %A Schück,Stéphane %A Texier,Nathalie %A González-Caballero,Juan Luis %A , %+ Bordeaux Population Health UMRS1219, University of Bordeaux, Institut national de la santé et de la recherche médicale, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 0642193363, ilaria.montagni@u-bordeaux.fr %K Internet %K literacy %K measurement %K vaccination %K vaccine %K health information %K health literacy %K online %K content %K validity %K reliability %K digital literacy %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online. Objective: This study aims to develop a tool measuring DVL and assess its psychometric properties. Methods: A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity. Results: We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01). Conclusions: The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL. %M 36515982 %R 10.2196/39220 %U https://www.jmir.org/2022/12/e39220 %U https://doi.org/10.2196/39220 %U http://www.ncbi.nlm.nih.gov/pubmed/36515982 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e29675 %T A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study %A Nunes-Da-Silva,Catarina %A Victorino,André %A Lemos,Marta %A Porojan,Ludmila %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute Dinis %A Rodrigues,Ana Maria %A Canhão,Helena %+ Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, Lisbon, 1169-056, Portugal, 351 218803110 ext 27006, helena.canhao@nms.unl.pt %K mobile app %K technology %K treatment adherence %K health literacy %K seniors %K older adults %D 2022 %7 7.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app’s utility in promoting health-related knowledge in people aged ≥65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II – Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool’s utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app’s ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II – Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. International Registered Report Identifier (IRRID): PRR1-10.2196/29675 %M 36476754 %R 10.2196/29675 %U https://www.researchprotocols.org/2022/12/e29675 %U https://doi.org/10.2196/29675 %U http://www.ncbi.nlm.nih.gov/pubmed/36476754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36585 %T A Web-Based Program About Sustainable Development Goals Focusing on Digital Learning, Digital Health Literacy, and Nutrition for Professional Development in Ethiopia and Rwanda: Development of a Pedagogical Method %A Bälter,Katarina %A Javan Abraham,Feben %A Mutimukwe,Chantal %A Mugisha,Reuben %A Persson Osowski,Christine %A Bälter,Olle %+ Department of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Universitetsplan 1, Västerås, 722 20, Sweden, 46 021151753, katarina.balter@mdu.se %K digital learning %K digital health literacy %K sustainable development goals %K public health %K nutrition %K question-based learning %K open learning initiative %K Rwanda %K Ethiopia %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development. Objective: This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda. Methods: A web-based program—OneLearns (Online Education for Leaders in Nutrition and Sustainability)—uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021. Results: Of the 70 applicants, 25 (36%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80%, 95% CI 64%-96%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68%, 95% CI 50%-86%) and 18 (72%, 95% CI 54%-90%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively. Conclusions: Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda. %M 36469416 %R 10.2196/36585 %U https://formative.jmir.org/2022/12/e36585 %U https://doi.org/10.2196/36585 %U http://www.ncbi.nlm.nih.gov/pubmed/36469416 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40341 %T Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial %A Ngiam,Nerice Heng Wen %A Yee,Wan Qi %A Teo,Nigel %A Yow,Ka Shing %A Soundararajan,Amrish %A Lim,Jie Xin %A Lim,Haikel A %A Tey,Angeline %A Tang,Kai Wen Aaron %A Tham,Celine Yi Xin %A Tan,Jamaica Pei Ying %A Lu,Si Yinn %A Yoon,Sungwon %A Ng,Kennedy Yao Yi %A Low,Lian Leng %+ Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, Level 7, Singapore, 168582, Singapore, 65 69703018, low.lian.leng@singhealth.com.sg %K digital literacy %K health determinants %K COVID-19 pandemic %K social distancing %K older adults %K loneliness %K social connectedness %K quality of life %K well-being %K digital inclusivity %K web-based %K information and communication technology %D 2022 %7 2.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. Objective: We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. Methods: A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ≥55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. Results: There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. Conclusions: This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult–friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes. %M 36459398 %R 10.2196/40341 %U https://www.jmir.org/2022/12/e40341 %U https://doi.org/10.2196/40341 %U http://www.ncbi.nlm.nih.gov/pubmed/36459398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38347 %T Measuring the Digital Skills of Catalan Health Care Professionals as a Key Step Toward a Strategic Training Plan: Digital Competence Test Validation Study %A Reixach,Elisenda %A Andrés,Erik %A Sallent Ribes,Josuè %A Gea-Sánchez,Montserrat %A Àvila López,Alícia %A Cruañas,Bea %A González Abad,Anna %A Faura,Ricard %A Guitert,Montse %A Romeu,Teresa %A Hernández-Encuentra,Eulàlia %A Bravo-Ramirez,Sandra %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933 263 622, fsaigi@uoc.edu %K digital health %K eHealth %K digital competences %K digital literacy %K information and communication technology %K ICT %K training %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite Catalonia being an advanced region in terms of digital health adoption, the “Forum for Professional Dialogue” identified the need to improve information and communication technology (ICT) competences as one of the present and future challenges for health care professionals (HPs). Objective: We aimed to validate the digital competence test developed ad hoc for this study and to measure the digital competence level of Catalan HPs to establish their current level as the baseline for designing a strategic training plan. Methods: An exploratory observational study was conducted based on a voluntary survey where sociodemographic, professional and digital tool knowledge, digital tool use, and training needs data were collected and based on the score obtained from a digital competence test developed ad hoc. The digital competence test consisted of 2 “real-life scenarios” with 7 and 11 questions. Results: In total, 803 HPs, of whom 612 (76.2%) were women, completed the survey between June 28 and July 16, 2021. Most participants self-rated their digital competence level as either intermediate (384/803, 47.8%) or basic (357/803, 44.5%). The mean score in the digital competence test was 22.6 (SD 4.3). Therefore, most participants displayed a basic level of digital competence. The internal consistency of the digital competence test was 0.66, and the discrimination index of all questions was ≥0.2 for all items except for 1 question. Conclusions: This exploratory study highlights the need to improve the digital competence of HPs working in Catalonia, with special effort being made to provide training according to the specific needs of the different HP profiles. The results have informed the Health Plan for Catalonia 2021-2025 and lay the foundations for the development and deployment of a framework program for the digital competences of HPs. The developed digital competence test shows acceptable consistency for the objective pursued, although improvements are needed to fine-tune its accuracy. %M 36449330 %R 10.2196/38347 %U https://www.jmir.org/2022/11/e38347 %U https://doi.org/10.2196/38347 %U http://www.ncbi.nlm.nih.gov/pubmed/36449330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39973 %T Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis %A Lear,Rachael %A Freise,Lisa %A Kybert,Matthew %A Darzi,Ara %A Neves,Ana Luisa %A Mayer,Erik K %+ National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, 10F Queen Elizabeth Queen Mother Wing Praed Street, St Mary's Campus, London, W2 1NY, United Kingdom, 44 (0)20 7594 1419, r.lear12@imperial.ac.uk %K electronic health records %K personal health records %K patient participation %K patient safety %K care quality %K digital health literacy %D 2022 %7 17.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based patient portals enable patients access to, and interaction with, their personal electronic health records. However, little is known about the impact of patient portals on quality of care. Users of patient portals can contribute important insights toward addressing this knowledge gap. Objective: We aimed to describe perceived changes in the quality of care among users of a web-based patient portal and to identify the characteristics of patients who perceive the greatest benefit of portal use. Methods: A cross-sectional web-based survey study was conducted to understand patients’ experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographic location, motivation to self-manage, and digital health literacy (measured by the eHealth Literacy Scale). Patients with experience using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine’s 6 domains of quality of care. Users’ responses were examined to understand their perceptions of how portal use has changed the overall quality of their care, different aspects of care related to the 6 domains of care quality, and patient’s satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with perceived improvements in overall care quality and greater satisfaction with care. Results: Of 445 CIE users, 38.7% (n=172) reported that the overall quality of their care was better; 3.2% (n=14) said their care was worse. In the patient centeredness domain, 61.2% (273/445) of patients felt more in control of their health care, and 53.9% (240/445) felt able to play a greater role in decision-making. Regarding timeliness, 40.2% (179/445) of patients reported they could access appointments, diagnoses, and treatment more quickly. Approximately 30% of CIE users reported better care related to the domains of effectiveness (123/445, 27.6%), safety (138/445, 31%), and efficiency (174/445, 28.6%). Regarding equity, patients self-reporting higher digital health literacy (odds ratio 2.40, 95% CI 1.07-5.42; P=.03) and those belonging to ethnic minority groups (odds ratio 2.27, 95% CI 1.26-3.73; P<.005) were more likely to perceive improvements in care quality. Across ethnic groups, Asian and British Asian patients perceived the greatest benefits. Increased frequency of CIE use also predicted perceived better care quality and greater satisfaction with care. Conclusions: A large proportion of CIE users perceived better care quality and greater satisfaction with care, although many portal users reported no change. The most favorable perceived improvements related to the domain of patient centeredness. With national policy directed toward addressing health disparities, patient portals could be valuable in improving care quality for ethnic minority groups. Future research should test the causal relationship between patient portal use and care quality. %M 36394922 %R 10.2196/39973 %U https://www.jmir.org/2022/11/e39973 %U https://doi.org/10.2196/39973 %U http://www.ncbi.nlm.nih.gov/pubmed/36394922 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37505 %T The Impact of Social Influence on the Intention to Use Physician Rating Websites: Moderated Mediation Analysis Using a Mixed Methods Approach %A Guetz,Bernhard %A Bidmon,Sonja %+ Department of Marketing and International Management, Alpen-Adria-Universitaet Klagenfurt, Universitaetsstrasse 65-67, Klagenfurt am Woerthersee, 9020, Austria, 43 6508611182, beguetz@edu.aau.at %K social influence %K eHealth literacy %K patient satisfaction %K physician rating websites %D 2022 %7 14.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Physician rating websites (PRWs) have become increasingly important in the cross-section between health and digitalization. Social influence plays a crucial role in human behavior in many domains of life, as can be demonstrated by the increase in high-profile influential individuals such as social media influencers (SMIs). Particularly in the health-specific environment, the opinion of family and friends has a significant influence on health-related decisions. However, so far, there has been little discussion about the role of social influence as an antecedent of behavioral intention to use PRWs. Objective: On the basis of theories of social psychology and technology acceptance and theories from the economic perspective, this study aimed to evaluate the impact of social influence on the behavioral intention to use PRWs. Methods: We conducted 2 studies by applying a mixed methods approach including a total of 712 participants from the Austrian population. The impact of social influence on the behavioral intention to use PRWs was investigated through linear regression and mediation and moderated mediation analysis using the PROCESS macro 4.0 in SPSS 27 (IBM Corp). Results: The 2 studies show similar results. In study 1, an experiment, no direct effect of social influence on the behavioral intention to use PRWs could be detected. However, an indirect effect of social influence on the behavioral intention to use PRWs via credibility (b=0.572; P=.005) and performance expectancy (b=0.340; P<.001) could be confirmed. The results of study 2, a cross-sectional study, demonstrate that social influence seems to have a direct impact on the behavioral intention to use PRWs (b=0.410; P<.001). However, when calculating the proposed mediation model, it becomes clear that this impact may partly be explained through the 2 mediator variables—credibility (b=0.208; P<.001) and performance expectancy (b=0.312; P<.001). In contrast to the observed direct and indirect effect, neither demographic nor psychographic variables have a significant moderating impact on the influencing chain in study 2. Conclusions: This study provides an indication that social influence has at least an indirect impact on the behavioral intention to use PRWs. It was observed that this impact is exerted through credibility and performance expectancy. According to the findings of both studies, social influence has the potential to boost the use of PRWs. As a result, these web-based networks might be a promising future interface between health care and digitalization, allowing health care practitioners to gain a beneficial external impact while also learning from feedback. Social influence nowadays is not just limited to friends and family but can also be exerted by SMIs in the domain of PRW use. Thus, from a marketing perspective, PRW providers could think of collaborating with SMIs, and our results could contribute to stimulating discussion in this vein. %M 36374547 %R 10.2196/37505 %U https://www.jmir.org/2022/11/e37505 %U https://doi.org/10.2196/37505 %U http://www.ncbi.nlm.nih.gov/pubmed/36374547 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e39866 %T Digital Health Literacy During the COVID-19 Pandemic Among Health Care Providers in Resource-Limited Settings: Cross-sectional Study %A Ahmed,Mohammedjud Hassen %A Guadie,Habtamu Alganeh %A Ngusie,Habtamu Setegn %A Teferi,Gizaw Hailiye %A Gullslett,Monika Knudsen %A Hailegebreal,Samuel %A Hunde,Mekonnen Kenate %A Donacho,Dereje Oljira %A Tilahun,Binyam %A Siraj,Shuayib Shemsu %A Debele,Gebiso Roba %A Hajure,Mohammedamin %A Mengiste,Shegaw Anagaw %+ Department of Management Information Systems, University of South East Norway, Dalegårdsveien 24 C, Drammen, 3028, Norway, 47 31009832, Shegaw.Mengiste@usn.no %K digital, health %K literacy %K COVID-19 %K professionals %K Ethiopia %K health professionals %K digital literacy %K skills %K knowledge %K perception %K use %K education %K training %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Digital health literacy is the use of information and communication technology to support health and health care. Digital health literacy is becoming increasingly important as individuals continue to seek medical advice from various web-based sources, especially social media, during the pandemics such as COVID-19. Objective: The study aimed to assess health professionals’ digital health literacy level and associated factors in Southwest Ethiopia in 2021. Methods: An institution-based cross-sectional study was conducted from January to April 2021 in Ethiopia. Simple random sampling technique was used to select 423 study participants among health professionals. SPSS (version 20) software was used for data entry and analysis. A pretested self-administered questionnaire was used to collect the required data. Multivariable logistic regression was used to examine the association between the digital health literacy skill and associated factors. Significance value was obtained at 95% CI and P<.05. Results: In total, 401 study subjects participated in the study. Overall, 43.6% (n=176) of respondents had high digital health literacy skills. High computer literacy (adjusted odds ratio [AOR] 4.43, 95% CI 2.34-5.67; P=.01); master’s degree and above (AOR 3.42, 95% CI 2.31-4.90; P=.02); internet use (AOR 4.00, 95% CI 1.78-4.02; P=.03); perceived ease of use (AOR 2.65, 95% CI 1.35-4.65; P=.04); monthly income of >15,000 Ethiopian birr (>US $283.68; AOR 7.55, 95% CI 6.43-9.44; P<.001); good knowledge of eHealth (AOR 2.22, 95% CI 1.32-4.03; P=.04); favorable attitudes (AOR 3.11, 95% CI 2.11-4.32; P=.04); and perceived usefulness (AOR 3.43, 95% CI 2.43-5.44; P=.02) were variables associated with eHealth literacy level. Conclusions: In general, less than half of the study participants had a high digital health literacy level. High computer literacy, master’s degree and above, frequent internet use, perceived ease to use, income of >15,000 Ethiopian birr (>US $283.68), good knowledge of digital health literacy, favorable attitude, and perceived usefulness were the most determinant factors in the study. Having high computer literacy, frequent use of internet, perceived ease of use, perceived usefulness, favorable attitude, and a high level of education will help to promote a high level of digital health literacy. %M 36301671 %R 10.2196/39866 %U https://nursing.jmir.org/2022/1/e39866 %U https://doi.org/10.2196/39866 %U http://www.ncbi.nlm.nih.gov/pubmed/36301671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42447 %T Online Health Information Seeking Among Patients With Chronic Conditions: Integrating the Health Belief Model and Social Support Theory %A Zhao,Yuxiang Chris %A Zhao,Mengyuan %A Song,Shijie %+ Business School, Hohai University, Fo-Cheng West Rd 8, Nanjing, 211100, China, 86 15951973800, ssong@hhu.edu.cn %K health information seeking %K patients with chronic conditions %K health belief model, social support %K critical health literacy %D 2022 %7 2.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic diseases are the leading causes of death and disability. With the growing patient population and climbing health care expenditures, researchers and policy makers are seeking new approaches to improve the accessibility of health information on chronic diseases while lowering costs. Online health information sources can play a substantial role in effective patient education and health communication. However, some contradictory evidence suggests that patients with chronic conditions may not necessarily seek online health information. Objective: This study aims to integrate 2 theories (ie, the health belief model and social support theory) and a critical health literacy perspective to understand online health information seeking (OHIS) among patients with chronic conditions. Methods: We used the survey method to collect data from online chronic disease communities and groups on social media platforms. Eligible participants were consumers with at least 1 chronic condition and those who have experience with OHIS. A total of 390 valid questionnaires were collected. The partial least squares approach to structural equation modeling was employed to analyze the data. Results: The results suggested that perceived risk (t=3.989, P<.001) and perceived benefits (t=3.632, P<.001) significantly affected patients’ OHIS. Perceived susceptibility (t=7.743, P<.001) and perceived severity (t=8.852, P<.001) were found to influence the perceived risk of chronic diseases significantly. Informational support (t=5.761, P<.001) and emotional support (t=5.748, P<.001) also impacted the perceived benefits of online sources for patients. In addition, moderation analysis showed that critical health literacy significantly moderated the link between perceived risk and OHIS (t=3.097, P=.002) but not the relationship between perceived benefits and OHIS (t=0.288, P=.774). Conclusions: This study shows that the health belief model, when combined with social support theory, can predict patients’ OHIS. The perceived susceptibility and severity can effectively explain perceived risk, further predicting patients’ OHIS. Informational support and emotional support can contribute to perceived benefits, thereby positively affecting patients’ OHIS. This study also demonstrated the important negative moderating effects of critical health literacy on the association between perceived risk and OHIS. %M 36322124 %R 10.2196/42447 %U https://www.jmir.org/2022/11/e42447 %U https://doi.org/10.2196/42447 %U http://www.ncbi.nlm.nih.gov/pubmed/36322124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37845 %T General Health Statuses as Indicators of Digital Inequality and the Moderating Effects of Age and Education: Cross-sectional Study %A van Deursen,Alexander J A M %+ Department of Communication Science, University of Twente, Drienerlolaan 5, Enschede, 7500AE, Netherlands, 31 622942142, a.j.a.m.vandeursen@utwente.nl %K digital inequality %K health %K MOS %K eHealth %K digital health %K online health %K age %K education %K survey %K digital divide %K attitude %K health outcome %K patient outcome %K internet access %K internet skill %K technology skill %D 2022 %7 21.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considerable effort has been directed to offering online health information and services aimed at the general population. Such efforts potentially support people to obtain improved health outcomes. However, when health information and services are moved online, issues of equality need to be considered. In this study, we focus on the general population and take as a point of departure how health statuses (physical functioning, social functioning, mental health, perceived health, and physical pain) are linked to internet access (spanning internet attitude, material access, internet skills, and health-related internet use). Objective: This study aims to reveal to what extent (1) internet access is important for online health outcomes, (2) different health statuses are important for obtaining internet access and outcomes, and (3) age and education moderate the contribution of health statuses to internet access. Methods: A sequence of 2 online surveys drawing upon a sample collected in the Netherlands was used, and a data set with 1730 respondents over the age of 18 years was obtained. Results: Internet attitude contributes positively to material access, internet skills, and health outcomes and negatively to health-related internet use. Material access contributes positively to internet skills and health-related internet use and outcomes. Internet skills contribute positively to health-related internet use and outcomes. Physical functioning contributes positively to internet attitude, material access, and internet skills but negatively to internet health use. Social functioning contributes negatively to internet attitude and positively to internet skills and internet health use. Mental health contributes positively to internet attitude and negatively to material access and internet health use. Perceived health positively contributes to material access, internet skills, and internet health use. Physical pain contributes positively to internet attitude and material access and indirectly to internet skills and internet health use. Finally, most contributions are moderated by age (<65 and ≥65 years) and education (low and high). Conclusions: To make online health care attainable for the general population, interventions should focus simultaneously on internet attitude, material access, internet skills, and internet health use. However, issues of equality need to be considered. In this respect, digital inequality research benefits from considering health as a predictor of all 4 access stages. Furthermore, studies should go beyond single self-reported measures of health. Physical functioning, social functioning, mental health, perceived health, and physical pain all show unique contributions to the different internet access stages. Further complicating this issue, online health-related interventions for people with different health statuses should also consider age and the educational level of attainment. %M 36269664 %R 10.2196/37845 %U https://www.jmir.org/2022/10/e37845 %U https://doi.org/10.2196/37845 %U http://www.ncbi.nlm.nih.gov/pubmed/36269664 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e37730 %T Google Images Search Results as a Resource in the Anatomy Laboratory: Rating of Educational Value %A Wink,Alexandra Elisabeth %A Telfer,Amanda N %A Pascoe,Michael A %+ Division of Translational Anatomy, Department of Radiology, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 6920, alexandra.wink@umassmed.edu %K anatomy laboratory %K information literacy %K internet search %K anatomical images %K scoring rubric %K Google %K images %K educational value %K literacy information %K medical education %K medical students %K anatomy %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Preclinical medical learners are embedded in technology-rich environments, allowing them rapid access to a large volume of information. The anatomy laboratory is an environment in which faculty can assess the development of professional skills such as information literacy in preclinical medical learners. In the anatomy laboratory, many students use Google Images searches in addition to or in place of other course materials as a resource to locate and identify anatomical structures. However, the most frequent sources as well as the educational quality of these images are unknown. Objective: This study was designed to assess the sources and educational value of Google Images search results for commonly searched anatomical structures. Methods: The top 10 Google Images search results were collected for 39 anatomical structures. Image source websites were recorded and categorized based on the purpose and target audience of the site publishing the image. Educational value was determined through assessment of relevance (is the searched structure depicted in the image?), accuracy (does the image contain errors?), and usefulness (will the image assist a learner in locating the structure on an anatomical donor?). A reliable scoring rubric was developed to assess an image’s usefulness. Results: A total of 390 images were analyzed. Most often, images were sourced from websites targeting health care professionals and health care professions students (38% of images), while Wikipedia was the most frequent single source of image results (62/390 results). Of the 390 total images, 363 (93.1%) depicted the searched structure and were therefore considered relevant. However, only 43.0% (156/363) of relevant images met the threshold to be deemed useful in identifying the searched structure in an anatomical donor. The usefulness of images did not significantly differ across source categories. Conclusions: Anatomy faculty may use these results to develop interventions for gaps in information literacy in preclinical medical learners in the context of image searches in the anatomy laboratory. %M 36269663 %R 10.2196/37730 %U https://mededu.jmir.org/2022/4/e37730 %U https://doi.org/10.2196/37730 %U http://www.ncbi.nlm.nih.gov/pubmed/36269663 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37713 %T Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program %A Kader,Farah %A Kruchten,Stephanie %A Campo,Marc %A Collica-Cox,Kimberly %A Davidson,Charis %A Wald,Adrienne %A Hewlett Jr,Dial %+ Westchester County Department of Health, 148 Martine Ave, White Plains, NY, 10601, United States, 1 9149957731, fxkt@westchestergov.com %K community engagement %K dialogic learning %K training of trainers %K COVID-19 %K health literacy %K correctional facility health %K health equity %K racial disparities %K community participation %D 2022 %7 21.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. Objective: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. Methods: Grounded in dialogic learning, the program entails training community-based “trusted messengers” and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. Results: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. Conclusions: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19–specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. International Registered Report Identifier (IRRID): PRR1-10.2196/37713 %M 36194870 %R 10.2196/37713 %U https://www.researchprotocols.org/2022/10/e37713 %U https://doi.org/10.2196/37713 %U http://www.ncbi.nlm.nih.gov/pubmed/36194870 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e39023 %T Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review %A Grepmeier,Eva-Maria %A Pawellek,Maja %A Curbach,Janina %A Sommoggy,Julia von %A Drewitz,Karl Philipp %A Hasenpusch,Claudia %A Bitzer,Eva Maria %A Apfelbacher,Christian %A Matterne,Uwe %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 39124300, eva-maria.grepmeier@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K health competence %K COVID-19–related health literacy %K health care worker %D 2022 %7 17.10.2022 %9 Review %J JMIR Med Educ %G English %X Background: Health literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19–related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce. Objective: In this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps. Methods: This scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19–related health information. Results: The search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19–related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19–related HL outcome. Conclusions: High levels of COVID-19–related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19–related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary. Trial Registration: Open Science Framework dbfa5; https://osf.io/dbfa5/ %M 36179148 %R 10.2196/39023 %U https://mededu.jmir.org/2022/4/e39023 %U https://doi.org/10.2196/39023 %U http://www.ncbi.nlm.nih.gov/pubmed/36179148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37844 %T Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review %A Birati,Yosefa %A Yefet,Enav %A Perlitz,Yuri %A Shehadeh,Naim %A Spitzer,Sivan %+ The Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold Street, Safed, 1311502, Israel, 972 522684065, ebirati1@hotmail.com %K gestational diabetes mellitus %K maternal health %K mobile health %K mHealth %K mobile apps %K mobile phone %K telemedicine %K culture %K health literacy %K vulnerable populations %K pregnancy outcome %D 2022 %7 14.10.2022 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective: This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems’ effectiveness in improving glycemic control and maternal and infant outcomes. Methods: We conducted a scoping review using a framework adapted from Arksey and O’Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results: We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ≥3 out of 5 in our assessment of digital health literacy. Conclusions: mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women’s self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes. %M 36240008 %R 10.2196/37844 %U https://www.jmir.org/2022/10/e37844 %U https://doi.org/10.2196/37844 %U http://www.ncbi.nlm.nih.gov/pubmed/36240008 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37687 %T Online Health Information Seeking and eHealth Literacy Among Spanish Language–Dominant Latino Adults Receiving Care in a Community Clinic: Secondary Analysis of Pilot Randomized Controlled Trial Data %A Chavarria,Enmanuel A %A Christy,Shannon M %A Feng,Han %A Miao,Hongyu %A Abdulla,Rania %A Gutierrez,Liliana %A Lopez,Diana %A Sanchez,Julian %A Gwede,Clement K %A Meade,Cathy D %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, United States, 1 4047278741, enmanuel.chavarria@emory.edu %K eHealth literacy %K online health information seeking %K medically underserved %K Hispanic %K Latino %K Spanish language–dominant %K health communications %K colorectal cancer screening %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. Objective: This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. Methods: Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants’ sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy—among those seeking OHI—assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. Results: A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (β=1.20, 95% CI 0.14-2.26; P=.02). Conclusions: Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. Trial Registration: ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361 %M 35238785 %R 10.2196/37687 %U https://formative.jmir.org/2022/10/e37687 %U https://doi.org/10.2196/37687 %U http://www.ncbi.nlm.nih.gov/pubmed/35238785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36714 %T Comparing Transactional eHealth Literacy of Individuals With Cancer and Surrogate Information Seekers: Mixed Methods Study %A Vasquez,Taylor S %A Bylund,Carma L %A Alpert,Jordan %A Close,Julia %A Le,Tien %A Markham,Merry Jennifer %A Taylor,Greenberry B %A Paige,Samantha R %+ College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL, 32608, United States, 1 3215370306, tsthelander@ufl.edu %K eHealth literacy %K cancer communication %K individuals with cancer %K surrogate seekers %K web-based information credibility appraisal %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships with one another. One role that a member of a support network may enact is that of a surrogate seeker, who seeks information in an informal capacity on behalf of others. Individuals with cancer and surrogate seekers often use the internet to learn about cancer, but differences in their skills and strategies have received little empirical attention. Objective: This study aimed to examine the eHealth literacy of individuals with cancer and surrogate information seekers, including an investigation of how each group evaluates the credibility of web-based cancer information. As a secondary aim, we sought to explore the differences that exist between individuals with cancer and surrogate seekers pertaining to eHealth literacies and sociodemographic contexts. Methods: Between October 2019 and January 2020, we conducted a web-based survey of 282 individuals with cancer (n=185) and surrogate seekers (n=97). We used hierarchical linear regression analyses to explore differences in functional, communicative, critical, and translational eHealth literacy between individuals with cancer and surrogate seekers using the Transactional eHealth Literacy Instrument. Using a convergent, parallel mixed methods design, we also conducted a thematic content analysis of an open-ended survey response to qualitatively examine how each group evaluates web-based cancer information. Results: eHealth literacy scores did not differ between individuals with cancer and surrogate seekers, even after adjusting for sociodemographic variables. Individuals with cancer and surrogate seekers consider the credibility of web-based cancer information based on its channel (eg, National Institutes of Health). However, in evaluating web-based information, surrogate seekers were more likely than individuals with cancer to consider the presence and quality of scientific references supporting the information. Individuals with cancer were more likely than surrogate seekers to cross-reference other websites and web-based sources to establish consensus. Conclusions: Web-based cancer information accessibility and evaluation procedures differ among individuals with cancer and surrogate seekers and should be considered in future efforts to design web-based cancer education interventions. Future studies may also benefit from more stratified recruitment approaches and account for additional contextual factors to better understand the unique circumstances experienced within this population. %M 36170007 %R 10.2196/36714 %U https://formative.jmir.org/2022/9/e36714 %U https://doi.org/10.2196/36714 %U http://www.ncbi.nlm.nih.gov/pubmed/36170007 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35772 %T Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study %A Cheng,Christina %A Gearon,Emma %A Hawkins,Melanie %A McPhee,Crystal %A Hanna,Lisa %A Batterham,Roy %A Osborne,Richard H %+ Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Room 907, Level 9, AMDC Building, 453/469-477 Burwood Road, Hawthorn, Victoria 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K mobile health %K mHealth %K health literacy %K health equity %K electronic health records %K vulnerable populations %K disadvantaged populations %D 2022 %7 16.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries. Objective: With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR). Methods: A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire. Results: A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR. Conclusions: This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities. %M 36112404 %R 10.2196/35772 %U https://www.jmir.org/2022/9/e35772 %U https://doi.org/10.2196/35772 %U http://www.ncbi.nlm.nih.gov/pubmed/36112404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36777 %T Translation and Validation Study of the French Version of the eHealth Literacy Scale: Web-Based Survey on a Student Population %A Chaniaud,Noémie %A Sagnier,Camille %A Loup-Escande,Emilie %+ Centre de Recherche en Psychologie : Cognition, Psychisme, Organisations (UR 7273), Université de Picardie Jules Verne, Chemin du Thil, Amiens, 80 000, France, 33 3 22 82 70 59, noemie.chaniaud@gmail.com %K eHealth Literacy Scale %K eHEALS %K eHealth literacy %K transcultural validation process %K Health Literacy Survey–Europe %K HLS-EU %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth literacy is emerging as a crucial concept for promoting patient self-management in an overloaded hospital system. However, to the best of our knowledge, no tool currently exists to measure the level of eHealth literacy among French-speaking people. The eHealth Literacy Scale (eHEALS) is an easy-to-administer 8-item questionnaire (5-point Likert scale, ranging from strongly disagree to strongly agree) that has already been translated into many languages. Currently, it is the most cited questionnaire in the literature. Objective: The aim of this study was to translate eHEALS to French and validate the French version of eHEALS (F-eHEALS). Methods: The validation of the F-eHEALS scale followed the 5 steps of the transcultural validation method: double reverse translation, validation by a committee of experts (n=4), pretest measurement to check the clarity of the items (n=22), administration of the scale in French via a web-based quantitative study combined with two other questionnaires (Health Literacy Survey-Europe–16 and Patient Activation Measure–13; N=328 students), and finally test-retest (n=78) to check the temporal stability of the measurements obtained from the scale. Results: The results obtained for the measurement of factor structure, internal consistency, and temporal stability (intraclass correlation coefficient=0.84; 95% CI 0.76-0.9; F77,77=6.416; P<.001) prove the validity and fidelity of the proposed scale. The internal consistency of F-eHEALS was estimated by Cronbach α of .89. The factor analysis with varimax rotation used to validate the construct showed a 2-factor scale. The effect of the construct was analyzed using 3 hypotheses related to the theory. The F-eHEALS score was correlated with the Health Literacy Survey-Europe–16 score (r=0.34; P<.001) and the Patient Activation Measure–13 score (r=0.31; P<.001). Conclusions: F-eHEALS is consistent with the original version. It presents adequate levels of validity and fidelity. This 2D scale will need to be generalized to other populations in a French-speaking context. Finally, a version taking into account collaborative applications (ie, Health 2.0; eg, Digital Health Literacy Instrument scale) should be considered on the basis of this study. %M 36044264 %R 10.2196/36777 %U https://formative.jmir.org/2022/8/e36777 %U https://doi.org/10.2196/36777 %U http://www.ncbi.nlm.nih.gov/pubmed/36044264 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e39909 %T Evaluation of the SUCCESS Health Literacy App for Australian Adults With Chronic Kidney Disease: Protocol for a Pragmatic Randomized Controlled Trial %A Isautier,Jennifer %A Webster,Angela C %A Lambert,Kelly %A Shepherd,Heather L %A McCaffery,Kirsten %A Sud,Kamal %A Kim,Jinman %A Liu,Na %A De La Mata,Nicole %A Raihana,Shahreen %A Kelly,Patrick J %A Muscat,Danielle M %A , %+ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 127A Edward Ford Building, Sydney, 2006, Australia, 61 93517819, danielle.muscat@sydney.edu.au %K chronic kidney disease %K health literacy %K shared decision-making %K eHealth %K smartphone app %D 2022 %7 31.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: We developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by a theoretical model of health literacy that recognizes the importance of reducing the complexity of health information as well as providing skills necessary to access, understand, and act on this information. Objective: The purpose of this study is to investigate the efficacy of the SUCCESS app intervention. Methods: We designed a multicenter pragmatic randomized controlled trial to compare the SUCCESS app plus usual care (intervention) to usual care alone (control). A total of 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis will be recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. To avoid intervention contamination, a pragmatic randomization approach will be used for participants undergoing in-center dialysis, in which randomization will be based on the days they receive hemodialysis and by center (ie, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday). Participants undergoing home-based dialysis will be individually randomized centrally using simple randomization and two stratification factors: language spoken at home and research site. Consenting participants will be invited to use the SUCCESS app for 12 months. The primary endpoints, which will be assessed after 3, 6, and 12 months of app usage, are health literacy skills, evaluated using the Health Literacy Questionnaire; decision self-efficacy, evaluated using the Decision Self-Efficacy Scale; and rates of unscheduled health encounters. Secondary outcomes include patient-reported outcomes (ie, quality of life, evaluated with the 5-level EQ-5D; knowledge; confidence; health behavior; and self-management) and clinical outcomes (ie, symptom burden, evaluated with the Palliative care Outcome Scale–Renal; nutritional status, evaluated with the Patient-Generated Subjective Global Assessment; and intradialytic weight gain). App engagement will be determined via app analytics. All analyses will be undertaken using an intention-to-treat approach comparing the intervention and usual care arms. Results: The study has been approved by Nepean Blue Mountains Human Research Ethics Committee (2020/ETH00910) and recruitment has begun at nine sites. We expect to finalize data collection by 2023 and publish the manuscript by 2024. Conclusions: Enhancing health literacy skills for patients undergoing hemodialysis is an important endeavor, given the association between poor health literacy and poor health outcomes, especially among culturally diverse groups. The findings from this trial will be published in peer-reviewed journals and disseminated at conferences, and updates will be shared with partners, including participating local health districts, Kidney Health Australia, and consumers. The SUCCESS app will continue to be available to all participants following trial completion. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000235808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380754&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/39909 %M 36044265 %R 10.2196/39909 %U https://www.researchprotocols.org/2022/8/e39909 %U https://doi.org/10.2196/39909 %U http://www.ncbi.nlm.nih.gov/pubmed/36044265 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e34997 %T Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework %A Li,Karen S %A Nagallo,Nathan %A McDonald,Erica %A Whaley,Colin %A Grindrod,Kelly %A Boluk,Karla %+ Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22235, colin.whaley@mcmaster.ca %K older adult %K technology %K retirement home %K long-term care %K social connections %K technology literacy program %K retirement %K elderly %K literacy %K implementation %K concept %K framework %K knowledge translation %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips. Objective: This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care. Methods: Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: “structure,” “process,” and “outcome.” Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions. Results: All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under “structure,” 4 domains under “process,” and 2 domains under “outcome.” Domains in the “structure” category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the “process” category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the “outcome” category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category. Conclusions: Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term. %M 35984689 %R 10.2196/34997 %U https://aging.jmir.org/2022/3/e34997 %U https://doi.org/10.2196/34997 %U http://www.ncbi.nlm.nih.gov/pubmed/35984689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36414 %T Digital Health Competencies Among Health Care Professionals: Systematic Review %A Longhini,Jessica %A Rossettini,Giacomo %A Palese,Alvisa %+ Department of Medical Sciences, University of Udine, Viale Ungheria, 20, Udine, 33100, Italy, 39 0432590926, alvisa.palese@uniud.it %K eHealth literacy %K eHealth competencies %K digital health %K competencies %K eHealth %K health literacy %K digital technology %K health care professionals %K health care workers %K review %K systematic review %D 2022 %7 18.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. Objective: This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. Methods: A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. Results: A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was “Self-rated competencies,” followed by “Psychological and emotional aspects toward digital technologies,” “Use of digital technologies,” and “Knowledge about digital technologies.” In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Conclusions: Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775 %M 35980735 %R 10.2196/36414 %U https://www.jmir.org/2022/8/e36414 %U https://doi.org/10.2196/36414 %U http://www.ncbi.nlm.nih.gov/pubmed/35980735 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40191 %T A Web-Based Intervention to Improve Health Literacy and Obesogenic Behaviors Among Adolescents: Protocol of a Randomized Pilot Feasibility Study for a Parallel Randomized Controlled Trial %A Fleary,Sasha A %+ Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, New York, NY, 10027, United States, 1 6463640282, sasha.fleary@sph.cuny.edu %K health literacy %K adolescent %K obesity %K prevention %K diet %K physical activity %K web-based intervention %K eHealth %D 2022 %7 16.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Predictive theoretical models suggest that health knowledge works in conjunction with motivation and behavioral skills to influence adolescents’ obesogenic behavior. However, most of the existing adolescent interventions target these variables in isolation. Furthermore, health literacy (HL), a precursor to health knowledge, is necessary for translating health knowledge into behavior and is negatively related to adolescents’ obesity status. However, HL has not been included in obesity interventions targeting adolescents. Objective: This study aims to pilot the feasibility of a 2-armed web-based obesity prevention intervention in school settings and assess the preliminary effectiveness of adding an HL module to an obesity prevention intervention for adolescents. Methods: This web-based pilot feasibility study will take place in the Northeastern United States. Participants will be adolescents (aged 13-16 years) attending school, and recruitment will be conducted through flyers to parents and adolescents in participating classes or advisory groups at the school. The intervention includes 2 arms: an experimental arm that will receive an HL module and 3 obesity prevention modules and a comparison arm that will receive a vaping module and 3 obesity prevention modules. A blinded randomized procedure will be used to allocate classrooms and advisory groups to the experimental and comparison arms. The intervention will be fully web-based. Participants will complete measures of their HL and obesogenic behavior–related health knowledge, motivation, and behaviors at 3 time points (baseline, 1 month after the intervention, and 3 months after the intervention) via web-based surveys. The primary outcomes will be the measures of study feasibility (recruitment, retention, completion, and treatment fidelity rates). Secondary outcomes will be preliminary efficacy, as measured by logistic and linear regressions and calculation of effect sizes. Descriptive statistics will be calculated for all measures at each time point. Results: This study was approved by the City University of New York Institutional Review Board in August 2020. As of June 2022, the web-based intervention design is complete and ready for use. Recruitment, data collection, and intervention implementation are scheduled to begin in September 2022. These results are expected to be published in 2023. Conclusions: This study’s feasibility findings will inform changes to the intervention content and randomized controlled trial design. The study’s efficacy findings will inform the sample size for the full-scale randomized controlled trial and the preliminary utility of the intervention. Trial Registration: ClinicalTrials.gov NCT04252677; https://clinicaltrials.gov/ct2/show/NCT04252677 International Registered Report Identifier (IRRID): PRR1-10.2196/40191 %M 35972787 %R 10.2196/40191 %U https://www.researchprotocols.org/2022/8/e40191 %U https://doi.org/10.2196/40191 %U http://www.ncbi.nlm.nih.gov/pubmed/35972787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38193 %T Equity and Accessibility of Washington State’s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders %A Bonnell,Tyler Jarvis %A Revere,Debra %A Baseman,Janet %A Hills,Rebecca %A Karras,Bryant Thomas %+ Department of Health Systems & Population Health, School of Public Health, University of Washington, Box 354809 University of Washington, Seattle, WA, 98195-4809, United States, 1 206 616 2728, drevere@uw.edu %K COVID-19 exposure notifications %K digital public health %K health equity %K mHealth %K mobile health %K mHealth equity %K digital health tool %K public health %K surveillance %K COVID-19 %K smartphone %K health inequity %K sociodemographic factor %K epidemiology %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In November 2020, WA Notify, Washington State’s COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity–triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. Objective: We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. Methods: We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). Results: Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. Conclusions: As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention. %M 35787520 %R 10.2196/38193 %U https://formative.jmir.org/2022/8/e38193 %U https://doi.org/10.2196/38193 %U http://www.ncbi.nlm.nih.gov/pubmed/35787520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38076 %T Contributions of Trustworthiness, Health Literacy, and Self-Efficacy in Communicating With COVID-19 Vaccine–Hesitant Audiences: Web-Based Survey Study %A Weerakoon,Sitara M %A Henson-Garcia,Mike %A Valerio-Shewmaker,Melissa A %A Messiah,Sarah E %A Knell,Gregory %+ Center for Pediatric Population Health, School of Public Health and Children's Health System of Texas, University of Texas Health Science Center, Dallas Campus, 2777 N Stemmons Fwy, Suite 8400, Dallas, TX, 75207, United States, 1 9725462950, sitara.m.weerakoon@uth.tmc.edu %K vaccine hesitancy %K health literacy %K COVID-19 %K COVID-19 vaccine hesitancy %K health communication %K vaccination %K health professional %K health information   %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Large-scale health communication challenges during the COVID-19 pandemic, such as widespread misinformation and distrust in health care professionals, have influenced reluctance to take the COVID-19 vaccine, also known as vaccine hesitancy. Trust in health professionals, adequate health literacy, and high self-efficacy are key components of actively pursuing preventative and protective health care measures. These factors may be associated with intentions to seek and complete a COVID-19 vaccine dosing. Objective: The objective of this analysis was to identify factors associated with COVID-19 vaccine hesitancy. Methods: In February 2021, US adults (N=5872) responded to a web-based survey on COVID-19 vaccine hesitancy and components of health communication (trust in sources of health information, health literacy, and self-efficacy). Multivariable logistic regression models were used to explore associations between these factors and vaccine hesitancy while adjusting for key demographics. We hypothesized that low levels of trust, health literacy, and self-efficacy would be associated with increased vaccine hesitancy. Results: The adjusted odds of vaccine hesitancy was greater among those who placed little to no trust in health professionals compared to those who held a lot of trust (adjusted odds ratio [AOR] 8.54, 95% CI 6.52-11.19). The odds of vaccine hesitancy was also greater among those who felt frustrated about finding health information compared to those who did not (AOR 2.10, 95% CI 1.62-2.70). Participants who had little to no confidence in receiving health advice or information had greater odds of vaccine hesitancy compared to those who had a lot of confidence (AOR 3.05, 95% CI 2.34-3.97). Conclusions: This study underscores the importance of trust between health professionals and their patients, and a need for improving health literacy regarding vaccines. Perceptions of mistrust and low levels of health literacy were associated with high levels of vaccine hesitancy, providing empirical support of framing these factors as perceived barriers to vaccine uptake. %M 35878123 %R 10.2196/38076 %U https://formative.jmir.org/2022/8/e38076 %U https://doi.org/10.2196/38076 %U http://www.ncbi.nlm.nih.gov/pubmed/35878123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38332 %T The Relationship Between Information Sources, Health Literacy, and COVID-19 Knowledge in the COVID-19 Infodemic: Cross-sectional Online Study in Japan %A Inoue,Mami %A Shimoura,Kanako %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K COVID-19 infodemic %K information source %K health literacy %K COVID-19 knowledge %K social media %K cross-sectional study %K mass media %K digital media %D 2022 %7 22.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused not only a disease epidemic but also an infodemic. Due to the increased use of the internet and social media, along with the development of communication technology, information has spread faster and farther during the COVID-19 infodemic. Moreover, the increased choice of information sources has made it more difficult to make sound decisions regarding information. Although social media is the most common source of misinformation, other forms of media can also spread misinformation. However, the media sources used by people with high health literacy and COVID-19 knowledge to obtain information are unclear. Furthermore, the association between the use of multiple information sources and health literacy or COVID-19 knowledge is ill-defined. Objective: This study aims to examine the following 3 aspects regarding the COVID-19 infodemic: (1) the relationship between health literacy, COVID-19 knowledge, and the number of information sources used; (2) the impact of media use on health literacy; and (3) the impact of media use on COVID-19 knowledge. Methods: An online cross-sectional study was conducted in November 2021. Participants were 477 individuals aged 20-69 years. After obtaining consent to participate in the study, participants were asked about sociodemographic indicators, sources of health-related information, health literacy, and COVID-19 knowledge. Sources of health-related information were categorized into 4 types: mass media, digital media, social media, and face-to-face communication. The Spearman rank correlation test was conducted to determine the relationship between health literacy, the number of correct answers to COVID-19 knowledge, and the number of information sources used. Multiple regression analysis was conducted with health literacy and the number of correct answers as dependent variables, the 4 media types as independent variables, and age and sex as adjustment variables. Results: Mass media was the most frequently used source of information, followed by digital media, face-to-face communication, and social media. Social media use was significantly higher among individuals aged 20-29 years than among other age groups. Significant positive correlations were found between health literacy, the number of positive responses to COVID-19 knowledge, and the number of information sources used. Multiple linear regression analysis showed that health literacy is associated with access to information from digital media and face-to-face communication. Additionally, COVID-19 knowledge was associated with access to information from mass media, digital media, and face-to-face communication. Conclusions: Health literacy and COVID-19 knowledge could be improved using diverse information sources, especially by providing opportunities to use digital media and face-to-face communication. Furthermore, it may be important to improve health literacy and provide accurate knowledge about COVID-19 to young adults. %M 35839380 %R 10.2196/38332 %U https://www.jmir.org/2022/7/e38332 %U https://doi.org/10.2196/38332 %U http://www.ncbi.nlm.nih.gov/pubmed/35839380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36206 %T eHealth Literacy and its Associated Factors Among Health Professionals During the COVID-19 Pandemic in Resource-Limited Settings: Cross-sectional Study %A Tesfa,Getanew Aschalew %A Yehualashet,Delelegn Emwodew %A Ewune,Helen Ali %A Zemeskel,Addisu Getnet %A Kalayou,Mulugeta Hayelom %A Seboka,Binyam Tariku %+ School of Public Health, College of Medicine and Health Science, Dilla University, 15th Road, Dilla, 419, Ethiopia, 251 31167972, getanewaschalew@gmail.com %K eHealth literacy %K COVID-19 %K health information %K health literacy %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has wreaked havoc on health care systems and governments worldwide. Although eHealth literacy is acknowledged as a critical component of public health, it was overlooked during the pandemic. To assist patients and their families, health professionals should be knowledgeable about online health information resources and capable of evaluating relevant online information. In a resource-constrained situation, the level of eHealth literacy among health professionals is not well documented. Objective: The aim of this study was to assess the eHealth literacy level and its associated factors among health professionals working in Amhara regional state teaching hospitals, Ethiopia. Methods: A self-administered questionnaire was used in an institutional-based cross-sectional study design. Descriptive statistics were calculated to describe eHealth literacy statements and key variables using SPSS v.24. Bivariable and multivariable logistic regression models were fit to identify factors related to eHealth literacy. Variables with P<.05 were declared to be statistically significant predictors. Results: A total of 383 participants completed and returned the questionnaire with a response rate of 90.5%. Health professionals demonstrated a moderate level of eHealth literacy (mean 29.21). Most of the professionals were aware of the available health resources located on the internet, and know how to search and locate these resources. However, they lack the ability to distinguish high-quality health resources from low-quality resources. Factors that were significantly associated with eHealth literacy were computer access, computer knowledge, perceived ease of use, and perceived usefulness of eHealth information resources. Conclusions: It is crucial to provide training and support to health care workers on how to find, interpret, and, most importantly, evaluate the quality of health information found on the internet to improve their eHealth literacy level. Further research is needed to explore the role of eHealth literacy in mitigating pandemics in developing countries. %M 35737897 %R 10.2196/36206 %U https://formative.jmir.org/2022/7/e36206 %U https://doi.org/10.2196/36206 %U http://www.ncbi.nlm.nih.gov/pubmed/35737897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e35816 %T Digital Health Literacy: Bibliometric Analysis %A Yang,Keng %A Hu,Yekang %A Qi,Hanying %+ China National Health Development Research Center, No. 9 Chegongzhuang Street, Xicheng District, Beijing, 100044, China, 86 15991750561, freyak5277@hotmail.com %K digital health literacy %K eHealth %K digital divide %K bibliometrics %K VOSviewer %K CiteSpace %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community. Objective: The purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field. Methods: Methods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. Results: The results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. Conclusions: We summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field. %M 35793141 %R 10.2196/35816 %U https://www.jmir.org/2022/7/e35816 %U https://doi.org/10.2196/35816 %U http://www.ncbi.nlm.nih.gov/pubmed/35793141 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38269 %T Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet %A Stokes-Parish,Jessica %+ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, 4227, Australia, 61 755951468, jstokesp@bond.edu.au %K science communication %K critical appraisal %K social media %K health literacy %K digital literacy %K misinformation %K COVID-19 %K online health %K infodemic %K infodemiology %D 2022 %7 17.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic. %M 35649183 %R 10.2196/38269 %U https://www.jmir.org/2022/6/e38269 %U https://doi.org/10.2196/38269 %U http://www.ncbi.nlm.nih.gov/pubmed/35649183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34708 %T The Dispersion of Health Information–Seeking Behavior and Health Literacy in a State in the Southern United States: Cross-sectional Study %A Rao,Nikita %A Tighe,Elizabeth L %A Feinberg,Iris %+ Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P O Box 3995, Atlanta, GA, 30302, United States, 1 404 413 1281, nrao3@gsu.edu %K health information–seeking behavior %K health literacy %K digital literacy %K information retrieval %K health literacy questionnaire %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transmission of health information from in-person communication to web-based sources has changed over time. Patients can find, understand, and use their health information without meeting a health care provider and are able to participate more in their health care management. In recent years, the internet has emerged as the primary source of health information, although clinical providers remain the most credible source. The ease of access, anonymity, and busy schedules may be motivating factors to seek health information on the web. Social media has surfaced as a popular source of health information, as it can provide news in real time. The increase in the breadth and depth of health information available on the web has also led to a plethora of misinformation, and individuals are often unable to discern facts from fiction. Competencies in health literacy (HL) can help individuals better understand health information and enhance patient decision-making, as adequate HL is a precursor to positive health information–seeking behaviors (HISBs). Several factors such as age, sex, and socioeconomic status are known to moderate the association between HL and HISBs. Objective: In this study, we aimed to examine the relationship between HL and HISBs in individuals living in a southern state in the United States by considering different demographic factors. Methods: Participants aged ≥18 years were recruited using Qualtrics Research Services and stratified to match the statewide demographic characteristics of race and age. Demographics and source and frequency of health information were collected. The Health Literacy Questionnaire was used to collect self-reported HL experiences. SPSS (version 27; IBM Corp) was used for the analysis. Results: A total of 520 participants met the criteria and completed the survey (mean age 36.3, SD 12.79 years). The internet was cited as the most used source of health information (mean 2.41, SD 0.93). Females are more likely to seek health information from physicians than males (r=0.121; P=.006). Older individuals are less likely to seek health information from the internet (r=−0.108; P=.02), social media (r=−0.225; P<.001), and friends (r=−0.090; P=.045) than younger individuals. Cluster analysis demonstrated that individuals with higher levels of HISBs were more likely to seek information from multiple sources than those with lower levels of HISBs (mean range 3.05-4.09, SD range 0.57-0.66; P<.001). Conclusions: Age and sex are significantly associated with HISB. Older adults may benefit from web-based resources to monitor their health conditions. Higher levels of HL are significantly associated with greater HISB. Targeted strategies to improve HISB among individuals with lower levels of HL may improve their access, understanding, and use of health information. %M 35704357 %R 10.2196/34708 %U https://formative.jmir.org/2022/6/e34708 %U https://doi.org/10.2196/34708 %U http://www.ncbi.nlm.nih.gov/pubmed/35704357 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35478 %T Development of a Digital Tool for People With a Long-Term Condition Using Stroke as a Case Example: Participatory Design Approach %A Kjörk,Emma K %A Sunnerhagen,Katharina S %A Lundgren-Nilsson,Åsa %A Andersson,Anders K %A Carlsson,Gunnel %+ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3 floor, Gothenburg, 413 45, Sweden, 46 735124309, emma.kjork@gu.se %K eHealth %K digital tool %K Strokehälsa %K follow-up %K chronic care %K stroke %K Post-Stroke Checklist %K health literacy %K co-design %K shared decision making %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In patient care, demand is growing for digital health tools to enable remote services and enhance patient involvement. People with chronic conditions often have multiple health problems, and long-term follow-up is recommended to meet their needs and enable access to appropriate support. A digital tool for previsit preparation could enhance time efficiency and guide the conversation during the visit toward the patient’s priorities. Objective: This study aims to develop a digital previsit tool and explore potential end user’s perceptions, using a participatory approach with stroke as a case example. Methods: The digital tool was developed and prototyped according to service design principles, informed by qualitative participant data and feedback from an expert panel. All features were processed in workshops with a team that included a patient partner. The resulting tool presented questions about health problems and health information. Study participants were people with stroke recruited from an outpatient clinic and patient organizations in Sweden. Development and data collection were conducted in parallel. For conceptualization, the initial prototype was based on the Post-Stroke Checklist and research. Needs and relevance were explored in focus groups, and we used a web survey and individual interviews to explore perceived utility, ease of use, and acceptance. Data were thematically analyzed following the Framework Method. Results: The development process included 22 participants (9 women) with a median age of 59 (range 42-83) years and a median of 51 (range 4-228) months since stroke. Participants were satisfied or very satisfied with using the tool and recommended its use in clinical practice. Three main themes were constructed based on focus group data (n=12) and interviews (n=10). First, valuable accessible information illuminated the need for information to confirm experiences, facilitate responses, and invite engagement in their care. Amendments to the information in turn reconfigured their expectations. Second, utility and complexity in answering confirmed that the questions were relevant and comprehensible. Some participants perceived the answer options as limiting and suggested additional space for free text. Third, capturing needs and value of the tool highlighted the tool’s potential to identify health problems and the importance of encouraging further dialog. The resulting digital tool, Strokehälsa [Strokehealth] version 1.0, is now incorporated into a national health platform. Conclusions: The participatory approach to tool development yielded a previsit digital tool that the study group perceived as useful. The holistic development process used here, which integrated health information, validated questions, and digital functionality, offers an example that could be applicable in the context of other long-term conditions. Beyond its potential to identify care needs, the tool offers information that confirms experiences and supports answering the questions in the tool. The tool is freely shared for adaptation in different contexts. Trial Registration: researchweb 236341; https://www.researchweb.org/is/vgr/project/236341 %M 35657650 %R 10.2196/35478 %U https://humanfactors.jmir.org/2022/2/e35478 %U https://doi.org/10.2196/35478 %U http://www.ncbi.nlm.nih.gov/pubmed/35657650 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e33577 %T Cross-Verification of COVID-19 Information Obtained From Unofficial Social Media Accounts and Associated Changes in Health Behaviors: Web-Based Questionnaire Study Among Chinese Netizens %A Li,Peiyi %A Chen,Bo %A Deveaux,Genevieve %A Luo,Yunmei %A Tao,Wenjuan %A Li,Weimin %A Wen,Jin %A Zheng,Yuan %+ Publicity Department, West China Hospital, Sichuan University, Guo Xue Xiang 37, Chengdu, 610041, China, 86 028 85422406, 248485329@qq.com %K COVID-19 %K pandemic %K social media %K behavior change %K information cross-verification %K eHealth literacy %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As social media platforms have become significant sources of information during the pandemic, a significant volume of both factual and inaccurate information related to the prevention of COVID-19 has been disseminated through social media. Thus, disparities in COVID-19 information verification across populations have the potential to promote the dissemination of misinformation among clustered groups of people with similar characteristics. Objective: This study aimed to identify the characteristics of social media users who obtained COVID-19 information through unofficial social media accounts and were (1) most likely to change their health behaviors according to web-based information and (2) least likely to actively verify the accuracy of COVID-19 information, as these individuals may be susceptible to inaccurate prevention measures and may exacerbate transmission. Methods: An online questionnaire consisting of 17 questions was disseminated by West China Hospital via its official online platforms, between May 18, 2020, and May 31, 2020. The questionnaire collected the sociodemographic information of 14,509 adults, and included questions surveying Chinese netizens’ knowledge about COVID-19, personal social media use, health behavioral change tendencies, and cross-verification behaviors for web-based information during the pandemic. Multiple stepwise regression models were used to examine the relationships between social media use, behavior changes, and information cross-verification. Results: Respondents who were most likely to change their health behaviors after obtaining web-based COVID-19 information from celebrity sources had the following characteristics: female sex (P=.004), age ≥50 years (P=.009), higher COVID-19 knowledge and health literacy (P=.045 and P=.03, respectively), non–health care professional (P=.02), higher frequency of searching on social media (P<.001), better health conditions (P<.001), and a trust rating score of more than 3 for information released by celebrities on social media (P=.005). Furthermore, among participants who were most likely to change their health behaviors according to social media information released by celebrities, female sex (P<.001), living in a rural residence rather than first-tier city (P<.001), self-reported medium health status and lower health care literacy (P=.007 and P<.001, respectively), less frequent search for COVID-19 information on social media (P<.001), and greater level of trust toward celebrities’ social media accounts with a trust rating score greater than 1 (P≤.04) were associated with a lack of cross-verification of information. Conclusions: The findings suggest that governments, health care agencies, celebrities, and technicians should combine their efforts to decrease the risk in vulnerable groups that are inclined to change health behaviors according to web-based information but do not perform any fact-check verification of the accuracy of the unofficial information. Specifically, it is necessary to correct the false information related to COVID-19 on social media, appropriately apply celebrities’ star power, and increase Chinese netizens’ awareness of information cross-verification and eHealth literacy for evaluating the veracity of web-based information. %M 35486529 %R 10.2196/33577 %U https://publichealth.jmir.org/2022/5/e33577 %U https://doi.org/10.2196/33577 %U http://www.ncbi.nlm.nih.gov/pubmed/35486529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37523 %T The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study %A König,Lars %A Marbach-Breitrück,Eugenia %A Engler,Anne %A Suhr,Ralf %+ Stiftung Gesundheitswissen, Friedrichstr 134, Berlin, 10117, Germany, 49 30419549262, lars.koenig@stiftung-gesundheitswissen.de %K digital education %K digital health literacy %K digital literacy %K e-learning %K health education %K health information %K health literacy %K learning material %K school %K school-age children %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). Objective: The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants’ health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants’ subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course. Methods: The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement). Results: To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]–0=676,000; δ=–0.316), practical knowledge (BF–0=92,300; δ=–0.294), critical thinking (BF–0=7.42e+13; δ=–0.482), self-awareness (BF–0=11,500,000; δ=–0.345), and citizenship (BF–0=266,000; δ=–0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF–0=2.339; δ=–0.135), evaluating reliability (BF–0=2.03e+11; δ=–0.434), and determining relevance (BF–0=316,000; δ=–0.308). Moreover, participants demonstrated higher subjective (BF–0=3.58e+82; δ=–1.515) and objective knowledge (BF–0=3.82e+97; δ=–1.758) in the domain of (digital) health literacy. Conclusions: The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). %M 35576572 %R 10.2196/37523 %U https://www.jmir.org/2022/5/e37523 %U https://doi.org/10.2196/37523 %U http://www.ncbi.nlm.nih.gov/pubmed/35576572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36835 %T Readability of English, German, and Russian Disease-Related Wikipedia Pages: Automated Computational Analysis %A Gordejeva,Jelizaveta %A Zowalla,Richard %A Pobiruchin,Monika %A Wiesner,Martin %+ Department of Medical Informatics, Heilbronn University, Max-Planck-Str 39, Heilbronn, 74081, Germany, 49 7131504 ext 6947, martin.wiesner@hs-heilbronn.de %K readability %K health literacy %K health education %K Wikipedia %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Wikipedia is a popular encyclopedia for health- and disease-related information in which patients seek advice and guidance on the web. Yet, Wikipedia articles can be unsuitable as patient education materials, as investigated in previous studies that analyzed specific diseases or medical topics with a comparatively small sample size. Currently, no data are available on the average readability levels of all disease-related Wikipedia pages for the different localizations of this particular encyclopedia. Objective: This study aimed to analyze disease-related Wikipedia pages written in English, German, and Russian using well-established readability metrics for each language. Methods: Wikipedia database snapshots and Wikidata metadata were chosen as resources for data collection. Disease-related articles were retrieved separately for English, German, and Russian starting with the main concept of Human Diseases and Disorders (German: Krankheit; Russian: Заболевания человека). In the case of existence, the corresponding International Classification of Diseases, Tenth Revision (ICD-10), codes were retrieved for each article. Next, the raw texts were extracted and readability metrics were computed. Results: The number of articles included in this study for English, German, and Russian Wikipedia was n=6127, n=6024, and n=3314, respectively. Most disease-related articles had a Flesch Reading Ease (FRE) score <50.00, signaling difficult or very difficult educational material (English: 5937/6125, 96.93%; German: 6004/6022, 99.7%; Russian: 2647/3313, 79.9%). In total, 70% (7/10) of the analyzed articles could be assigned an ICD-10 code with certainty (English: 4235/6127, 69.12%; German: 4625/6024, 76.78%; Russian: 2316/3314, 69.89%). For articles with ICD-10 codes, the mean FRE scores were 28.69 (SD 11.00), 20.33 (SD 9.98), and 38.54 (SD 13.51) for English, German, and Russian, respectively. A total of 9 English ICD-10 chapters (11 German and 10 Russian) showed significant differences: chapter F (FRE 23.88, SD 9.95; P<.001), chapter E (FRE 25.14, SD 9.88; P<.001), chapter H (FRE 30.04, SD 10.57; P=.049), chapter I (FRE 30.05, SD 9.07; P=.04), chapter M (FRE 31.17, 11.94; P<.001), chapter T (FRE 32.06, SD 10.51; P=.001), chapter A (FRE 32.63, SD 9.25; P<.001), chapter B (FRE 33.24, SD 9.07; P<.001), and chapter S (FRE 39.02, SD 8.22; P<.001). Conclusions: Disease-related English, German, and Russian Wikipedia articles cannot be recommended as patient education materials because a major fraction is difficult or very difficult to read. The authors of Wikipedia pages should carefully revise existing text materials for readers with a specific interest in a disease or its associated symptoms. Special attention should be given to articles on mental, behavioral, and neurodevelopmental disorders (ICD-10 chapter F) because these articles were most difficult to read in comparison with other ICD-10 chapters. Wikipedia readers should be supported by editors providing a short and easy-to-read summary for each article. %M 35576562 %R 10.2196/36835 %U https://www.jmir.org/2022/5/e36835 %U https://doi.org/10.2196/36835 %U http://www.ncbi.nlm.nih.gov/pubmed/35576562 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e29618 %T Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search %A Kubb,Christian %A Foran,Heather M %+ Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstr. 65-67, Klagenfurt, 9020, Austria, 43 463 2700 1631, christian.kubb@aau.at %K online health information seeking %K digital health %K parents %K parent-child %K eHealth literacy %K human computer interaction %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics. Objective: This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers. Methods: In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child’s (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants’ search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined. Results: Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (rs=−0.39, P=.01), stress after the search (rs=−0.33, P=.02), and the number of search queries (rs=−0.29, P=.04) but was not significantly associated with eHealth literacy (rs=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (rs=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (rs=0.08, P=.56), number of performed search queries (rs=0.20, P=.17), or total clicks (rs=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child’s symptoms. Conclusions: This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public. %M 35532970 %R 10.2196/29618 %U https://pediatrics.jmir.org/2022/2/e29618 %U https://doi.org/10.2196/29618 %U http://www.ncbi.nlm.nih.gov/pubmed/35532970 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34764 %T Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore %A Lim,Haikel A %A Lee,Joanne Sze Win %A Lim,Meng Han %A Teo,Lynn Pei Zhen %A Sin,Natalene Siew Wen %A Lim,Rou Wei %A Chua,Si Min %A Yeo,Jia Qi %A Ngiam,Nerice Heng Wen %A Tey,Angeline Jie-Yin %A Tham,Celine Yi Xin %A Ng,Kennedy Yao Yi %A Low,Lian Leng %A Tang,Kai Wen Aaron %+ Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore, 65 62223322, aaron_kw_tang@nhg.com.sg %K COVID-19 %K digital literacy %K digital literacy training %K digital disparities %K digital divide %K social construction of health technologies %K health technology %K COVID-19 pandemic %K pandemic %K COVID %K social isolation %K elder %K older adult %K Asia %K access %K barrier %K empower %K volunteer %K vulnerable %K digital skill %K low income %D 2022 %7 3.5.2022 %9 Viewpoint %J JMIR Aging %G English %X This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives. %M 35503520 %R 10.2196/34764 %U https://aging.jmir.org/2022/2/e34764 %U https://doi.org/10.2196/34764 %U http://www.ncbi.nlm.nih.gov/pubmed/35503520 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e29780 %T Health Professionals’ eHealth Literacy and System Experience Before and 3 Months After the Implementation of an Electronic Health Record System: Longitudinal Study %A Kayser,Lars %A Karnoe,Astrid %A Duminski,Emily %A Jakobsen,Svend %A Terp,Rikke %A Dansholm,Susanne %A Roeder,Michael %A From,Gustav %+ Section of Health Service Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 28757291, lk@sund.ku.dk %K health care professionals %K eHealth literacy %K electronic health record %K implementation %K digital health %K eHealth %K health literacy %K health records %K eHealth records %K patient care %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The implementation of an integrated electronic health record (EHR) system can potentially provide health care providers with support standardization of patient care, pathways, and workflows, as well as provide medical staff with decision support, easier access, and the same interface across features and subsystems. These potentials require an implementation process in which the expectations of the medical staff and the provider of the new system are aligned with respect to the medical staff’s knowledge and skills, as well as the interface and performance of the system. Awareness of the medical staff’s level of eHealth literacy may be a way of understanding and aligning these expectations and following the progression of the implementation process. Objective: The objective of this study was to investigate how a newly developed and modified instrument measuring the medical staff’s eHealth literacy (staff eHealth Literacy Questionnaire [eHLQ]) can be used to inform the system provider and the health care organization in the implementation process and evaluate whether the medical staff’s perceptions of the ease of use change and how this may be related to their level of eHealth literacy. Methods: A modified version of the eHLQ was distributed to the staff of a medical department in Denmark before and 3 months after the implementation of a new EHR system. The survey also included questions related to users’ perceived ease of use and their self-reported information technology skills. Results: The mean age of the 194 participants before implementation was 43.1 (SD 12.4) years, and for the 198 participants after implementation, it was 42.3 (SD 12.5) years. After the implementation, the only difference compared with the preimplementation data was a small decrease in staff eHLQ5 (motivated to engage with digital services; unpaired 2-tailed t test; P=.009; effect size 0.267), and the values of the scales relating to the medical staff’s knowledge and skills (eHLQ1-3) were approximately ≥3 both before and after implementation. The range of scores was narrower after implementation, indicating that some of those with the lowest ability benefited from the training and new experiences with the EHR. There was an association between perceived ease of use and the 3 tested staff eHLQ scales, both before and after implementation. Conclusions: The staff eHLQ may be a good candidate for monitoring the medical staff’s digital competence in and response to the implementation of new digital solutions. This may enable those responsible for the implementation to tailor efforts to the specific needs of segments of users and inform them if the process is not going according to plan with respect to the staff’s information technology–related knowledge and skills, trust in data security, motivation, and experience of a coherent system that suits their needs and supports the workflows and data availability. %M 35486414 %R 10.2196/29780 %U https://humanfactors.jmir.org/2022/2/e29780 %U https://doi.org/10.2196/29780 %U http://www.ncbi.nlm.nih.gov/pubmed/35486414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36043 %T A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study %A Nelson,Lyndsay A %A Pennings,Jacquelyn S %A Sommer,Evan C %A Popescu,Filoteia %A Barkin,Shari L %+ Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 450, Nashville, TN, 37203, United States, 1 6156009027, lyndsay.a.nelson@vumc.org %K digital literacy %K digital health care %K telehealth %K health equity %K scale development %K mobile phone %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with using these services. Objective: The goal of this study was to develop and validate a brief scale that assesses digital health care literacy. Methods: We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital health care use. Results: Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of 0.7), with good convergent validity (average variance extracted >0.5) and discriminant validity (square root of average variance extracted are greater than the correlation coefficients between factors). The findings also revealed that these 8 factors should be grouped under a second-order factor model (χ2/df=2.701; comparative fit index 0.921; root mean square error of approximation 0.056; target coefficient 0.831). The second survey revealed that mHealth use had a significant impact (β=0.43, P<.001) on mHealth literacy and that mHealth literacy had a significant impact (β=0.23, P<.001) on health prevention behavior. Conclusions: This study revealed the distinctiveness of mHealth literacy by placing mHealth needs, the ability to understand medical terms, and the skills in patient–doctor interactions in the foreground. The Problem-Based mHealth Literacy Scale is a useful instrument for comprehensively measuring individuals’ mHealth literacy and extends the concept of health literacy to the context of mobile communication. %M 35394446 %R 10.2196/31459 %U https://mhealth.jmir.org/2022/4/e31459 %U https://doi.org/10.2196/31459 %U http://www.ncbi.nlm.nih.gov/pubmed/35394446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29955 %T eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey %A Makowsky,Mark J %A Davachi,Shahnaz %A Jones,Charlotte A %+ Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-142E Katz Group - Rexall Centre for Pharmacy & Health Research, 11361 87 Avenue, Edmonton, AB, T6G 2E1, Canada, 1 7804921735, makowsky@ualberta.ca %K eHealth literacy %K consumer health information %K ethnicity %K cross-sectional survey %K Canada %K digital health %K eHealth %K ePatient %K health technology %K cardiovascular disease %K diabetes %K sociodemographics, mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population. Objective: The aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians. Methods: We analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy. Results: The analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was “I can tell high-quality health resources from low-quality health resources on the internet” (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient –6.0, 95% CI –9.61 to –2.39). Conclusions: In our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions. %M 35353044 %R 10.2196/29955 %U https://formative.jmir.org/2022/3/e29955 %U https://doi.org/10.2196/29955 %U http://www.ncbi.nlm.nih.gov/pubmed/35353044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31727 %T Egyptian Students Open to Digital Mental Health Care: Cross-Sectional Survey %A Mamdouh,Mostafa %A Tai,Andy Man Yeung %A Westenberg,Jean Nicolas %A Shams,Farhud %A Jang,Kerry %A Badawy,Adel %A Elsawi,Houssam %A Krausz,Michael %+ Department of Psychiatry, University of British Columbia, Vancouver Campus 430-5950, University Boulevard, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada, 1 6474024088, andytai7@student.ubc.ca %K students %K youth %K eMental health %K Arab countries %K mental health care %K eHealth solutions %K youth mental health %K mental health %K youth engagement %K young adults %K EMH %K therapy %K emotional support %K barriers %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success. Objective: The objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth. Methods: A web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05. Results: Of the 707 individuals who completed the survey (90.9% response rate), 60.5% (428) were female, 62% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50%). Conclusions: EMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design. %M 35311692 %R 10.2196/31727 %U https://formative.jmir.org/2022/3/e31727 %U https://doi.org/10.2196/31727 %U http://www.ncbi.nlm.nih.gov/pubmed/35311692 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32538 %T Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review %A Jenkins,Catherine L %A Imran,Sumayyah %A Mahmood,Aamina %A Bradbury,Katherine %A Murray,Elizabeth %A Stevenson,Fiona %A Hamilton,Fiona L %+ eHealth Unit, Research Department of Primary Care & Population Health, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 2037940272, flodocs@hotmail.com %K digital divide %K digital health interventions %K DHIs %K eHealth %K digital health literacy %K health inequalities %K health inequities %K mHealth %K mobile health %D 2022 %7 18.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective: The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods: This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results: The review is underway and is anticipated to be completed by September 2022. Conclusions: The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/32538 %M 35302946 %R 10.2196/32538 %U https://www.researchprotocols.org/2022/3/e32538 %U https://doi.org/10.2196/32538 %U http://www.ncbi.nlm.nih.gov/pubmed/35302946 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31820 %T Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study %A Man,Alice %A van Ballegooie,Courtney %+ Department of Experimental Therapeutics, British Columbia Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada, 1 604 675 8000 ext 7024, cballegooie@bccrc.ca %K health literacy %K accessibility %K online health information %K pediatrics %K patient education %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes. %M 35293875 %R 10.2196/31820 %U https://pediatrics.jmir.org/2022/1/e31820 %U https://doi.org/10.2196/31820 %U http://www.ncbi.nlm.nih.gov/pubmed/35293875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32678 %T Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey %A Medero,Kristina %A Merrill Jr,Kelly %A Ross,Morgan Quinn %+ School of Communication, Ohio State University, 154 N Oval Mall, Columbus, OH, 43210-1132, United States, 1 5313017556, medero.2@osu.edu %K Black %K African American %K first-level digital divide %K health disparities %K home computer %K internet access %K intersectionality %K Latino %K Latine %K Hispanic %K mobile %K online health information seeking %K public computer %K structural equation modeling %K work computer %K mobile phone %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital divide refers to technological disparities based on demographic characteristics (eg, race and ethnicity). Lack of physical access to the internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Research on the digital divide examines where and how people access the internet, whereas research on OHIS investigates how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context–device access pairings operate differently across intersectional identities—particularly racial and ethnic groups—in the domain of OHIS. Objective: This study aims to examine how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships among predisposing characteristics (ie, age, sex, education, and income), internet access (home computer, public computer, work computer, and mobile), health needs, and OHIS. Methods: Analysis was conducted using data from the 2019 Health Information National Trends Survey. Our theoretical model of OHIS explicates the roles of internet access and health needs for racial and ethnic minority groups’ OHIS. Participant responses were analyzed using structural equation modeling. Three separate group structural equation modeling models were specified based on Black, Latine, and White self-categorizations. Results: Overall, predisposing characteristics (ie, age, sex, education, and income) were associated with internet access, health needs, and OHIS; internet access was associated with OHIS; and health needs were associated with OHIS. Home computer and mobile access were most consistently associated with OHIS. Several notable linkages between predisposing characteristics and internet access differed for Black and Latine individuals. Older racial and ethnic minorities tended to access the internet on home and public computers less frequently; home computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals. Conclusions: Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, affects specific racial and ethnic groups and their OHIS. We not only find support for prior work on the digital divide but also surface new insights, including distinct impacts of context–device access pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide. %M 35289761 %R 10.2196/32678 %U https://www.jmir.org/2022/3/e32678 %U https://doi.org/10.2196/32678 %U http://www.ncbi.nlm.nih.gov/pubmed/35289761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32777 %T Validity Evidence of the eHealth Literacy Questionnaire (eHLQ) Part 2: Mixed Methods Approach to Evaluate Test Content, Response Process, and Internal Structure in the Australian Community Health Setting %A Cheng,Christina %A Elsworth,Gerald R %A Osborne,Richard H %+ School of Health Sciences, Centre for Global Health and Equity, Swinburne University of Technology, Room 907, Level 9, AMCD Building, 453/469-477 Burwood Road, Hawthorn, 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K health literacy %K health equity %K questionnaire design %K validity evidence %K eHLQ %K mobile phone %D 2022 %7 8.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies have changed how we manage our health, and eHealth literacy is needed to engage with health technologies. Any eHealth strategy would be ineffective if users’ eHealth literacy needs are not addressed. A robust measure of eHealth literacy is essential for understanding these needs. On the basis of the eHealth Literacy Framework, which identified 7 dimensions of eHealth literacy, the eHealth Literacy Questionnaire (eHLQ) was developed. The tool has demonstrated robust psychometric properties in the Danish setting, but validity testing should be an ongoing and accumulative process. Objective: This study aims to evaluate validity evidence based on test content, response process, and internal structure of the eHLQ in the Australian community health setting. Methods: A mixed methods approach was used with cognitive interviewing conducted to examine evidence on test content and response process, whereas a cross-sectional survey was undertaken for evidence on internal structure. Data were collected at 3 diverse community health sites in Victoria, Australia. Psychometric testing included both the classical test theory and item response theory approaches. Methods included Bayesian structural equation modeling for confirmatory factor analysis, internal consistency and test-retest for reliability, and the Bayesian multiple-indicators, multiple-causes model for testing of differential item functioning. Results: Cognitive interviewing identified only 1 confusing term, which was clarified. All items were easy to read and understood as intended. A total of 525 questionnaires were included for psychometric analysis. All scales were homogenous with composite scale reliability ranging from 0.73 to 0.90. The intraclass correlation coefficient for test-retest reliability for the 7 scales ranged from 0.72 to 0.95. A 7-factor Bayesian structural equation modeling using small variance priors for cross-loadings and residual covariances was fitted to the data, and the model of interest produced a satisfactory fit (posterior productive P=.49, 95% CI for the difference between observed and replicated chi-square values −101.40 to 108.83, prior-posterior productive P=.92). All items loaded on the relevant factor, with loadings ranging from 0.36 to 0.94. No significant cross-loading was found. There was no evidence of differential item functioning for administration format, site area, and health setting. However, discriminant validity was not well established for scales 1, 3, 5, 6, and 7. Item response theory analysis found that all items provided precise information at different trait levels, except for 1 item. All items demonstrated different sensitivity to different trait levels and represented a range of difficulty levels. Conclusions: The evidence suggests that the eHLQ is a tool with robust psychometric properties and further investigation of discriminant validity is recommended. It is ready to be used to identify eHealth literacy strengths and challenges and assist the development of digital health interventions to ensure that people with limited digital access and skills are not left behind. %M 35258475 %R 10.2196/32777 %U https://www.jmir.org/2022/3/e32777 %U https://doi.org/10.2196/32777 %U http://www.ncbi.nlm.nih.gov/pubmed/35258475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32752 %T Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter %A Gabarron,Elia %A Dechsling,Anders %A Skafle,Ingjerd %A Nordahl-Hansen,Anders %+ Department of Education, ICT and Learning, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 94863460, egabarron@gmail.com %K social media %K autism spectrum disorder %K health literacy %K famous persons %K Asperger %K Elon Musk %K twitter %K tweets %K mental health %K autism %K sentiment analysis %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk's disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition. Objective: The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure. Methods: We extracted tweets that were published 1 week before and after Musk's disclosure that had received >30 likes and included the terms “Aspergers” or “Aspie.” The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool. Results: We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement. Conclusions: The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition. %M 35254265 %R 10.2196/32752 %U https://formative.jmir.org/2022/3/e32752 %U https://doi.org/10.2196/32752 %U http://www.ncbi.nlm.nih.gov/pubmed/35254265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30085 %T Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %A Cho,Yoon Jeong %+ Department of Family Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K health literacy %K readability %K public health %K health equity %K consumer health information %K information dissemination %K health education %K eHealth %K online %K social media %K pandemic %K infodemic %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. %M 35072633 %R 10.2196/30085 %U https://formative.jmir.org/2022/3/e30085 %U https://doi.org/10.2196/30085 %U http://www.ncbi.nlm.nih.gov/pubmed/35072633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28771 %T The Effect of Digital Health Interventions on Parents’ Mental Health Literacy and Help Seeking for Their Child’s Mental Health Problem: Systematic Review %A Peyton,Daniel %A Goods,Marquelle %A Hiscock,Harriet %+ Murdoch Children's Research Institute, 50 Flemington Road, Parkville, 3052, Australia, 61 93456910, harriet.hiscock@rch.org.au %K child %K mental health %K systematic review %K caregiver %K health literacy %K digital health %D 2022 %7 10.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear. Objective: This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes. Methods: Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction. Results: Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature. Conclusions: There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074 %M 35142623 %R 10.2196/28771 %U https://www.jmir.org/2022/2/e28771 %U https://doi.org/10.2196/28771 %U http://www.ncbi.nlm.nih.gov/pubmed/35142623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28252 %T Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale %A Marsall,Matthias %A Engelmann,Gerrit %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR–University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany, 49 17678909441, matthias.marsall@stud.uni-due.de %K eHealth %K eHeals %K health literacy %K factor analysis %K validation %K measurement invariance %K internet %K health information %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy. %M 35107437 %R 10.2196/28252 %U https://www.jmir.org/2022/2/e28252 %U https://doi.org/10.2196/28252 %U http://www.ncbi.nlm.nih.gov/pubmed/35107437 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26308 %T The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study %A Wang,Zhuoxin %A Fan,Yanyan %A Lv,Hekai %A Deng,Shanshan %A Xie,Hui %A Zhang,Li %A Luo,Aijing %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600# Donghai Rd, Bengbu, Anhui Province, PRC, Bengbu, 233030, China, 86 18855202156, wfz.bbmc@foxmail.com %K online %K health information %K barriers to acquisition %K middle-aged patients with chronic diseases %K rural community %K chronic conditions %K chronic %K rural %K literacy %K information seeking %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. Objective: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. Methods: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants’ behavior during the web-based operational tasks. Results: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. Conclusions: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information. %M 35099401 %R 10.2196/26308 %U https://www.jmir.org/2022/1/e26308 %U https://doi.org/10.2196/26308 %U http://www.ncbi.nlm.nih.gov/pubmed/35099401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25760 %T Impact of Internet Use on Cognitive Decline in Middle-Aged and Older Adults in China: Longitudinal Observational Study %A Yu,Xinyue %A Mu,Aruhan %A Wu,Xiang %A Zhou,Liqin %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China, 86 15927686325, zhoulq@hust.edu.cn %K internet use %K cognitive decline %K China %K fixed-effects analysis %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Given that cognitive decline lacks effective treatment options and has severe implications for healthy aging, internet use may achieve nonpharmacological relief of cognitive decline through cognitive stimulation and social engagement. Objective: This longitudinal study aimed to investigate the relationship between the diversity, frequency, and type of internet use and cognitive decline, and to provide theoretical support and suggestions for mitigating cognitive decline in middle-aged and older adults. Methods: Data were obtained from a total of 10,532 survey respondents from the China Family Panel Studies database from wave 3 (2014) and wave 5 (2018) of the survey. Cognitive function was measured using vocabulary tests, and internet use was categorized into five aspects: study, work, socializing, entertainment, and commercial-related activities. Associations between the diversity, frequency, and type of internet use and cognitive decline were estimated by controlling for demographic variables and health status risk factors through fixed-effects models. Results: After controlling for demographic and health status risk factors, the type and frequency of internet use were found to be associated with cognitive functioning during the subsequent 4-year period, and different types of internet use had different effects on cognitive decline. Frequency of internet use of at least once a week for study (β=0.620, 95% CI 0.061 to 1.180; P=.04), work (β=0.896, 95% CI 0.271 to 1.520; P=.01), and entertainment (β=0.385, 95% CI –0.008 to 0.778; P=.06), as well as less than once a week for social purposes (β=0.860, 95% CI 0.074 to 1.650; P=.06), were associated with better cognitive function. Frequency of internet use of less than once a week for commercial-related activities (β=–0.906, 95% CI –1.480 to –0.337; P=.005) was associated with poorer cognitive function. Using the internet for more than one type of activity (β=0.458, 95% CI 0.065 to 0.850; P=.03) and at least once a week (β=0.436, 95% CI 0.066 to 0.806; P=.02) was associated with better cognitive function. Conclusions: This study shows that breadth and depth of internet use are positively associated with cognitive function and that different types of internet use have different roles in cognitive decline. The importance of the internet as a nonpharmacological intervention pathway for cognitive decline is emphasized. Future research could explore specific mechanisms of influence. %M 35072642 %R 10.2196/25760 %U https://www.jmir.org/2022/1/e25760 %U https://doi.org/10.2196/25760 %U http://www.ncbi.nlm.nih.gov/pubmed/35072642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34966 %T COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study %A Nakayama,Kazuhiro %A Yonekura,Yuki %A Danya,Hitomi %A Hagiwara,Kanako %+ Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 5550 2284, nakayama@slcn.ac.jp %K coronavirus %K COVID-19 %K health literacy %K health information %K decision-making %K health promotion %K prevention %K behavior %K survey %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. %M 34982036 %R 10.2196/34966 %U https://formative.jmir.org/2022/1/e34966 %U https://doi.org/10.2196/34966 %U http://www.ncbi.nlm.nih.gov/pubmed/34982036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32855 %T Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study %A Chen,Yu-Chi %A Cheng,Christina %A Osborne,Richard H %A Kayser,Lars %A Liu,Chieh-Yu %A Chang,Li-Chun %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Section 2, Li-Nong Street, Beitou District, Taipei, 112, Taiwan, 886 228267093, ycchen2@nycu.edu.tw %K chronic illness %K eHealth literacy questionnaire %K eHLQ %K validation %K cultural adaptation %K eHealth %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs. %M 35044310 %R 10.2196/32855 %U https://www.jmir.org/2022/1/e32855 %U https://doi.org/10.2196/32855 %U http://www.ncbi.nlm.nih.gov/pubmed/35044310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22586 %T Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors %A Hoang,Victor %A Parekh,Amit %A Sagers,Kevin %A Call,Trevor %A Howard,Shain %A Hoffman,Jason %A Lee,Daniel %+ Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV, 89106, United States, 1 7148374577, hoangorthopedics@gmail.com %K orthopedics %K practice management %K physician selection %K internet reviews %K patient decision %K practice %K patient online review %K social media %K physician perception %K patient choice %K health literacy %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons. Objective: The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level. Methods: This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information. Results: Patient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups. Conclusions: This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors. %M 35044319 %R 10.2196/22586 %U https://formative.jmir.org/2022/1/e22586 %U https://doi.org/10.2196/22586 %U http://www.ncbi.nlm.nih.gov/pubmed/35044319 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e33118 %T Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study %A Wu,Vivien Xi %A Dong,Yanhong %A Tan,Poh Choo %A Gan,Peiying %A Zhang,Di %A Chi,Yuchen %A Chao,Felicia Fang Ting %A Lu,Jinhua %A Teo,Boon Heng Dennis %A Tan,Yue Qian %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K eHealth %K self-management %K older adults %K chronic disease %K community care %K elderly %K community %K innovation %K development %K pilot %K evaluation %K health literacy %K empowerment %K feasibility %K engagement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic diseases may impact older adults’ health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. %M 35037882 %R 10.2196/33118 %U https://aging.jmir.org/2022/1/e33118 %U https://doi.org/10.2196/33118 %U http://www.ncbi.nlm.nih.gov/pubmed/35037882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32627 %T Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study %A Egerton,Thorlene %A Lawford,Belinda J %A Campbell,Penny K %A Plinsinga,Melanie L %A Spiers,Libby %A Mackenzie,David A %A Graham,Bridget %A Mills,Kathryn %A Eyles,Jillian %A Knox,Gabrielle %A Metcalf,Ben %A Maclachlan,Liam R %A Besomi,Manuela %A Dickson,Chris %A Abraham,Charles %A Vicenzino,Bill %A Hodges,Paul W %A Hunter,David J %A Bennell,Kim L %+ Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Level 7, Alan Gilbert Building, Melbourne, VIC 3010, Australia, 61 3 83441233, thorlene.egerton@unimelb.edu.au %K support group %K online support group %K knee %K osteoarthritis %K arthritis %K online forums %K patient education %K self-efficacy %K health literacy %K self-management %K qualitative %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. Objective: The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. Methods: This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. Results: Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. Conclusions: Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958 %M 35037880 %R 10.2196/32627 %U https://formative.jmir.org/2022/1/e32627 %U https://doi.org/10.2196/32627 %U http://www.ncbi.nlm.nih.gov/pubmed/35037880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25863 %T Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice %A Hyman,Antonia %A Stacy,Elizabeth %A Mohsin,Humaira %A Atkinson,Kaitlin %A Stewart,Kurtis %A Novak Lauscher,Helen %A Ho,Kendall %+ Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 3rd Floor (Blusson Spinal Cord Centre), 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048228757, kurtis.stewart@ubc.ca %K immigrants %K community-based participatory action research %K eHealth %K delivery of health care %K photovoice %K South Asian %K digital health %K mobile phone %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences. %M 35023842 %R 10.2196/25863 %U https://www.jmir.org/2022/1/e25863 %U https://doi.org/10.2196/25863 %U http://www.ncbi.nlm.nih.gov/pubmed/35023842 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27220 %T Use of Health Information Technology by Adults With Diabetes in the United States: Cross-sectional Analysis of National Health Interview Survey Data (2016-2018) %A Wang,Seamus Y %A Yeh,Hsin-Chieh %A Stein,Arielle Apfel %A Miller,Edgar R %+ Department of Medicine, Johns Hopkins University, 2024 E Monument St, Suite 1-500L, Baltimore, MD, 21205, United States, 1 410 502 6444, ermiller@jhmi.edu %K health information technology %K National Health Interview Survey %K diabetes %K Healthy People 2020 %K Healthy People 2030 %K mobile phone %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The use of health information technology (HIT) has been proposed to improve disease management in patients with type 2 diabetes mellitus. Objective: This study aims to report the prevalence of HIT use in adults with diabetes in the United States and examine the factors associated with HIT use. Methods: We analyzed data from 7999 adults who self-reported a diabetes diagnosis as collected by the National Health Interview Survey (2016-2018). All analyses were weighted to account for the complex survey design. Results: Overall, 41.2% of adults with diabetes reported looking up health information on the web, and 22.8% used eHealth services (defined as filled a prescription on the web, scheduled an appointment with a health care provider on the web, or communicated with a health care provider via email). In multivariable models, patients who were female (vs male: prevalence ratio [PR] 1.16, 95% CI 1.10-1.24), had higher education (above college vs less than high school: PR 3.61, 95% CI 3.01-4.33), had higher income (high income vs poor: PR 1.40, 95% CI 1.23-1.59), or had obesity (vs normal weight: PR 1.11, 95% CI 1.01-1.22) were more likely to search for health information on the web. Similar associations were observed among age, race and ethnicity, education, income, and the use of eHealth services. Patients on insulin were more likely to use eHealth services (on insulin vs no medication: PR 1.21, 95% CI 1.04-1.41). Conclusions: Among adults with diabetes, HIT use was lower in those who were older, were members of racial minority groups, had less formal education, or had lower household income. Health education interventions promoted through HIT should account for sociodemographic factors. %M 35019844 %R 10.2196/27220 %U https://diabetes.jmir.org/2022/1/e27220 %U https://doi.org/10.2196/27220 %U http://www.ncbi.nlm.nih.gov/pubmed/35019844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e22122 %T Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study %A Martínez Silvagnoli,Leia %A Shepherd,Caroline %A Pritchett,James %A Gardner,Jason %+ CMC Connect, McCann Health Medical Communications, Complete House, 19–21 King Edward Street, Macclesfield, SK10 1AQ, United Kingdom, 44 1625 62 4000, Caroline.Shepherd@connect-cmc.com %K biomedical research %K health literacy %K multiple sclerosis %K plain language summary %K psoriasis %K rheumatoid arthritis %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Plain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored. Objective: This study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups. Methods: Articles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents’ ranked preferences for each PLS format. Results: For all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats. Conclusions: Audience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular. Plain Language Summary: Patients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.) %M 35014966 %R 10.2196/22122 %U https://www.jmir.org/2022/1/e22122 %U https://doi.org/10.2196/22122 %U http://www.ncbi.nlm.nih.gov/pubmed/35014966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27178 %T Understanding Health Empowerment From the Perspective of Information Processing: Questionnaire Study %A Jiang,Fei %A Liu,Yongmei %A Hu,Junhua %A Chen,Xiaohong %+ Business School of Central South University, No 932, Lushan South Road, Yuelu District, Changsha, 410083, China, 86 13974834821, liuyongmeicn@163.com %K online health information %K perceived argument quality %K perceived source credibility %K health literacy %K health empowerment %K information seeking %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Massive, easily accessible online health information empowers users to cope with health problems better. Most patients search for relevant online health information before seeing a doctor to alleviate information asymmetry. However, the mechanism of how online health information affects health empowerment is still unclear. Objective: To study how online health information processing affects health empowerment. Methods: We conducted a cross-sectional questionnaire study that included 343 samples from participants who had searched online health information before the consultation. Respondents' perceptions of online information cues, benefits, health literacy, and health empowerment were assessed. Results: Perceived argument quality and perceived source credibility have significant and positive effects on perceived information benefits, but only perceived argument quality has a significant effect on perceived decision-making benefits. Two types of perceived benefits, in turn, affect health empowerment. The effects of perceived argument quality on perceived informational benefits and perceived decision-making benefits on health empowerment are significantly stronger for the high health literacy group than the low health literacy group (t269=7.156, P<.001; t269=23.240, P<.001). While, the effects of perceived source credibility on perceived informational benefits and perceived informational benefits on health empowerment are significantly weaker for the high health literacy group than the low health literacy group (t269=–10.497, P<.001; t269=–6.344, P<.001). The effect of perceived argument quality on perceived informational benefits shows no significant difference between high and low health literacy groups. Conclusions:  In the context of online health information, perceived information benefits and perceived decision-making benefits are the antecedents of health empowerment, which in turn will be affected by perceived argument quality and perceived source credibility. Health literacy plays a moderating role in the relationship of some variables. To maximize health empowerment, online health information providers should strengthen information quality and provide differentiated information services based on users' health literacy. %M 35014957 %R 10.2196/27178 %U https://www.jmir.org/2022/1/e27178 %U https://doi.org/10.2196/27178 %U http://www.ncbi.nlm.nih.gov/pubmed/35014957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31284 %T Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment %A Pearson,Keon %A Ngo,Summer %A Ekpo,Eson %A Sarraju,Ashish %A Baird,Grayson %A Knowles,Joshua %A Rodriguez,Fatima %+ Department of Medicine, Stanford University, 300 Pasteur Drive, Room S102, Stanford, CA, 94305, United States, 1 6507236028, keonp@stanford.edu %K lipoprotein(a) %K readability %K online patient education material %K health education %K health literacy %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public. Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association. Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non–patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM. Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association. Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a). %M 35014955 %R 10.2196/31284 %U https://www.jmir.org/2022/1/e31284 %U https://doi.org/10.2196/31284 %U http://www.ncbi.nlm.nih.gov/pubmed/35014955 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27221 %T Internet-Based Patient Education Materials Regarding Diabetic Foot Ulcers: Readability and Quality Assessment %A Lee,David Michael %A Grose,Elysia %A Cross,Karen %+ Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 3157, 1 King's College Circle, Toronto, ON, M5S 1A1, Canada, 1 4165582872, davidm.lee@mail.utoronto.ca %K diabetic foot ulcer %K patient education %K patient education materials %K online resources %K readability %K diabetic foot %K diabetes %K online eduction %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: While diabetic foot ulcers (DFU) are a common complication of diabetes, little is known about the content and readability of online patient education materials (PEM) for DFU. The recommended reading grade level for these materials is grades 6-8. Objective: The aim of this paper was to evaluate the quality and readability of online PEM on DFU. Methods: A Google search was performed using 4 different search terms related to DFU. Two readability formulas were used to assess the readability of the included PEM. These included the Flesch-Kincaid grade level and the Flesch-Reading ease score. The DISCERN tool was used to determine quality and reliability. Results: A total of 41 online PEM were included. The average Flesch-Reading ease score for all PEM was 63.43 (SD 14.21), indicating a standard difficulty level of reading. The average reading grade level was 7.85 (SD 2.38), which is higher than the recommended reading level for PEM. The mean DISCERN score was 45.66 (SD 3.34), and 27% (11/41) of the articles had DISCERN scores of less than 39, corresponding to poor or very poor quality. Conclusions: The majority of online PEM on DFU are written above the recommended reading levels and have significant deficiencies in quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients’ self-management. %M 35014960 %R 10.2196/27221 %U https://diabetes.jmir.org/2022/1/e27221 %U https://doi.org/10.2196/27221 %U http://www.ncbi.nlm.nih.gov/pubmed/35014960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25419 %T Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment %A Lee,Edmund WJ %A McCloud,Rachel F %A Viswanath,Kasisomayajula %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Wee Kim Wee School of Communication and Information Building, Singapore, 637718, Singapore, 65 69083429, elwj88@gmail.com %K eHealth %K mobile health %K communication inequalities %K health disparities %K health informatics %K mobile phone %D 2022 %7 7.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups. %M 34994700 %R 10.2196/25419 %U https://www.jmir.org/2022/1/e25419 %U https://doi.org/10.2196/25419 %U http://www.ncbi.nlm.nih.gov/pubmed/34994700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32329 %T Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 02 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K vaccination %K vaccine hesitancy %K media use %K social media %K public health %K pandemic %K epidemiology %K online information %K health information %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public’s vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one’s COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population’s vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. %M 34870605 %R 10.2196/32329 %U https://www.jmir.org/2022/1/e32329 %U https://doi.org/10.2196/32329 %U http://www.ncbi.nlm.nih.gov/pubmed/34870605 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28981 %T Patient Perspectives on the Digitization of Personal Health Information in the Emergency Department: Mixed Methods Study During the COVID-19 Pandemic %A Ly,Sophia %A Tsang,Ricky %A Ho,Kendall %+ Faculty of Medicine, University of British Columbia, 3312-818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048220327, sophia.ly@alumni.ubc.ca %K emergency medicine %K digital health %K health informatics %K electronic health record %K patient portal %K patient-physician relationship %K COVID-19 %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. Objective: The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. Methods: This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. Results: A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75%) and patient portals (91/107, 85%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90% in emergencies), family physicians (up to 91%), and family caregivers (up to 75%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Conclusions: Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools. %M 34818211 %R 10.2196/28981 %U https://medinform.jmir.org/2022/1/e28981 %U https://doi.org/10.2196/28981 %U http://www.ncbi.nlm.nih.gov/pubmed/34818211 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31617 %T Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey %A Breil,Bernhard %A Salewski,Christel %A Apolinário-Hagen,Jennifer %+ Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, Reinarzstraße 49, Krefeld, 47805, Germany, 49 21518226710, bernhard.breil@hs-niederrhein.de %K patient acceptance of health care %K mobile apps %K blood pressure %K mobile health %K health applications %K technology acceptance %K patients %K physicians %K digital health %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. %M 34989683 %R 10.2196/31617 %U https://cardio.jmir.org/2022/1/e31617 %U https://doi.org/10.2196/31617 %U http://www.ncbi.nlm.nih.gov/pubmed/34989683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26684 %T Genomic Health Literacy Interventions in Pediatrics: Scoping Review %A Gupta,Aarushi %A Cafazzo,Joseph A %A IJzerman,Maarten J %A Swart,Joost F %A Vastert,Sebastiaan %A Wulffraat,Nico M %A Benseler,Susanne %A Marshall,Deborah %A Yeung,Rae %A Twilt,Marinka %+ Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada, 1 403 955 7771, marinka.twilt@ahs.ca %K pediatrics %K patient education %K genetics %K genomics %K mHealth %K digital health %K internet %K genetic knowledge %K genomic health literacy %K children %K adolescents %D 2021 %7 24.12.2021 %9 Review %J J Med Internet Res %G English %X Background: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results: Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts. %M 34951592 %R 10.2196/26684 %U https://www.jmir.org/2021/12/e26684 %U https://doi.org/10.2196/26684 %U http://www.ncbi.nlm.nih.gov/pubmed/34951592 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31665 %T Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review %A Mörelius,Evalotte %A Robinson,Suzanne %A Arabiat,Diana %A Whitehead,Lisa %+ School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia, 61 8 6304 2272, e.morelius@ecu.edu.au %K child %K child health services %K digital technology %K health literacy %K infant %K internet-based intervention %K parents %K patient compliance %K pediatric hospitals %D 2021 %7 22.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child’s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents’ engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents’ health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386 %M 34941559 %R 10.2196/31665 %U https://www.jmir.org/2021/12/e31665 %U https://doi.org/10.2196/31665 %U http://www.ncbi.nlm.nih.gov/pubmed/34941559 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e30603 %T Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study %A Alvarez-Perez,Yolanda %A Perestelo-Perez,Lilisbeth %A Rivero-Santana,Amado %A Wagner,Ana M %A Torres-Castaño,Alezandra %A Toledo-Chávarri,Ana %A Duarte-Díaz,Andrea %A Alvarado-Martel,Dácil %A Piccini,Barbara %A Van den Broucke,Stephan %A Vandenbosch,Jessica %A González-González,Carina %A Perello,Michelle %A Serrano-Aguilar,Pedro %A , %+ Canary Islands Health Research Institute Foundation (FIISC), Camino Candelaria, s/n, CS El Chorrillo, Tenerife, 38109, Spain, 34 922 478 267, yolanda.alvarezperez@sescs.es %K diabetes %K digital health literacy %K health education %K MOOC %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective: We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods: The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results: A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions: Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population. %M 34898453 %R 10.2196/30603 %U https://diabetes.jmir.org/2021/4/e30603 %U https://doi.org/10.2196/30603 %U http://www.ncbi.nlm.nih.gov/pubmed/34898453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30323 %T Factors Influencing Willingness to Share Health Misinformation Videos on the Internet: Web-Based Survey %A Keselman,Alla %A Arnott Smith,Catherine %A Leroy,Gondy %A Kaufman,David R %+ Office of Engagement and Training, National Library of Medicine, 8600 Rockville Pike, Bethesda, MD, 20894, United States, 1 301 827 5671, keselmana@nih.gov %K misinformation %K information literacy %K science literacy %K webcasts as topic %K YouTube %D 2021 %7 9.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapidly evolving digital environment of the social media era has increased the reach of both quality health information and misinformation. Platforms such as YouTube enable easy sharing of attractive, if not always evidence-based, videos with large personal networks and the public. Although much research has focused on characterizing health misinformation on the internet, it has not sufficiently focused on describing and measuring individuals’ information competencies that build resilience. Objective: This study aims to assess individuals’ willingness to share a non–evidence-based YouTube video about strengthening the immune system; to describe types of evidence that individuals view as supportive of the claim by the video; and to relate information-sharing behavior to several information competencies, namely, information literacy, science literacy, knowledge of the immune system, interpersonal trust, and trust in health authority. Methods: A web-based survey methodology with 150 individuals across the United States was used. Participants were asked to watch a YouTube excerpt from a morning TV show featuring a wellness pharmacy representative promoting an immunity-boosting dietary supplement produced by his company; answer questions about the video and report whether they would share it with a cousin who was frequently sick; and complete instruments pertaining to the information competencies outlined in the objectives. Results: Most participants (105/150, 70%) said that they would share the video with their cousins. Their confidence in the supplement would be further boosted by a friend’s recommendations, positive reviews on a crowdsourcing website, and statements of uncited effectiveness studies on the producer’s website. Although all information literacy competencies analyzed in this study had a statistically significant relationship with the outcome, each competency was also highly correlated with the others. Information literacy and interpersonal trust independently predicted the largest amount of variance in the intention to share the video (17% and 16%, respectively). Interpersonal trust was negatively related to the willingness to share the video. Science literacy explained 7% of the variance. Conclusions: People are vulnerable to web-based misinformation and are likely to propagate it on the internet. Information literacy and science literacy are associated with less vulnerability to misinformation and a lower propensity to spread it. Of the two, information literacy holds a greater promise as an intervention target. Understanding the role of different kinds of trust in information sharing merits further research. %M 34889750 %R 10.2196/30323 %U https://www.jmir.org/2021/12/e30323 %U https://doi.org/10.2196/30323 %U http://www.ncbi.nlm.nih.gov/pubmed/34889750 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27988 %T Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study %A Schroeder,Kristin %A Maiarana,James %A Gisiri,Mwitasrobert %A Joo,Emma %A Muiruri,Charles %A Zullig,Leah %A Masalu,Nestory %A Vasudevan,Lavanya %+ Department of Pediatric Oncology, Duke University Medical Center, Box 102382, Durham, NC, 27710, United States, 1 9196686288, kristin.schroeder@duke.edu %K mHealth %K literacy %K smartphone use %K developing countries %K pediatric cancer %K cancer %K pediatrics %K children %K parents %K caregivers %K mobile health %K smartphone %K SMS %K education %K knowledge transfer %K communication %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone–based education and communication strategy suggests that a mobile phone–based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. %M 34889763 %R 10.2196/27988 %U https://pediatrics.jmir.org/2021/4/e27988 %U https://doi.org/10.2196/27988 %U http://www.ncbi.nlm.nih.gov/pubmed/34889763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28503 %T Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review %A Bailey,James E %A Gurgol,Cathy %A Pan,Eric %A Njie,Shirilyn %A Emmett,Susan %A Gatwood,Justin %A Gauthier,Lynne %A Rosas,Lisa G %A Kearney,Shannon M %A Robler,Samantha Kleindienst %A Lawrence,Raymona H %A Margolis,Karen L %A Osunkwo,Ifeyinwa %A Wilfley,Denise %A Shah,Vallabh O %+ Tennessee Population Health Consortium, University of Tennessee Health Science Center, Coleman Building, Suite D222, 956 Court Avenue, Memphis, TN, 38163, United States, 1 9014482475, jeb@uthsc.edu %K telehealth %K scoping review %K disparities %K implementation science %D 2021 %7 7.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. Objective: This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. Methods: A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O’Malley Scoping Review Framework and focused on PCORI’s active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. Results: PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI’s priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. Conclusions: Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information. %M 34878986 %R 10.2196/28503 %U https://www.jmir.org/2021/12/e28503 %U https://doi.org/10.2196/28503 %U http://www.ncbi.nlm.nih.gov/pubmed/34878986 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31774 %T COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey %A Bohnhoff,James %A Davis,Alexander %A Bruine de Bruin,Wändi %A Krishnamurti,Tamar %+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu %K COVID-19 %K health behavior %K health behaviour %K pregnancy %K obstetrics %K perinatal %K preventive %K preventative %K mHealth %K risk %K information source %K medical literacy %K media literacy %K information literacy %K protection %K protective %K harm %K women %K engagement %K online health information %K behavior %K information-seeking %K critical appraisal %K communication %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals’ choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19–related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. %M 34926994 %R 10.2196/31774 %U https://infodemiology.jmir.org/2021/1/e31774 %U https://doi.org/10.2196/31774 %U http://www.ncbi.nlm.nih.gov/pubmed/34926994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e23804 %T Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review %A Airola,Ella %+ Media Education Hub, Faculty of Education, University of Lapland, P.O. Box 122, Rovaniemi, FI-96101, Finland, 358 44 4744389, ella.airola@ulapland.fi %K aged %K barrier %K digital competence %K deinstitutionalization %K eHealth %K home care %K learning %K older adult %K rural health %D 2021 %7 2.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective: The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods: A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results: In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions: The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use. %M 34860664 %R 10.2196/23804 %U https://www.jmir.org/2021/12/e23804 %U https://doi.org/10.2196/23804 %U http://www.ncbi.nlm.nih.gov/pubmed/34860664 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e24144 %T eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study %A Huang,Chiao Ling %A Chiang,Chia-Hsun %A Yang,Shu Ching %+ Intelligent Electronic Commerce Research Center, Institute of Education, National Sun Yat-Sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan, 886 75251521, shyang@mail.nsysu.edu.tw %K beliefs about medicines %K college student %K eHealth literacy %K health education %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students’ eHealth literacy and beliefs about medicines, as well as gender differences. Objective: This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students. Methods: We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses. Results: The t test (t473=3.73; P<.001; t473=–2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed. Conclusions: These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines. %M 34851301 %R 10.2196/24144 %U https://medinform.jmir.org/2021/11/e24144 %U https://doi.org/10.2196/24144 %U http://www.ncbi.nlm.nih.gov/pubmed/34851301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25170 %T Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study %A Rauwerdink,Anneloek %A Kasteleyn,Marise J %A Chavannes,Niels H %A Schijven,Marlies P %+ Department of Radiology and Nuclear Medicine, Amsterdam UMC, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 566 9111, anneloek@hotmail.com %K CSIRO framework %K evaluation strategy %K eHealth %K telemedicine %K qualitative research %K formative evaluation %K digital health %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. Objective: The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. Methods: To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. Results: The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects’ progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. Conclusions: The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects’ progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. International Registered Report Identifier (IRRID): RR2-10.1016/j.ceh.2020.12.002 %M 34842536 %R 10.2196/25170 %U https://www.jmir.org/2021/11/e25170 %U https://doi.org/10.2196/25170 %U http://www.ncbi.nlm.nih.gov/pubmed/34842536 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e16006 %T Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey %A Seckin,Gul %A Hughes,Susan %+ Department of Sociology, University of North Texas, 1155 Union Circle #311157, Denton, TX, 76203, United States, 1 9405652296, gul.seckin@unt.edu %K internet %K information %K health %K communication %K strain %K education %K eHealth literacy %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients’ ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. Objective: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. Methods: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. Results: Age (β=–.17; P=.02), gender (β=–.22; P=.01), and medical satisfaction (β=–.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=–.18; P=.03) and eHealth literacy (β=–.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=–.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=–.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=–.22; P=.01). Conclusions: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals. %M 34822340 %R 10.2196/16006 %U https://aging.jmir.org/2021/4/e16006 %U https://doi.org/10.2196/16006 %U http://www.ncbi.nlm.nih.gov/pubmed/34822340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e33012 %T Physicians’ Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study %A Dahlhausen,Florian %A Zinner,Maximillian %A Bieske,Linn %A Ehlers,Jan P %A Boehme,Philip %A Fehring,Leonard %+ Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58448, Germany, 49 2302 926 78608, leonard.fehring@uni-wh.de %K mobile health %K mHealth %K digital health %K apps %K physicians %K general practitioners %K technology acceptance %K adoption %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective: The aim of this study was to investigate physicians’ and psychotherapists’ current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods: We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results: A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions: To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended. %M 34817385 %R 10.2196/33012 %U https://mhealth.jmir.org/2021/11/e33012 %U https://doi.org/10.2196/33012 %U http://www.ncbi.nlm.nih.gov/pubmed/34817385 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32951 %T Digitization and Health in Germany: Cross-sectional Nationwide Survey %A De Santis,Karina Karolina %A Jahnel,Tina %A Sina,Elida %A Wienert,Julian %A Zeeb,Hajo %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, Bremen, 28359, Germany, 49 42121856 ext 908, desantis@leibniz-bips.de %K digital health %K literacy %K survey %K attitude %K usage %K eHEALS %K COVID-19 %K physical activity %K general population %K misinformation %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. %M 34813493 %R 10.2196/32951 %U https://publichealth.jmir.org/2021/11/e32951 %U https://doi.org/10.2196/32951 %U http://www.ncbi.nlm.nih.gov/pubmed/34813493 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25783 %T Assessing the Quality of Online Health Information About Breast Cancer from Chinese Language Websites: Quality Assessment Survey %A Sun,Weiwei %A Luo,Aijing %A Bian,Zhiwei %A Zhao,Bin %A Liu,Peng %A Wang,Kai %A Liu,Yuwen %A Xie,Wenzhao %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600#, Donghai Rd, Anhui, Bengbu, 233000, China, 86 18855202156, wfz.bbmc@foxmail.com %K online health information %K breast cancer %K Chinese language websites %K quantitative evaluations %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: In China, the internet has become one of the most important ways to obtain information about breast cancer. However, quantitative evaluations of the quality of Chinese health websites and the breast cancer treatment information they publish are lacking. Objective: This study aimed to evaluate the quality of Chinese breast cancer websites and the value, suitability, and accuracy of the breast cancer treatment information they publish. Methods: Chinese breast cancer health websites were searched and manually screened according to their Alexa and Baidu search engine rankings. For each website included in the survey, which was conducted on April 8, 2019, the three most recently published papers on the website that met the inclusion criteria were included for evaluation. Three raters assessed all materials using the LIDA, DISCERN, and Suitability Assessment of Materials (SAM) tools and the Michigan Checklist. Data analysis was completed with the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: This survey included 20 Chinese breast cancer websites and 60 papers on breast cancer treatment. The LIDA tool was used to evaluate the quality of the 20 websites. The LIDA’s scores of the websites (mean=54.85, SD 3.498; total possible score=81) were low. In terms of the layout, color scheme, search facility, browsing facility, integration of nontextual media, submission of comments, declaration of objectives, content production method, and robust method, more than half of the websites scored 0 (never) or 1 (sometimes). For the online breast cancer treatment papers, the scores were generally low. Regarding suitability, 32 (53.33%) papers were evaluated as presenting unsuitable material. Regarding accuracy, the problems were that the papers were largely not original (44/60, 73%) and lacked references (46/60, 77%). Conclusions: The quality of Chinese breast cancer websites is poor. The color schemes, text settings, user comment submission functions, and language designs should be improved. The quality of Chinese online breast cancer treatment information is poor; the information has little value to users, and pictorial information is scarcely used. The online breast cancer treatment information is accurate but lacks originality and references. Website developers, governments, and medical professionals should play a full role in the design of health websites, the regulation of online health information, and the use of online health information. %M 34792471 %R 10.2196/25783 %U https://cancer.jmir.org/2021/4/e25783 %U https://doi.org/10.2196/25783 %U http://www.ncbi.nlm.nih.gov/pubmed/34792471 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e20964 %T Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study %A Mallmann,Christoph A %A Domröse,Christian M %A Schröder,Lars %A Engelhardt,David %A Bach,Frederik %A Rueckel,Helena %A Abramian,Alina %A Kaiser,Christina %A Mustea,Alexander %A Faridi,Andree %A Malter,Wolfram %A Mallmann,Peter %A Rudlowski,Christian %A Zivanovic,Oliver %A Mallmann,Michael R %+ Department of Obstetrics & Gynecology, University Hospital of Cologne, Kerpener St 34, Cologne, 50924, Germany, 49 221 478 4910, mallmann.michael@gmail.com %K digitalization %K eHealth %K breast cancer %K internet %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the <59-year-old group used the internet in 2020, 92% of the 60 to 69-year-old group [11/12] and only 47% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ≥2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364 %M 34792468 %R 10.2196/20964 %U https://cancer.jmir.org/2021/4/e20964 %U https://doi.org/10.2196/20964 %U http://www.ncbi.nlm.nih.gov/pubmed/34792468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30644 %T eHealth Literacy Instruments: Systematic Review of Measurement Properties %A Lee,Jiyeon %A Lee,Eun-Hyun %A Chae,Duckhee %+ Graduate School of Public Health, Ajou University, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 31 219 5296, ehlee@ajou.ac.kr %K eHealth literacy %K systematic review %K meta-analysis %K psychometrics %K reliability %K validity %K scale %K instrument %D 2021 %7 15.11.2021 %9 Review %J J Med Internet Res %G English %X Background: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. Objective: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. Methods: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. Results: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. Conclusions: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. %M 34779781 %R 10.2196/30644 %U https://www.jmir.org/2021/11/e30644 %U https://doi.org/10.2196/30644 %U http://www.ncbi.nlm.nih.gov/pubmed/34779781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e23481 %T Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study %A Neves,Ana Luisa %A Smalley,Katelyn R %A Freise,Lisa %A Harrison,Paul %A Darzi,Ara %A Mayer,Erik K %+ Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, St Mary’s Campus, Queen Elizabeth Queen Mother Wing, London, W2 1NY, United Kingdom, 44 (0)20 7589 5111, ana.luisa.neves@gmail.com %K patient portals %K electronic health records %K patient participation %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective: This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods: A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results: A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system’s users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (≥30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). Conclusions: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care. %M 34762063 %R 10.2196/23481 %U https://www.jmir.org/2021/11/e23481 %U https://doi.org/10.2196/23481 %U http://www.ncbi.nlm.nih.gov/pubmed/34762063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26450 %T Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review %A Lang,Michael %A Lemieux,Sébastien %A Hébert,Josée %A Sauvageau,Guy %A Zawati,Ma'n H %+ Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, 740 Avenue Dr. Penfield, Montreal, QC, H3A 0G1, Canada, 1 (514) 398 8155, man.zawati@mcgill.ca %K medical ethics %K web portal %K scoping review %K eHealth %K portal %D 2021 %7 11.11.2021 %9 Review %J J Med Internet Res %G English %X Background: This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective: This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods: This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O’Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results: We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions: We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care. %M 34762055 %R 10.2196/26450 %U https://www.jmir.org/2021/11/e26450 %U https://doi.org/10.2196/26450 %U http://www.ncbi.nlm.nih.gov/pubmed/34762055 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31527 %T The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study %A Burmann,Anja %A Tischler,Max %A Faßbach,Mira %A Schneitler,Sophie %A Meister,Sven %+ Fraunhofer Institute for Software and Systems Engineering, Emil-Figge-Str 91, Dortmund, 44227, Germany, 49 2319 7677435, anja.burmann@isst.fraunhofer.de %K digitalization %K digital transformation %K health care %K human factor %K physicians %K digital natives %K web-based survey %K digital health %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of “digital natives” suggests a lower hurdle for younger generations to engage with digital technologies. Objective: The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor. Methods: We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups. Results: The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents’ age (η=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23%) and the least in patient engagement (213/1274, 16.72%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17%), treatment of orphan diseases (1016/1274, 79.75%), and medical research (1023/1274, 80.30%). Conclusions: Respondents defined their role in the digitalization of health care provision as ambivalent: “scrutinizing” on the one hand but “active” and “open” on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training. %M 34545813 %R 10.2196/31527 %U https://medinform.jmir.org/2021/11/e31527 %U https://doi.org/10.2196/31527 %U http://www.ncbi.nlm.nih.gov/pubmed/34545813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30605 %T A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study %A Drazich,Brittany F %A Nyikadzino,Yeukai %A Gleason,Kelly T %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 3023530657, bdrazich@umaryland.edu %K technology %K disparities %K digital access %K digital literacy %K community %K stakeholders %K digital health %K digital divide %K patient-centered outcomes %D 2021 %7 10.11.2021 %9 Early Report %J JMIR Form Res %G English %X Background: For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations. Objective: We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants’ perceived comfort with digital technology before and after the program. Methods: To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes. Results: We found that the program was feasible to implement and worthwhile for participants (15/16, 94%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions. Conclusions: Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives. %M 34757316 %R 10.2196/30605 %U https://formative.jmir.org/2021/11/e30605 %U https://doi.org/10.2196/30605 %U http://www.ncbi.nlm.nih.gov/pubmed/34757316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26136 %T Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19 %A Perrins,Genevieve %A Ferdous,Tabassum %A Hay,Dawn %A Harreveld,Bobby %A Reid-Searl,Kerry %+ Central Queensland Multicultural Association, CQUniversity Rockhampton North, Room 31, Building 41 Buzacott Circle, 554-700 Yaamba Road, Norman Gardens, Rockhampton, 4701, Australia, 61 423853809, evie.perrins@cqma.org.au %K health literacy %K cultural and linguistic diversity %K COVID-19 %K health care barriers %K hard-to-reach research participants %K regional Australia %K health literacy profiles %K literacy %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. Objective: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. Methods: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. Results: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93% (14/15), compared with 84.6% (11/13) in the during-COVID period. Lastly, 93% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). Conclusions: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants. %M 34581673 %R 10.2196/26136 %U https://formative.jmir.org/2021/11/e26136 %U https://doi.org/10.2196/26136 %U http://www.ncbi.nlm.nih.gov/pubmed/34581673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29155 %T Sources of Health Information, Technology Access, and Use Among Non–English-Speaking Immigrant Women: Descriptive Correlational Study %A Chae,Steve %A Lee,Yoon-Jae %A Han,Hae-Ra %+ Johns Hopkins University School of Nursing, 525 N Wolfe St, Room 533, Baltimore, MD, 21205, United States, 1 310 614 2669, hhan3@jhu.edu %K technology use %K internet %K text messaging %K health literacy %K English proficiency %K immigrant %K health disparities %K Korean American %K women %K mobile phone %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information. Objective: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet. Methods: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy–focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women’s internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use. Results: Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24). Conclusions: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans. %M 34714249 %R 10.2196/29155 %U https://www.jmir.org/2021/10/e29155 %U https://doi.org/10.2196/29155 %U http://www.ncbi.nlm.nih.gov/pubmed/34714249 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e22809 %T Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study %A Iacobelli,Francisco %A Dragon,Ginger %A Mazur,Giselle %A Guitelman,Judith %+ Computer Science Department, Northeastern Illinois University, 5500 N. St. Louis Ave., Chicago, IL, 60625, United States, 1 7734424728, f-iacobelli@neiu.edu %K low literacy %K health literacy %K online searches %K Hispanic breast cancer survivors %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. Objective: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. Methods: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. Results: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. Conclusions: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web. %M 34704952 %R 10.2196/22809 %U https://formative.jmir.org/2021/10/e22809 %U https://doi.org/10.2196/22809 %U http://www.ncbi.nlm.nih.gov/pubmed/34704952 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29764 %T Digital Health Literacy in Bipolar Disorder: International Web-Based Survey %A Morton,Emma %A Ho,Kendall %A Barnes,Steven J %A Michalak,Erin E %+ Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 3393, erin.michalak@ubc.ca %K eHealth %K health literacy %K bipolar disorder %K self-management %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based resources can support people with bipolar disorder (BD) to improve their knowledge and self-management. However, publicly available resources are heterogeneous in terms of their quality and ease of use. Characterizing digital health literacy (the skillset that enable people to navigate and make use of health information in a web-based context) in BD will support the development of educational resources. Objective: The aim of this study was to develop understanding of digital health literacy and its predictors in people with BD. Methods: A web-based survey was used to explore self-reported digital health literacy (as measured by the e-Health Literacy Scale [eHEALS]) in people with BD. Multiple regression analysis was used to evaluate potential predictors, including demographic/clinical characteristics and technology use. Results: A total of 919 respondents (77.9% female; mean age 36.9 years) completed the survey. Older age (β=0.09; P=.01), postgraduate education (β=0.11; P=.01), and current use of self-management apps related to BD (β=0.13; P<.001) were associated with higher eHEALS ratings. Conclusions: Levels of self-reported digital health literacy were comparable or higher than other studies in the general population and specific physical/mental health conditions. However, individuals with BD who are younger, have completed less education, or are less familiar with mental health apps may require extra support to safely and productively navigate web-based health resources. Relevant educational initiatives are discussed. Future studies should evaluate skill development interventions for less digitally literate groups. %M 34665143 %R 10.2196/29764 %U https://mental.jmir.org/2021/10/e29764 %U https://doi.org/10.2196/29764 %U http://www.ncbi.nlm.nih.gov/pubmed/34665143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30243 %T Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity %A Cheng,Christina %A Elsworth,Gerald %A Osborne,Richard H %+ Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Room 907, Level 9, AMDC Building, 453/469-477 Burwood Road, Hawthorn, Victoria 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K digital health %K health literacy %K health equity %K questionnaire design %K health literacy questionnaire %K validity evidence %K mediation effect %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process. Objective: This study aims to examine validity evidence based on relations to other variables—using data collected with the known-groups approach—to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales. Methods: A Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia. Results: Responses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect –0.37; P<.001), followed by 1. Using technology to process health information (total effect –0.32; P<.001), 5. Motivated to engage with digital services (total effect –0.21; P=.01), and 7. Digital services that suit individual needs (total effect –0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups. Conclusions: By using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people’s eHealth literacy needs to help optimize access and use of digital health and promote health equity. %M 34647897 %R 10.2196/30243 %U https://www.jmir.org/2021/10/e30243 %U https://doi.org/10.2196/30243 %U http://www.ncbi.nlm.nih.gov/pubmed/34647897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26721 %T The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study %A Xu,Richard Huan %A Zhou,Ling-Ming %A Wong,Eliza Lai-Yi %A Wang,Dong %+ School of Health Management, Southern Medical University, No. 1023 Shatai nan Road, Guangzhou, 510515, China, 86 61648573, dongw96@smu.edu.cn %K eHealth literacy %K shared decision-making %K well-being %K eHEALS %K ICECAP-A %D 2021 %7 24.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. Objective: This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being. Methods: The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics. Results: A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables. Conclusions: This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM. %M 34559062 %R 10.2196/26721 %U https://www.jmir.org/2021/9/e26721 %U https://doi.org/10.2196/26721 %U http://www.ncbi.nlm.nih.gov/pubmed/34559062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31627 %T Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study %A Liu,Hua-Xuan %A Chow,Bik-Chu %A Liang,Wei %A Hassel,Holger %A Huang,YaJun Wendy %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, Room 926, 9/F, Academic and Administration Building, Kowloon, Hong Kong, China (Hong Kong), 852 1 305 157 5809, xuan0402@life.hkbu.edu.hk %K eHealth literacy %K scale development %K validation %K college students %D 2021 %7 23.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured. Objective: This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students. Methods: In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages. Results: Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 (χ2244=903.076, χ2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability (α=.976, ρ=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing). Conclusions: The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students. %M 34554098 %R 10.2196/31627 %U https://www.jmir.org/2021/9/e31627 %U https://doi.org/10.2196/31627 %U http://www.ncbi.nlm.nih.gov/pubmed/34554098 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26197 %T Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study %A Bickham,David S %A Moukalled,Summer %A Inyart,Heather K %A Zlokower,Rona %+ Digital Wellness Lab, Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, CMCH BCH3186, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 6173556031, david.bickham@childrens.harvard.edu %K digital citizenship %K cyberbullying %K evaluation %K media literacy %K middle school %K conflict resolution %K internet safety %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people’s mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants’ knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males’ and females’ conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students’ increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students’ high ratings of the relevance of Screenshots’ content reinforce the need for this type of intervention. %M 34524098 %R 10.2196/26197 %U https://mental.jmir.org/2021/9/e26197 %U https://doi.org/10.2196/26197 %U http://www.ncbi.nlm.nih.gov/pubmed/34524098 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e14908 %T Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study %A Lu,Xinyi %A Zhang,Runtong %+ School of Management and E-business, Zhejiang Gongshang University, 18 Xuezheng Street, Qiantang District, Hangzhou, 310018, China, 86 18801329327, xinyilu@bjtu.edu.cn %K online health communities %K OHCs %K eHealth literacy %K patient adherence %K health information %K physician-patient communication %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs. Objective: This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory. Methods: This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses. Results: The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs. Conclusions: Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality. %M 34515638 %R 10.2196/14908 %U https://www.jmir.org/2021/9/e14908 %U https://doi.org/10.2196/14908 %U http://www.ncbi.nlm.nih.gov/pubmed/34515638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26434 %T Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach %A Salim,Hani %A Lee,Ping Yein %A Sharif-Ghazali,Sazlina %A Cheong,Ai Theng %A Wong,Jasmine %A Young,Ingrid %A Pinnock,Hilary %A , %+ NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Old Medical School, Doorway 3, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 0131 650 94, hilary.pinnock@ed.ac.uk %K asthma %K self-management %K design sprint %K health literacy %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. %M 34499039 %R 10.2196/26434 %U https://www.jmir.org/2021/9/e26434 %U https://doi.org/10.2196/26434 %U http://www.ncbi.nlm.nih.gov/pubmed/34499039 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e26708 %T Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results %A Champlin,Sara %A Cuculick,Jessica %A Hauser,Peter C %A Wyse,Kelley %A McKee,Michael M %+ Mayborn School of Journalism, The University of North Texas, 1155 Union Circle #310499, Denton, TX, 76205, United States, 1 9403697851, sara.champlin@unt.edu %K gaze tracking %K deaf %K disabilities %K accessibility %K online health information %K health information seeking %K mobile phone %D 2021 %7 7.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. Objective: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. Methods: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. Results: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. Conclusions: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. International Registered Report Identifier (IRRID): RR1-10.2196/26708 %M 34491211 %R 10.2196/26708 %U https://www.researchprotocols.org/2021/9/e26708 %U https://doi.org/10.2196/26708 %U http://www.ncbi.nlm.nih.gov/pubmed/34491211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26881 %T Readiness and Acceptance of eHealth Services for Diabetes Care in the General Population: Cross-sectional Study %A AshaRani,PV %A Jue Hua,Lau %A Roystonn,Kumarasan %A Siva Kumar,Fiona Devi %A Peizhi,Wang %A Ying Jie,Soo %A Shafie,Saleha %A Chang,Sherilyn %A Jeyagurunathan,Anitha %A Boon Yiang,Chua %A Abdin,Edimansyah %A Ajit Vaingankar,Janhavi %A Sum,Chee Fang %A Lee,Eng Sing %A Chong,Siow Ann %A Subramaniam,Mythily %+ Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore, 65 63892961, asharani_pezhummoottil_vasudevan_n@imh.com.sg %K eHealth %K diabetes %K general population %K acceptance %K readiness %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes management is a growing health care challenge worldwide. eHealth can revolutionize diabetes care, the success of which depends on end user acceptance. Objective: This study aims to understand the readiness and acceptance of eHealth services for diabetes care among the general population, perceived advantages and disadvantages of eHealth, and factors associated with eHealth readiness and acceptance in a multiethnic Asian country. Methods: In this cross-sectional epidemiological study, participants (N=2895) were selected through disproportionate stratified random sampling from a population registry. Citizens or permanent residents of Singapore aged >18 years were recruited. The data were captured through computer-assisted personal interviews. An eHealth questionnaire was administered in one of four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant. Bivariate chi-square analyses were performed to compare the sociodemographic characteristics and perception of advantages and disadvantages of eHealth services between the diabetes and nondiabetes groups. Multivariable logistic regression models were used to determine factors associated with eHealth readiness and acceptance. All analyses were weighted using survey weights to account for the complex survey design. Results: The sample comprised participants with (n=436) and without (n=2459) diabetes. eHealth readiness was low, with 47.3% of the overall sample and 75.7% of the diabetes group endorsing that they were not ready for eHealth (P<.001). The most acceptable eHealth service overall was booking appointments (67.4%). There was a significantly higher preference in the diabetes group for face-to-face sessions for consultation with the clinician (nondiabetes: 83.5% vs diabetes: 92.6%; P<.001), receiving prescriptions (61.9% vs 79.3%; P<.001), referrals to other doctors (51.4% vs 72.2%; P<.001), and receiving health information (34% vs 63.4%; P<.001). The majority of both groups felt that eHealth requires users to be computer literate (90.5% vs 94.3%), does not build clinician-patient rapport compared with face-to-face sessions (77.5% vs 81%), and might not be credible (56.8% vs 64.2%; P=.03). Age (≥35 years), ethnicity (Indian), and lower education status had lower odds of eHealth readiness. Age (≥35 years), ethnicity (Indian), lower education status (primary school), BMI (being underweight), and marital status (being single) were associated with a lower likelihood of eHealth acceptance. Among only those with diabetes, a longer duration of diabetes (4-18 years), higher education (degree or above), and younger age (23-49 years) were associated with eHealth readiness, whereas younger age and income (SGD 2000-3999 [US $1481-$2961]) were associated with acceptance. Conclusions: Overall, an unfavorable attitude toward eHealth was observed, with a significantly higher number of participants with diabetes reporting their unwillingness to use these services for their diabetes care. Sociodemographic factors associated with acceptance and readiness identified a group of people who were unlikely to accept the technology and thus need to be targeted for eHealth literacy programs to avoid health care disparity. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-037125 %M 34473062 %R 10.2196/26881 %U https://www.jmir.org/2021/9/e26881 %U https://doi.org/10.2196/26881 %U http://www.ncbi.nlm.nih.gov/pubmed/34473062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e23367 %T Patients With Cancer Searching for Cancer- or Health-Specific Web-Based Information: Performance Test Analysis %A Lange-Drenth,Lukas %A Schulz,Holger %A Endsin,Gero %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040741056811, lu.lange@uke.de %K telemedicine %K eHealth %K eHealth literacy %K digital literacy %K internet %K web-based %K health information %K health education %K cancer %K mobile phone %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Searching the internet for cancer-related information helps patients with cancer satisfy their unmet information needs and empowers them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skill to search, select, appraise, and apply web-based health information. Objective: We aim to study the operational, navigational, information, and evaluation skills and problems of patients with cancer performing cancer-related search tasks using the internet. Methods: A total of 21 patients with cancer were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. Participants performed eight cancer-related search tasks using the internet. The participants were asked to think aloud while performing the tasks, and the screen activities were recorded. The types and frequencies of performance problems were identified and coded into categories following an inductive coding process. In addition, the performance and strategic characteristics of task execution were summarized descriptively. Results: All participants experienced problems or difficulties in executing the tasks, and a substantial percentage of tasks (57/142, 40.1%) could not be completed successfully. The participants’ performance problems were coded into four categories, namely operating the computer and web browser, navigating and orientating, using search strategies, and evaluating the relevance and reliability of web-based information. The most frequent problems occurred in the third and fourth categories. A total of 90% (19/21) of participants used nontask-related search terms or nonspecific search terms. A total of 95% (20/21) of participants did not control for the source or topicality of the information found. In addition, none of the participants verified the information on 1 website with that on another website for each task. Conclusions: A substantial group of patients with cancer did not have the necessary skills to benefit from cancer-related internet searches. Future interventions are needed to support patients in the development of sufficient internet-searching skills, focusing particularly on information and evaluation skills. %M 34398801 %R 10.2196/23367 %U https://www.jmir.org/2021/8/e23367 %U https://doi.org/10.2196/23367 %U http://www.ncbi.nlm.nih.gov/pubmed/34398801 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e19191 %T The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers %A Clarke,Martina A %A Fruhling,Ann L %A Lyden,Elizabeth L %A Tarrell,Alvin E %A Bernard,Tamara L %A Windle,John R %+ School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, 6001 Dodge Street, Omaha, NE, 68182-0116, United States, 1 402 554 2801, martinaclarke@unomaha.edu %K patient portal %K communication %K patients %K precision medicine %K health literacy %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective: The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods: A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results: There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions: In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies. %M 34309574 %R 10.2196/19191 %U https://humanfactors.jmir.org/2021/3/e19191 %U https://doi.org/10.2196/19191 %U http://www.ncbi.nlm.nih.gov/pubmed/34309574 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e30115 %T Predicting Writing Styles of Web-Based Materials for Children’s Health Education Using the Selection of Semantic Features: Machine Learning Approach %A Xie,Wenxiu %A Ji,Meng %A Liu,Yanmeng %A Hao,Tianyong %A Chow,Chi-Yin %+ School of Languages and Cultures, The University of Sydney, Room 635 A18, Brennan MacCallum Building, Sydney, 2006, Australia, 61 449858887, christine.ji@sydney.edu.au %K online health education %K health educational resource development %K machine learning %K health linguistics %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Medical writing styles can have an impact on the understandability of health educational resources. Amid current web-based health information research, there is a dearth of research-based evidence that demonstrates what constitutes the best practice of the development of web-based health resources on children’s health promotion and education. Objective: Using authoritative and highly influential web-based children’s health educational resources from the Nemours Foundation, the largest not-for-profit organization promoting children’s health and well-being, we aimed to develop machine learning algorithms to discriminate and predict the writing styles of health educational resources on children versus adult health promotion using a variety of health educational resources aimed at the general public. Methods: The selection of natural language features as predicator variables of algorithms went through initial automatic feature selection using ridge classifier, support vector machine, extreme gradient boost tree, and recursive feature elimination followed by revision by education experts. We compared algorithms using the automatically selected (n=19) and linguistically enhanced (n=20) feature sets, using the initial feature set (n=115) as the baseline. Results: Using five-fold cross-validation, compared with the baseline (115 features), the Gaussian Naive Bayes model (20 features) achieved statistically higher mean sensitivity (P=.02; 95% CI −0.016 to 0.1929), mean specificity (P=.02; 95% CI −0.016 to 0.199), mean area under the receiver operating characteristic curve (P=.02; 95% CI −0.007 to 0.140), and mean macro F1 (P=.006; 95% CI 0.016-0.167). The statistically improved performance of the final model (20 features) is in contrast to the statistically insignificant changes between the original feature set (n=115) and the automatically selected features (n=19): mean sensitivity (P=.13; 95% CI −0.1699 to 0.0681), mean specificity (P=.10; 95% CI −0.1389 to 0.4017), mean area under the receiver operating characteristic curve (P=.008; 95% CI 0.0059-0.1126), and mean macro F1 (P=.98; 95% CI −0.0555 to 0.0548). This demonstrates the importance and effectiveness of combining automatic feature selection and expert-based linguistic revision to develop the most effective machine learning algorithms from high-dimensional data sets. Conclusions: We developed new evaluation tools for the discrimination and prediction of writing styles of web-based health resources for children’s health education and promotion among parents and caregivers of children. User-adaptive automatic assessment of web-based health content holds great promise for distant and remote health education among young readers. Our study leveraged the precision and adaptability of machine learning algorithms and insights from health linguistics to help advance this significant yet understudied area of research. %M 34292167 %R 10.2196/30115 %U https://medinform.jmir.org/2021/7/e30115 %U https://doi.org/10.2196/30115 %U http://www.ncbi.nlm.nih.gov/pubmed/34292167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27860 %T Effect of a Consumer-Focused Website for Low Back Pain on Health Literacy, Treatment Choices, and Clinical Outcomes: Randomized Controlled Trial %A Hodges,Paul William %A Hall,Leanne %A Setchell,Jenny %A French,Simon %A Kasza,Jessica %A Bennell,Kim %A Hunter,David %A Vicenzino,Bill %A Crofts,Samuel %A Dickson,Chris %A Ferreira,Manuela %+ School of Health and Rehabilitation Sciences, The University of Queensland, Bldg 87A, Brisbane, 4072, Australia, 61 404 854 589, p.hodges@uq.edu.au %K low back pain %K randomized controlled trial %K internet resources %K health literacy %D 2021 %7 15.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is used for information related to health conditions, including low back pain (LBP), but most LBP websites provide inaccurate information. Few studies have investigated the effectiveness of internet resources in changing health literacy or treatment choices. Objective: This study aims to evaluate the effectiveness of the MyBackPain website compared with unguided internet use on health literacy, choice of treatments, and clinical outcomes in people with LBP. Methods: This was a pragmatic, web-based, participant- and assessor-blinded randomized trial of individuals with LBP stratified by duration. Participants were randomly allocated to have access to the evidence-based MyBackPain website, which was designed with input from consumers and expert consensus or unguided internet use. The coprimary outcomes were two dimensions of the Health Literacy Questionnaire (dimension 2: “having sufficient information to manage my health;” dimension 3: “actively managing my health;” converted to scores 1-100) at 3 months. Secondary outcomes included additional Health Literacy Questionnaire dimensions, quality of treatment choices, and clinical outcomes. Results: A total of 453 participants were recruited, and 321 (70.9%) completed the primary outcomes. Access to MyBackPain was not superior to unguided internet use on primary outcomes (dimension 2: mean difference −0.87 units, 95% CI −3.56 to 1.82; dimension 3: mean difference −0.41 units, 95% CI −2.78 to 1.96). Between-group differences in other secondary outcomes had inconsistent directions and were unlikely to be clinically important, although a small improvement of unclear importance in the quality of stated treatment choices at 1 month was found (mean difference 0.93 units, 95% CI 0.03 to 1.84). Conclusions: MyBackPain was not superior to unguided internet use for health literacy, but data suggest some short-term improvement in treatment choices. Future research should investigate if greater interactivity and engagement with the website may enhance its impact. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001292369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372926 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-027516 %M 34128822 %R 10.2196/27860 %U https://www.jmir.org/2021/6/e27860 %U https://doi.org/10.2196/27860 %U http://www.ncbi.nlm.nih.gov/pubmed/34128822 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24947 %T Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination) %A Oshima,Sachiko M %A Tait,Sarah D %A Thomas,Samantha M %A Fayanju,Oluwadamilola M %A Ingraham,Kearston %A Barrett,Nadine J %A Hwang,E Shelley %+ Department of Surgery, Duke University School of Medicine, 465 Seeley Mudd Building, Durham, NC, 27710, United States, 1 919 684 6849, shelley.hwang@duke.edu %K telehealth %K technology %K health literacy %K access to health care %K mobile phone %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective: This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods: Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results: Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions: We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth. %M 34106076 %R 10.2196/24947 %U https://www.jmir.org/2021/6/e24947 %U https://doi.org/10.2196/24947 %U http://www.ncbi.nlm.nih.gov/pubmed/34106076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23473 %T Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review %A El Benny,Mariam %A Kabakian-Khasholian,Tamar %A El-Jardali,Fadi %A Bardus,Marco %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO-Box 11-0236, Riad-El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 0000 ext 4694, marco.bardus@gmail.com %K eHealth literacy %K digital health interventions %K consumer health information %K scoping review %K mHealth %K mobile phone %D 2021 %7 3.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. Objective: This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. Methods: We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. Results: We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. Conclusions: Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective. %M 34081023 %R 10.2196/23473 %U https://www.jmir.org/2021/6/e23473 %U https://doi.org/10.2196/23473 %U http://www.ncbi.nlm.nih.gov/pubmed/34081023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26034 %T Objective Outcomes Evaluation of Innovative Digital Health Curricula. Comment on “Undergraduate Medical Competencies in Digital Health and Curricular Module Development: Mixed Methods Study” %A Grzeska,Alexander %A Ali,Shan %A Szmuda,Tomasz %A Słoniewski,Paweł %+ Medical University of Gdansk, ul M Skłodowskiej-Curie 3a, Gdańsk, 80-210, Poland, 48 572642516, alex.grzeska@gumed.edu.pl %K digital health %K eHealth %K mHealth %K digital health education %K elective module %K eHealth education %K curriculum %K medical school %K digital health mindset %K qualitative research %K interview %K survey %D 2021 %7 28.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 34047706 %R 10.2196/26034 %U https://www.jmir.org/2021/5/e26034 %U https://doi.org/10.2196/26034 %U http://www.ncbi.nlm.nih.gov/pubmed/34047706 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18771 %T Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study %A Donelle,Lorie %A Facca,Danica %A Burke,Shauna %A Hiebert,Bradley %A Bender,Emma %A Ling,Stephen %+ Arthur Labatt Family School of Nursing, The University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 5198688675, dfacca2@uwo.ca %K child %K children %K internet %K social media %K digital literacy %K digital inclusion %K quality of life %K mobile phone %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. %M 34037525 %R 10.2196/18771 %U https://formative.jmir.org/2021/5/e18771 %U https://doi.org/10.2196/18771 %U http://www.ncbi.nlm.nih.gov/pubmed/34037525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22915 %T A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study %A McMaughan,Darcy Jones %A Lin,Sherry %A Ozmetin,Jennifer %A Beverly,Judith Gayle %A Brog,Joshua %A Naiser,Emily %+ Oklahoma State University, 423 Willard, Stillwater, OK, United States, 1 979 204 3983, darcy.mcmaughan@okstate.edu %K youth with special health care needs %K health care transitions %K eHealth %K usability %K concurrent think aloud method %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. %M 34032579 %R 10.2196/22915 %U https://formative.jmir.org/2021/5/e22915 %U https://doi.org/10.2196/22915 %U http://www.ncbi.nlm.nih.gov/pubmed/34032579 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25955 %T Evaluation of the My Diabetes Care Patient Portal Intervention: Protocol for a Pilot Randomized Controlled Trial %A Martinez,William %A Hackstadt,Amber J %A Hickson,Gerald B %A Rosenbloom,S Trent %A Elasy,Tom A %+ Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, United States, 1 615 936 1010, william.martinez@vumc.org %K patient portals %K self-management %K patient activation %K diabetes mellitus %K type 2 %K health literacy %K health knowledge %K attitudes %K practice %K mobile phone %D 2021 %7 25.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: My Diabetes Care (MDC) is a multi-faceted intervention embedded within an established patient portal, My Health at Vanderbilt. MDC is designed to help patients better understand their diabetes health data and support self-care. MDC uses infographics to visualize and summarize patients’ diabetes health data, incorporates motivational strategies, provides literacy-level appropriate educational resources, and links to a diabetes online patient support community and diabetes news feeds. Objective: This study aims to evaluate the effects of MDC on patient activation in adult patients with type 2 diabetes mellitus. Moreover, we plan to assess secondary outcomes, including system use and usability, and the effects of MDC on cognitive and behavioral outcomes (eg, self-care and self-efficacy). Methods: We are conducting a 6-month, 2-arm, parallel-design, pragmatic pilot randomized controlled trial of the effect of MDC on patient activation. Adult patients with type 2 diabetes mellitus are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible for the study if they are currently being treated with at least one diabetes medication, are able to speak and read in English, are 21 years or older, and have an existing My Health at Vanderbilt account and reliable access to a desktop or laptop computer with internet access. We exclude patients living in long-term care facilities, patients with known cognitive deficits or severe visual impairment, and patients currently participating in any other diabetes-related research study. Participants are randomly assigned to MDC or usual care. We collect self-reported survey data, including the Patient Activation Measure (R) at baseline, 3 months, and 6 months. We will use mixed-effects regression models to estimate potentially time-varying intervention effects while adjusting for the baseline measure of the outcome. The mixed-effects model will use fixed effects for patient-level characteristics and random effects for health care provider variables (eg, primary care physicians). Results: This study is ongoing. Recruitment was closed in May 2020; 270 patients were randomized. Of those randomized, most (214/267, 80.1%) were non-Hispanic White, and 13.1% (35/267) were non-Hispanic Black, 43.7% (118/270) reported being 65 years or older, and 33.6% (90/268) reported limited health literacy. We obtained at least 95.6% (258/270) completion among participants through the 3-month follow-up assessment. Conclusions: This randomized controlled trial will be one of the first to evaluate a patient-facing diabetes digital health intervention delivered via a patient portal. By embedding MDC into Epic’s MyChart platform with more than 127 million patient records, our intervention is directly integrated into routine care, highly scalable, and sustainable. Our findings and evolving patient portal functionality will inform the continued development of MDC to best meet users’ needs and a larger trial focused on the impact of MDC on clinical end points. Trial Registration: ClinicalTrials.gov NCT03947333; https://clinicaltrials.gov/ct2/show/NCT03947333 International Registered Report Identifier (IRRID): DERR1-10.2196/25955 %M 34032578 %R 10.2196/25955 %U https://www.researchprotocols.org/2021/5/e25955 %U https://doi.org/10.2196/25955 %U http://www.ncbi.nlm.nih.gov/pubmed/34032578 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e27005 %T Older Patients’ Competence, Preferences, and Attitudes Toward Digital Technology Use: Explorative Study %A Terp,Rikke %A Kayser,Lars %A Lindhardt,Tove %+ Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hospitalsvej 4, Hellerup, 2900, Denmark, 45 26823909, rikke.terp@regionh.dk %K eHealth literacy %K eHealth %K self-management %K older patients %K explorative study %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Malnutrition is prevalent in older patients, which is associated with severe consequences such as a decline in functional status, increased risk of readmission, and increased mortality. A tablet-based eHealth solution (Food‘n’Go) was recently developed and introduced at our clinic to support older patients’ involvement in nutritional interventions during their hospitalization, thereby enhancing their awareness and motivation for choosing the right food to obtain sufficient calorie and protein intake. To reap the full benefits from the eHealth solution, the technology should be introduced and accompanied by support that targets the end users’ competence level and needs. Objective: In this study, we aimed to explore older patients’ readiness (ie, competence, preferences, and attitudes) toward the use of information and communication technology (ICT), and to identify the factors that may act as barriers or facilitators for their engagement with health technology. Methods: A descriptive and explorative study was performed using triangulation of data derived from semistructured interviews and questionnaires (based on the Readiness and Enablement Index for Health Technology [READHY] instrument). Older hospitalized patients (age ≥65 years; N=25) were included from two hospitals in Denmark. Results: The majority (16/25, 64%) of the older patients (median age 81 years) were users of ICT. The qualitative findings revealed that their experiences of benefits related to the use of ICT facilitated usage. Barriers for use of ICT were health-related challenges, limited digital literacy, and low self-efficacy related to ICT use due to age-related prejudices by their relatives and themselves. The qualitative findings were also reflected in the low median scores on the eHealth Literacy Questionnaire (eHLQ) READHY scales within dimensions addressing the user’s knowledge and skills (eHLQ1:1.8; eHLQ3: 2.0), and the user experience (eHLQ6: 2.0; eHLQ7: 1.5). Conclusions: Older patients are potential users of ICT, but experience a variety of barriers for using eHealth. When introducing older patients to eHealth, it is important to emphasize the possible benefits, and to offer support targeting their knowledge, skills, and motivation. %M 33988512 %R 10.2196/27005 %U https://humanfactors.jmir.org/2021/2/e27005 %U https://doi.org/10.2196/27005 %U http://www.ncbi.nlm.nih.gov/pubmed/33988512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26354 %T Evaluating the Effectiveness of NoteAid in a Community Hospital Setting: Randomized Trial of Electronic Health Record Note Comprehension Interventions With Patients %A Lalor,John P %A Hu,Wen %A Tran,Matthew %A Wu,Hao %A Mazor,Kathleen M %A Yu,Hong %+ Department of Computer Science, University of Massachusetts Lowell, Dandeneau Hall, 1 University Avenue, Lowell, MA, 01854, United States, 1 978 934 3620, hong.yu@umassmed.edu %K health literacy %K crowdsourcing %K natural language processing %K information storage and retrieval %K psychometrics %K intervention %K literacy %K electronic health record %K efficacy %K comprehension %D 2021 %7 13.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions to define medical jargon have been shown to improve electronic health record (EHR) note comprehension among crowdsourced participants on Amazon Mechanical Turk (AMT). However, AMT participants may not be representative of the general population or patients who are most at-risk for low health literacy. Objective: In this work, we assessed the efficacy of an intervention (NoteAid) for EHR note comprehension among participants in a community hospital setting. Methods: Participants were recruited from Lowell General Hospital (LGH), a community hospital in Massachusetts, to take the ComprehENotes test, a web-based test of EHR note comprehension. Participants were randomly assigned to control (n=85) or intervention (n=89) groups to take the test without or with NoteAid, respectively. For comparison, we used a sample of 200 participants recruited from AMT to take the ComprehENotes test (100 in the control group and 100 in the intervention group). Results: A total of 174 participants were recruited from LGH, and 200 participants were recruited from AMT. Participants in both intervention groups (community hospital and AMT) scored significantly higher than participants in the control groups (P<.001). The average score for the community hospital participants was significantly lower than the average score for the AMT participants (P<.001), consistent with the lower education levels in the community hospital sample. Education level had a significant effect on scores for the community hospital participants (P<.001). Conclusions: Use of NoteAid was associated with significantly improved EHR note comprehension in both community hospital and AMT samples. Our results demonstrate the generalizability of ComprehENotes as a test of EHR note comprehension and the effectiveness of NoteAid for improving EHR note comprehension. %M 33983124 %R 10.2196/26354 %U https://www.jmir.org/2021/5/e26354 %U https://doi.org/10.2196/26354 %U http://www.ncbi.nlm.nih.gov/pubmed/33983124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25600 %T Associations Between Health Literacy, eHealth Literacy, and COVID-19–Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study %A Li,Shaojie %A Cui,Guanghui %A Kaminga,Atipatsa Chiwanda %A Cheng,Sixiang %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Lane, Changsha, 410078, China, 86 13637480958, xhl_csu@163.com %K COVID-19 %K health literacy %K eHealth literacy %K COVID-19–related health behavior questionnaire %K Chinese college students %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors. Objective: The objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy. Methods: A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors. Results: Of 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth literacy=.277; P<.001). Conclusions: The COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students. %M 33822734 %R 10.2196/25600 %U https://www.jmir.org/2021/5/e25600 %U https://doi.org/10.2196/25600 %U http://www.ncbi.nlm.nih.gov/pubmed/33822734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25299 %T Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach %A Hernandez-Ramos,Rosa %A Aguilera,Adrian %A Garcia,Faviola %A Miramontes-Gomez,Jose %A Pathak,Laura Elizabeth %A Figueroa,Caroline Astrid %A Lyles,Courtney Rees %+ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94110, United States, 1 628 206 6483, courtney.Lyles@ucsf.edu %K digital literacy %K digital divide %K underserved %K patient-centered %K digital health %K mhealth %K intervention %K telehealth %K COVID-19 %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre–COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre–COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient’s digital literacy skills. Comparing recruitment during pre–COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre–COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 %M 33872184 %R 10.2196/25299 %U https://formative.jmir.org/2021/4/e25299 %U https://doi.org/10.2196/25299 %U http://www.ncbi.nlm.nih.gov/pubmed/33872184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24577 %T Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study %A Guo,Ziqiu %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wu,Yongda %A Weng,Xue %A Wong,Janet Yuen-Ha %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K COVID-19 %K eHealth literacy %K preventive behaviors %K socioeconomic disparities %K web-based information seeking %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. Objective: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. Methods: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. Results: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. Conclusions: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic. %M 33784240 %R 10.2196/24577 %U https://www.jmir.org/2021/4/e24577 %U https://doi.org/10.2196/24577 %U http://www.ncbi.nlm.nih.gov/pubmed/33784240 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e16518 %T Smartphone Users’ Persuasion Knowledge in the Context of Consumer mHealth Apps: Qualitative Study %A Joo,Eunsin %A Kononova,Anastasia %A Kanthawala,Shaheen %A Peng,Wei %A Cotten,Shelia %+ Department of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, 2000 Jintong Road, Tangjiawan, Zhuhai, 519087, China, 82 1086813554, eunsinjoo@uic.edu.hk %K mHealth app %K personal health information sharing %K mobile phone %K mobile promotion strategy %K persuasion knowledge %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Persuasion knowledge, commonly referred to as advertising literacy, is a cognitive dimension that embraces recognition of advertising, its source and audience, and understanding of advertisers’ persuasive and selling intents as well as tactics. There is little understanding of users’ awareness of organizations that develop or sponsor mobile health (mHealth) apps, especially in light of personal data privacy. Persuasion knowledge or recognition of a supporting organization’s presence, characteristics, competencies, intents, and persuasion tactics are crucial to investigate because app users have the right to know about entities that support apps and make informed decisions about app usage. The abundance of free consumer mHealth apps, especially those in the area of fitness, often makes it difficult for users to identify apps’ dual purposes, which may be related to not only helping the public manage health but also promoting the supporting organization itself and collecting users’ information for further consumer targeting by third parties. Objective: This study aims to investigate smartphone users’ awareness of mHealth apps’ affiliations with 3 different types of supporting organizations (commercial, government, and nonprofit); differences in users’ persuasion knowledge and mHealth app quality and credibility evaluations related to each of the 3 organization types; and users’ coping mechanisms for dealing with personal information management within consumer mHealth apps. Methods: In-depth semistructured interviews were conducted with 25 smartphone users from a local community in midwestern United States. Interviews were thematically analyzed using inductive and deductive approaches. Results: Participants indicated that their awareness of and interest in mHealth app–supporting organizations were secondary to the app’s health management functions. After being probed, participants showed a high level of persuasion knowledge regarding the types of app-supporting organizations and their promotional intents. They thought that commercial companies sponsored mHealth apps mostly as entertainment tools, whereas noncommercial entities sponsored mHealth apps for users’ education. They assigned self-promotional motives to commercial organizations; however, they associated commercial mHealth apps with good quality and functioning. Noncommercial entities were perceived as more credible. Participants were concerned about losing control over personal information within mHealth apps supported by different organizations. They used alternative digital identities to protect themselves from privacy invasion and advertising spam. They were willing to trade some personal information for high-quality commercial mHealth apps. There was a sense of fatalism in discussing privacy risks linked to mHealth app usage, and some participants did not perceive the risks to be serious. Conclusions: The discussion of and recommendations for the safe and ethical use of mHealth apps associated with organizations’ promotional strategies and personal data protection are provided to ensure users’ awareness of and enhanced control over digitalized personal information flows. The theoretical implications are discussed in the context of the Persuasion Knowledge Model and dual-processing theories. %M 33847596 %R 10.2196/16518 %U https://mhealth.jmir.org/2021/4/e16518 %U https://doi.org/10.2196/16518 %U http://www.ncbi.nlm.nih.gov/pubmed/33847596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25042 %T Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study %A An,Lawrence %A Bacon,Elizabeth %A Hawley,Sarah %A Yang,Penny %A Russell,Daniel %A Huffman,Scott %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, North Campus Research Complex, Building 16, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 763 6099, lcan@med.umich.edu %K internet %K digital health %K eHealth %K eHealth literacy %K coronavirus %K COVID-19 %K knowledge %K conspiracy beliefs %K protective behaviors %K social distancing %K survey %K health communication %K attitude %K behavior %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. Objective: The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs). Methods: We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs. Results: The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009). Conclusions: This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills. %M 33626015 %R 10.2196/25042 %U https://www.jmir.org/2021/3/e25042 %U https://doi.org/10.2196/25042 %U http://www.ncbi.nlm.nih.gov/pubmed/33626015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24466 %T Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study %A Wångdahl,Josefin %A Dahlberg,Karuna %A Jaensson,Maria %A Nilsson,Ulrica %+ Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 751 22, Sweden, 46 702034045, josefin.wangdahl@pubcare.uu.se %K eHealth %K digital health literacy %K eHEALS %K health literacy %K internet %K psychometrics %K evaluation, migrants, refugees, Arabic %D 2021 %7 22.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information is often communicated through the internet. It is vital for the end user to have a range of digital skills as well as understand the information to promote their health. There is a valid and reliable 8-item instrument, the Electronic Health Literacy Scale (eHEALS), that evaluates these skills. The number of Arabic-speaking people migrating to Sweden and to other parts of the world is increasing due to unstable military and political situations in their countries of origin. Poor health and limited health literacy have been described in this population in Sweden. Still, to our knowledge, an Arabic version of eHEALS has not been tested for validity or reliability. Thus, Arabic-speaking populations in Sweden cannot be included in studies measuring eHealth literacy, which does not support equal treatment in health care. Objective: The aim of this study was to translate and adapt the original English eHEALS version into Arabic and to evaluate its psychometric properties. Methods: The eHEALS was rigorously translated, adapted, and evaluated for content validity. We conducted prospective psychometric evaluation with natively Arabic-speaking participants living in Sweden. Construct validity, factor structure, internal consistency, and test-retest reliability were evaluated using Spearman correlation, principal component analysis, Cronbach α, and weighted quadratic Cohen κ, respectively. Results: The study population consisted of Arabic-speaking participants (n=298; age: mean 41.8 years, SD 10.5). Construct validity was supported with weak and moderate correlations. Principal component factor analysis revealed a one-factor structure. Internal consistency was high (Cronbach α=0.92); test-retest reliability was acceptable (weighted quadratic Cohen κ=0.76). Evaluation indicated that eHealth literacy threshold values should be dichotomized (limited and sufficient) rather than trichotomized (inadequate, problematic, and sufficient). Conclusions: The Arabic version of eHEALS, a unidimensional scale that is valid and reliable for measuring eHealth literacy among natively Arabic-speaking people in Sweden, was found to be acceptable and feasible in a general population. %M 33749614 %R 10.2196/24466 %U https://www.jmir.org/2021/3/e24466 %U https://doi.org/10.2196/24466 %U http://www.ncbi.nlm.nih.gov/pubmed/33749614 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17856 %T Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews %A Park,Eunhee %A Kwon,Misol %+ School of Nursing, University at Buffalo, 201 E Wende Hall, 3435 Main St, Buffalo, NY, 14214-3079, United States, 1 716 829 3701, eunheepa@buffalo.edu %K adolescent %K digital health literacy %K ehealth literacy %K cognitive interview %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. Objective: This study aims to explore the usability and content validity of DHLI. Methods: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Results: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. Conclusions: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy. %M 33720031 %R 10.2196/17856 %U https://www.jmir.org/2021/3/e17856 %U https://doi.org/10.2196/17856 %U http://www.ncbi.nlm.nih.gov/pubmed/33720031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e19134 %T Associations of Health Literacy, Social Media Use, and Self-Efficacy With Health Information–Seeking Intentions Among Social Media Users in China: Cross-sectional Survey %A Niu,Zhaomeng %A Willoughby,Jessica %A Zhou,Rongting %+ School of Humanities and Social Sciences, University of Science and Technology of China, Jinzhai Road 96, Hefei, 230026, China, 86 63600495, rongting@ustc.edu.cn %K behavioral intention %K health literacy %K self-efficacy %K social media %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Empirical research has demonstrated that people frequently use social media for gathering and sharing online health information. Health literacy, social media use, and self-efficacy are important factors that may influence people’s health behaviors online. Objective: We aimed to examine the associations between health literacy, health-related social media use, self-efficacy, and health behavioral intentions online. Methods: We conducted a cross-sectional survey of adults 18 years and older (n=449) to examine predictors of health-related behavioral intentions online including health literacy, social media use, and self-efficacy in China using 2 moderated mediation models. Mediation and moderation analyses were conducted. Results: Self-efficacy mediated the effects of health literacy (Bindirect=0.213, 95% CI 0.101 to 0.339) and social media use (Bindirect=0.023, 95% CI 0.008 to 0.045) on health behavioral intentions on social media. Age moderated the effects of health literacy on self-efficacy (P=.03), while previous experience moderated the effects of social media use on self-efficacy (P<.001). Conclusions: Health literacy and health-related social media use influenced health behavioral intentions on social media via their prior effects on self-efficacy. The association between health literacy and self-efficacy was stronger among younger respondents, whereas the association between health-related social media use and self-efficacy was stronger among those who previously had positive experiences with health information on social media. Health practitioners should target self-efficacy among older populations and increase positive media experience related to health. %M 33629955 %R 10.2196/19134 %U https://www.jmir.org/2021/2/e19134 %U https://doi.org/10.2196/19134 %U http://www.ncbi.nlm.nih.gov/pubmed/33629955 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 1 %P e18590 %T Willingness to Use Digital Health Tools in Patient Care Among Health Care Professionals and Students at a University Hospital in Saudi Arabia: Quantitative Cross-sectional Survey %A Thapa,Subash %A Nielsen,Jesper Bo %A Aldahmash,Abdullah M %A Qadri,Fatima R %A Leppin,Anja %+ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, Odense, 5000, Denmark, 45 65504931, sthapa@health.sdu.dk %K attitude %K digital health %K electronic medical record %K health care professionals %K health care students %K Saudi Arabia %K self-efficacy %K telemedicine %K willingness to use %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The adoption rate of digital health in the health care sector is low in many countries. A facilitating factor for successful implementation and adoption of digital health is acceptance by current and future health care professionals. Objective: This study was conducted to identify factors associated with willingness to use digital health tools in patient care among health care professionals and students. Methods: This was a quantitative cross-sectional survey study conducted among health care professionals and students at a university hospital in Riyadh, Saudi Arabia. A nonprobability convenience sampling procedure was used to recruit participants. Data were collected using a self-completed e-questionnaire that was distributed by email. Chi-square tests, t tests, and logistic regression were used to analyze the data. Results: We found that 181 out of 218 health care professionals (83.0%; 75.6% [59/78] physicians; 87.1% [122/140] nurses) and 115 out of 154 students (74.7%; 80.0% [76/95] medical students and 66.1% [39/59] nursing students) were willing to use digital tools in patient care. Willingness to use digital tools was significantly associated with attitude (Adjusted Odds Ratios [AOR] 1.96; 95% CI 1.14-3.36) and self-efficacy (AOR 1.64; 95% CI 1.17-2.30) among health care professionals, and with current year of study (AOR 2.08; 95% CI 1.18-3.68) and self-efficacy (AOR 1.77; 95% CI 1.17-2.69) among students. No significant difference in willingness to use digital tools was found between physicians and nurses (P=.113), and between medical and nursing students (P=.079). Conclusions: The findings of this study should encourage policy makers and hospital managers to implement relevant eHealth interventions within routine health care systems in Saudi Arabia. For successful implementation, digital health education programs should be implemented simultaneously, so that current and future health care professionals are able to develop required positive attitudes as well as practical skills and competencies. %M 33605896 %R 10.2196/18590 %U http://mededu.jmir.org/2021/1/e18590/ %U https://doi.org/10.2196/18590 %U http://www.ncbi.nlm.nih.gov/pubmed/33605896 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23767 %T Evaluation of an Intergenerational and Technological Intervention for Loneliness: Protocol for a Feasibility Randomized Controlled Trial %A Hoang,Peter %A Whaley,Colin %A Thompson,Karen %A Ho,Venus %A Rehman,Uzma %A Boluk,Karla %A Grindrod,Kelly A %+ School of Pharmacy, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 21392, colin.whaley@uwaterloo.ca %K seniors %K communication technology %K social isolation %K computers %K intergenerational %K older adults %K mobile phone %D 2021 %7 17.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social integration and mental health are vital aspects of healthy aging. However, close to half of Canadians older than 80 years report feeling socially isolated. Research has shown that social isolation leads to increased mortality and morbidity, and various interventions have been studied to alleviate loneliness among older adults. This proposal presents an evaluation of an intervention that provides one-on-one coaching, is intergenerational, provides both educational and socialization experiences, and increases technology literacy of older adults to overcome loneliness. Objective: This paper describes the protocol of a randomized, mixed-methods study that will take place in Ontario, Canada. The purpose of this study is to evaluate if an intergenerational technology literacy program can reduce social isolation and depression in older adults via quantitative and qualitative outcome measures. Methods: This study is a randomized, mixed-methods, feasibility trial with 2 conditions. Older adults in the intervention condition will receive 1 hour of weekly technological assistance to send an email to a family member, for 8 weeks, with the assistance of a volunteer. Participants in the control condition will not receive any intervention. The primary outcomes are loneliness, measured using the University of California, Los Angeles Loneliness Scale, and depression, measured using the Center for Epidemiologic Studies Depression scale, both of which are measured weekly. Secondary outcomes are quality of life, as assessed using the Older People’s Quality of Life-Brief version, and technological literacy, evaluated using the Computer Proficiency Questionnaire-12, both of which will be administered before and after the intervention. Semistructured interviews will be completed before and after the intervention to assess participants’ social connectedness, familiarity with technology, and their experience with the intervention. The study will be completed in a long-term care facility in Southwestern Ontario, Canada. Significance was set at P<.05. Results: This study was funded in April 2019 and ethical approval was obtained in August 2019. Recruitment for the study started in November 2019. The intervention began in February 2020 but was halted due to the COVID-19 pandemic. The trial will be restarted when safe. As of March 2020, 8 participants were recruited. Conclusions: Information and communication technology interventions have shown varying results in reducing loneliness and improving mental health among older adults. Few studies have examined the role of one-on-one coaching for older adults in addition to technology education in such interventions. Data from this study may have the potential to provide evidence for other groups to disseminate similar interventions in their respective communities. International Registered Report Identifier (IRRID): DERR1-10.2196/23767 %M 33595443 %R 10.2196/23767 %U http://www.researchprotocols.org/2021/2/e23767/ %U https://doi.org/10.2196/23767 %U http://www.ncbi.nlm.nih.gov/pubmed/33595443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e18404 %T Relationships Between Mobile eHealth Literacy, Diabetes Self-care, and Glycemic Outcomes in Taiwanese Patients With Type 2 Diabetes: Cross-sectional Study %A Guo,Sophie Huey-Ming %A Hsing,Hung-Chun %A Lin,Jiun-Lu %A Lee,Chun-Chuan %+ Department of Nursing, Mackay Medical College, No 46, Section 3, Zhongzheng Rd, Sanzhi District, New Taipei City, 252, Taiwan, 886 2 26360303 ext 1326, sophiecgu@gmail.com %K mHealth literacy %K eHealth literacy %K diabetes mellitus %K self-care behavior %K glycemic outcomes %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding how people with diabetes seek online health information and use health applications is important to ensure these electronic tools are successfully supporting patient self-care. Furthermore, identifying the relationship between patient mobile eHealth literacy (mobile eHL) and diabetes outcomes can have far-reaching utility, for example, in the design of targeted interventions to address mobile eHL limitations. However, only limited studies have explored the impact of mobile eHL in a population with diabetes. Objective: This study aims to present data about online information-seeking behavior and mobile health (mHealth) app usage, investigate the factors related to mobile eHL in Taiwanese patients with type 2 diabetes, and flesh out the relationship between eHealth literacy (eHL), mobile health literacy (mHL), and health outcomes. Methods: Subjects were recruited from January 2017 to December 2017 in the outpatient departments of 3 hospitals in Taiwan. A total of 249 Taiwanese patients with diabetes voluntarily completed a cross-sectional survey assessing sociodemographic characteristics; diabetes status; knowledge and skills of computers, the internet, and mobile apps; mobile eHL; and patient outcomes (self-care behaviors, self-rated health, HbA1c). Structural equation modeling analyses examined the model fit of mobile eHL scores and the interrelationships between latent constructs and observable variables. Results: Of the 249 patients with diabetes, 67% (164/249) reported they had searched for online diabetes information. The participants with smartphones had owned them for an average of 6.5 years and used them for an average of 4.5 (SD 3.81) hours per day. Only 1.6% (4/249) of the patients used health apps. Some demographic factors affecting mobile eHL included age, education, and duration of type 2 diabetes. Mobile eHL was related to self-care behaviors as well as knowledge and skills of computers, the internet, and mobile technology, but only had a weak, indirect effect on self-rated health. The final model had adequate goodness-of-fit indexes: chi-square (83)=149.572, P<.001; comparative fit index (CFI)=0.925; root mean square of approximation (RMSEA)=0.057 (90% CI 004-006); chi-square/df=1.082. Mobile eHL had a weak, indirect effect on self-rated health through the variables of knowledge with skills. Conclusions: Our study reveals that although people with diabetes who rated their health conditions as moderate were confident in using mobile eHealth and technology, few adopted these tools in their daily lives. The study found that mobile eHL had a direct effect on self-care behavior as well as knowledge and skills of computers, the internet, and mobile technology, and had an indirect effect on health outcomes (glycemic control and self-rated health status). Information about this population's experiences and the role mobile eHL plays in them can spur necessary mobile eHealth patient education. %M 33544088 %R 10.2196/18404 %U https://mhealth.jmir.org/2021/2/e18404 %U https://doi.org/10.2196/18404 %U http://www.ncbi.nlm.nih.gov/pubmed/33544088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26145 %T Measurement of Digital Literacy Among Older Adults: Systematic Review %A Oh,Sarah Soyeon %A Kim,Kyoung-A %A Kim,Minsu %A Oh,Jaeuk %A Chu,Sang Hui %A Choi,JiYeon %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3301, jychoi610@yuhs.ac %K healthy aging %K eHealth %K telehealth %K mobile health %K digital literacy %K ehealth literacy %K aging %K elderly %K older adults %K review %K literacy %D 2021 %7 3.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations. Objective: This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission’s Digital Competence (DigComp) Framework. Methods: Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use. Results: Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ≥50 years (10/27) or ≥60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework’s elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including “digital content creation” and “safety.” Conclusions: The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like “digital content creation” and “safety” that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged. %M 33533727 %R 10.2196/26145 %U https://www.jmir.org/2021/2/e26145 %U https://doi.org/10.2196/26145 %U http://www.ncbi.nlm.nih.gov/pubmed/33533727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e14088 %T Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study %A Lee,Hee Yun %A Jin,Seok Won %A Henning-Smith,Carrie %A Lee,Jongwook %A Lee,Jaegoo %+ Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States, 1 617 432 1232, jongwook_lee@hsph.harvard.edu %K digital divide %K health literacy %K internet %K technology %K access %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. Objective: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. Methods: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. Results: Better health literacy (β=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; β=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree (β=.28, SE 0.07), female gender (β=.15, SE 0.05), poor health (β=.22, SE 0.06), participation in social groups (β=.13, SE 0.05), and having an annual health exam (β=.35, SE 0.12) were all associated with online health-related information-seeking. Conclusions: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy. %M 33502332 %R 10.2196/14088 %U http://www.jmir.org/2021/1/e14088/ %U https://doi.org/10.2196/14088 %U http://www.ncbi.nlm.nih.gov/pubmed/33502332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20457 %T Effects of Objective and Subjective Health Literacy on Patients’ Accurate Judgment of Health Information and Decision-Making Ability: Survey Study %A Schulz,Peter Johannes %A Pessina,Annalisa %A Hartung,Uwe %A Petrocchi,Serena %+ Institute of Communication and Health, Università della Svizzera italiana, Via Guiseppe Buffi 13, Lugano, 6900, Switzerland, 41 58 666 4724, schulzp@usi.ch %K health literacy %K Newest Vital Sign %K eHealth Literacy Scale %K self-reported health literacy %K perception-based health literacy %K objective health literacy %K performance-based %K depression %K mental health %D 2021 %7 21.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Interpreting health information and acquiring health knowledge have become more important with the accumulation of scientific medical knowledge and ideals of patient autonomy. Health literacy and its tremendous success as a concept can be considered an admission that not all is well in the distribution of health knowledge. The internet makes health information much more easily accessible than ever, but it introduces its own problems, of which health disinformation is a major one. Objective: The objective of this study was to determine whether objective and subjective health literacy are independent concepts and to test which of the two was associated more strongly with accurate judgments of the quality of a medical website and with behavioral intentions beneficial to health. Methods: A survey on depression and its treatments was conducted online (n=362). The Newest Vital Sign was employed to measure objective, performance-based health literacy, and the eHealth Literacy Scale was used to measure subjective, perception-based health literacy. Correlations, comparisons of means, linear and binary logistic regression, and mediation models were used to determine the associations. Results: Objective and subjective health literacy were weakly associated with one another (r=0.06, P=.24). High objective health literacy levels were associated with an inclination to behave in ways that are beneficial to one’s own or others’ health (Exp[B]=2.068, P=.004) and an ability to recognize low-quality online sources of health information (β=–.4698, P=.005). The recognition also improved participants’ choice of treatment (β=–.3345, P<.001). Objective health literacy helped people to recognize misinformation on health websites and improved their judgment on their treatment for depression. Conclusions: Self-reported, perception-based health literacy should be treated as a separate concept from objective, performance-based health literacy. Only objective health literacy appears to have the potential to prevent people from becoming victims of health disinformation. %M 33475519 %R 10.2196/20457 %U http://www.jmir.org/2021/1/e20457/ %U https://doi.org/10.2196/20457 %U http://www.ncbi.nlm.nih.gov/pubmed/33475519 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25474 %T Awareness, Information-Seeking Behavior, and Information Preferences About Early Childhood Allergy Prevention Among Different Parent Groups: Protocol for a Mixed Methods Study %A Lander,Jonas %A Curbach,Janina %A von Sommoggy,Julia %A Bitzer,Eva Maria %A Dierks,Marie-Luise %+ Hanover Medical School, Carl-Neuberg-Str 1, Hanover, 30625, Germany, 49 5115324450, lander.jonas@mh-hannover.de %K health literacy %K allergy prevention %K children %K health information %K parents %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: In early childhood allergy prevention (ECAP), parents act on behalf of their children. Parental health literacy and the availability of high-quality information, both online and offline, are crucial for effective ECAP. Recent research highlights three main points. First, parents need sufficient health literacy to discriminate between high-quality and low-quality information. Second, ECAP information behaviors may vary between phases of childhood development and according to individual circumstances. Third, to strengthen user-centeredness of available services, a better overview of parents’ information practices and needs and how they handle uncertainties is required. Objective: This study aims to explore why, how, and when parents search for and apply ECAP-specific health information and which individual (eg, understanding of advice) and organizational challenges (eg, information services, information complexity, and changing recommendations) they perceive and how they handle them. This study also aims to assess the needs and preferences that parents express for future information formats and contents. The findings should inform the practical design of ECAP information as well as formats and channels specific to different parent groups. Methods: The above-named issues will be explored with parents in four German cities as one element in our efforts to cover the spectrum of perspectives. Based on a mixed methods design, including qualitative and quantitative assessments, the first year serves to prepare focus groups, a piloted focus group guide, a short standardized survey adapted from the European Health Literacy Project, recruitment channels, and the recruitment of participants. After conducting 20 focus groups in the second year, data will be analyzed via a constant comparison method in the third year. Based on this, practice implications on channels (ie, Where?), formats (ie, How?), and contents (ie, What?) of ECAP-specific information will be derived and discussed with parents and associated project partners before its dissemination to relevant ECAP actors (eg, childcare institutions and pediatricians). Results: The study began with preselection of recruitment channels, drafting of recruitment and study information for potential participants, and agreement on a first full version of the guideline. Then, a detailed contact list was compiled of health professionals, administrative and social institutions, and relevant social media channels (N=386) to be approached for assistance in contacting parents. The recruitment was postponed due to COVID-19 and will start in January 2021. Conclusions: ECAP is a relevant example for assessing how users (ie, parents) handle not only health information but the various and continuous changes, uncertainties, and controversies attached to it. So far, it is unclear how parents implement the respective scientific recommendations and expert advice, which is why this study aims to inform those who communicate with parents about ECAP information. International Registered Report Identifier (IRRID): PRR1-10.2196/25474 %M 33470948 %R 10.2196/25474 %U http://www.researchprotocols.org/2021/1/e25474/ %U https://doi.org/10.2196/25474 %U http://www.ncbi.nlm.nih.gov/pubmed/33470948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24097 %T Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study %A Dadaczynski,Kevin %A Okan,Orkan %A Messer,Melanie %A Leung,Angela Y M %A Rosário,Rafaela %A Darlington,Emily %A Rathmann,Katharina %+ Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Sraße 123, Fulda, 36037, Germany, 49 661 9640 6073, kevin.dadaczynski@pg.hs-fulda.de %K digital health %K literacy %K infodemic %K health information %K behaviour %K coronavirus %K COVID-19 %K university student %K student %K infodemiology %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19–related information and service environments. Objective: This study aimed to investigate university students’ digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. Methods: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. Results: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of “information searching” and “evaluating reliability.” Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. Conclusions: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key. %M 33395396 %R 10.2196/24097 %U http://www.jmir.org/2021/1/e24097/ %U https://doi.org/10.2196/24097 %U http://www.ncbi.nlm.nih.gov/pubmed/33395396 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18937 %T Interrelationships Between Patients’ Data Tracking Practices, Data Sharing Practices, and Health Literacy: Onsite Survey Study %A Luo,Yuhan %A Oh,Chi Young %A Jean,Beth St %A Choe,Eun Kyoung %+ College of Information Studies, University of Maryland, 4130 Campus Drive, Hornbake Library South, College Park, MD, , United States, 1 3014051085, choe@umd.edu %K consumer health informatics %K patient-generated health data %K self-tracking %K doctor-patient data sharing %K health literacy %K surveys and questionnaires %D 2020 %7 22.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the use of patient-generated data (PGD) in the optimization of patient care shows great promise, little is known about whether patients who track their PGD necessarily share the data with their clinicians. Meanwhile, health literacy—an important construct that captures an individual’s ability to manage their health and to engage with their health care providers—has often been neglected in prior studies focused on PGD tracking and sharing. To leverage the full potential of PGD, it is necessary to bridge the gap between patients’ data tracking and data sharing practices by first understanding the interrelationships between these practices and the factors contributing to these practices. Objective: This study aims to systematically examine the interrelationships between PGD tracking practices, data sharing practices, and health literacy among individual patients. Methods: We surveyed 109 patients at the time they met with a clinician at a university health center, unlike prior research that often examined patients’ retrospective experience after some time had passed since their clinic visit. The survey consisted of 39 questions asking patients about their PGD tracking and sharing practices based on their current clinical encounter. The survey also contained questions related to the participants’ health literacy. All the participants completed the survey on a tablet device. The onsite survey study enabled us to collect ecologically valid data based on patients’ immediate experiences situated within their clinic visit. Results: We found no evidence that tracking PGD was related to self-reports of having sufficient information to manage one’s health; however, the number of data types participants tracked positively related to their self-assessed ability to actively engage with health care providers. Participants’ data tracking practices and their health literacy did not relate to their data sharing practices; however, their ability to engage with health care providers positively related to their willingness to share their data with clinicians in the future. Participants reported several benefits of, and barriers to, sharing their PGD with clinicians. Conclusions: Although tracking PGD could help patients better engage with health care providers, it may not provide patients with sufficient information to manage their health. The gaps between tracking and sharing PGD with health care providers call for efforts to inform patients of how their data relate to their health and to facilitate efficient clinician-patient communication. To realize the full potential of PGD and to promote individuals’ health literacy, empowering patients to effectively track and share their PGD is important—both technologies and health care providers can play important roles. %M 33350960 %R 10.2196/18937 %U http://www.jmir.org/2020/12/e18937/ %U https://doi.org/10.2196/18937 %U http://www.ncbi.nlm.nih.gov/pubmed/33350960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19767 %T Relationship Between Levels of Digital Health Literacy Based on the Taiwan Digital Health Literacy Assessment and Accurate Assessment of Online Health Information: Cross-Sectional Questionnaire Study %A Liu,Peggy %A Yeh,Ling-Ling %A Wang,Jiun-Yi %A Lee,Shao-Ti %+ Social Enterprise and Innovation MA Program, Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, No 700, Fagu Rd, Jinshan Dist, New Taipei City, 20842, Taiwan, 886 224980707 ext 5205, YehLL@dila.edu.tw %K digital health literacy %K internet health information %K risk group %K Taiwan %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing amount of health information available on the internet makes it more important than ever to ensure that people can judge the accuracy of this information to prevent them from harm. It may be possible for platforms to set up protective mechanisms depending on the level of digital health literacy and thereby to decrease the possibility of harm by the misuse of health information. Objective: This study aimed to create an instrument for digital health literacy assessment (DHLA) based on the eHealth Literacy Scale (eHEALS) to categorize participants by level of risk of misinterpreting health information into high-, medium-, and low-risk groups. Methods: This study developed a DHLA and constructed an online health information bank with correct and incorrect answers. Receiver operating characteristic curve analysis was used to detect the cutoff value of DHLA, using 5 items randomly selected from the online health information bank, to classify users as being at low, medium, or high risk of misjudging health information. This provided information about the relationship between risk group for digital health literacy and accurate judgement of online health information. The study participants were Taiwanese residents aged 20 years and older. Snowball sampling was used, and internet questionnaires were anonymously completed by the participants. The reliability and validity of DHLA were examined. Logistic regression was used to analyze factors associated with risk groups from the DHLA. Results: This study collected 1588 valid questionnaires. The online health information bank included 310 items of health information, which were classified as easy (147 items), moderate (122 items), or difficult (41 items) based on the difficulty of judging their accuracy. The internal consistency of DHLA was satisfactory (α=.87), and factor analysis of construct validity found three factors, accounting for 76.6% of the variance. The receiver operating characteristic curve analysis found 106 people at high risk, 1368 at medium risk, and 114 at low risk of misinterpreting health information. Of the original grouped cases, 89.6% were correctly classified after discriminate analysis. Logistic regression analysis showed that participants with a high risk of misjudging health information had a lower education level, lower income, and poorer health. They also rarely or never browsed the internet. These differences were statistically significant. Conclusions: The DHLA score could distinguish those at low, medium, and high risk of misjudging health information on the internet. Health information platforms on the internet could consider incorporating DHLA to set up a mechanism to protect users from misusing health information and avoid harming their health. %M 33106226 %R 10.2196/19767 %U http://www.jmir.org/2020/12/e19767/ %U https://doi.org/10.2196/19767 %U http://www.ncbi.nlm.nih.gov/pubmed/33106226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18613 %T Psychometric Validation and Cultural Adaptation of the Simplified Chinese eHealth Literacy Scale: Cross-Sectional Study %A Xu,Richard Huan %A Zhou,Lingming %A Lu,Sabrina Yujun %A Wong,Eliza Laiyi %A Chang,Jinghui %A Wang,Dong %+ School of Health management, Southern Medical University, No. 1023 Shatai nan Road, Guangzhou, China, 86 61648573, dongw96@smu.edu.cn %K electronic health literacy %K eHEALS %K psychometric property %K classical test theory %K item response theory %K China %D 2020 %7 7.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid proliferation of web-based information on health and health care has profoundly changed individuals’ health-seeking behaviors, with individuals choosing the internet as their first source of information on their health conditions before seeking professional advice. However, barriers to the evaluation of people’s eHealth literacy present some difficulties for decision makers with respect to encouraging and empowering patients to use web-based resources. Objective: This study aims to examine the psychometric properties of a simplified Chinese version of the eHealth Literacy Scale (SC-eHEALS). Methods: Data used for analysis were obtained from a cross-sectional multicenter survey. Confirmatory factor analysis (CFA) was used to examine the structure of the SC-eHEALS. Correlations between the SC-eHEALS and ICEpop capability measure for adults (ICECAP-A) items and overall health status were estimated to assess the convergent validity. Internal consistency reliability was confirmed using Cronbach alpha (α), McDonald omega (ω), and split-half reliability (λ). A general partial credit model was used to perform the item response theory (IRT) analysis. Item difficulty, discrimination, and fit were reported. Item-category characteristic curves (ICCs) and item and test information curves were used to graphically assess the validity and reliability based on the IRT analysis. Differential item functioning (DIF) was used to check for possible item bias on gender and age. Results: A total of 574 respondents from 5 cities in China completed the SC-eHEALS. CFA confirmed that the one-factor model was acceptable. The internal consistency reliability was good, with α=0.96, ω=0.92, and λ=0.96. The item-total correlation coefficients ranged between 0.86 and 0.91. Items 8 and 4 showed the lowest and highest mean scores, respectively. The correlation coefficients between the SC-eHEALS and ICECAP-A items and overall health status were significant, but the strength was mild. The discrimination of SC-eHEALS items ranged between 2.63 and 5.42. ICCs indicated that the order of categories’ thresholds for all items was as expected. In total, 70% of the information provided by SC-eHEALS was below the average level of the latent trait. DIF was found for item 6 on age. Conclusions: The SC-eHEALS has been demonstrated to have good psychometric properties and can therefore be used to evaluate people’s eHealth literacy in China. %M 33284123 %R 10.2196/18613 %U http://www.jmir.org/2020/12/e18613/ %U https://doi.org/10.2196/18613 %U http://www.ncbi.nlm.nih.gov/pubmed/33284123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22894 %T Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey %A Do,Binh N %A Tran,Tien V %A Phan,Dung T %A Nguyen,Hoang C %A Nguyen,Thao T P %A Nguyen,Huu C %A Ha,Tung H %A Dao,Hung K %A Trinh,Manh V %A Do,Thinh V %A Nguyen,Hung Q %A Vo,Tam T %A Nguyen,Nhan P T %A Tran,Cuong Q %A Tran,Khanh V %A Duong,Trang T %A Pham,Hai X %A Nguyen,Lam V %A Nguyen,Kien T %A Chang,Peter W S %A Duong,Tuyen Van %+ School of Nutrition and Health Sciences, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan, 886 2 2736 1661 ext 6545, tvduong@tmu.edu.tw %K COVID-19 %K health literacy %K eHealth literacy %K health care workers %K personal protective equipment %K handwashing %K masks %K disposing %K lifestyle %K Vietnam %K eHealth %K adherence %K infection prevention %K control %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. Objective: The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown. Methods: We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations. Results: The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively. Conclusions: The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences. %M 33122164 %R 10.2196/22894 %U https://www.jmir.org/2020/11/e22894 %U https://doi.org/10.2196/22894 %U http://www.ncbi.nlm.nih.gov/pubmed/33122164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22161 %T Undergraduate Medical Competencies in Digital Health and Curricular Module Development: Mixed Methods Study %A Poncette,Akira-Sebastian %A Glauert,Daniel Leon %A Mosch,Lina %A Braune,Katarina %A Balzer,Felix %A Back,David Alexander %+ Dieter Scheffner Center for Medical Education and Educational Research, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany, 49 30 2841 1240, david.back@charite.de %K digital health %K eHealth %K mHealth %K digital health education %K elective module %K eHealth education %K curriculum %K medical school %K digital health mindset %K qualitative research %K interview %K survey %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to an increase in digital technologies in health care, recently leveraged by the COVID-19 pandemic, physicians are required to use these technologies appropriately and to be familiar with their implications on patient care, the health system, and society. Therefore, medical students should be confronted with digital health during their medical education. However, corresponding teaching formats and concepts are still largely lacking in the medical curricula. Objective: This study aims to introduce digital health as a curricular module at a German medical school and to identify undergraduate medical competencies in digital health and their suitable teaching methods. Methods: We developed a 3-week curricular module on digital health for third-year medical students at a large German medical school, taking place for the first time in January 2020. Semistructured interviews with 5 digital health experts were recorded, transcribed, and analyzed using an abductive approach. We obtained feedback from the participating students and lecturers of the module through a 17-item survey questionnaire. Results: The module received overall positive feedback from both students and lecturers who expressed the need for further digital health education and stated that the field is very important for clinical care and is underrepresented in the current medical curriculum. We extracted a detailed overview of digital health competencies, skills, and knowledge to teach the students from the expert interviews. They also contained suggestions for teaching methods and statements supporting the urgency of the implementation of digital health education in the mandatory curriculum. Conclusions: An elective class seems to be a suitable format for the timely introduction of digital health education. However, a longitudinal implementation in the mandatory curriculum should be the goal. Beyond training future physicians in digital skills and teaching them digital health’s ethical, legal, and social implications, the experience-based development of a critical digital health mindset with openness to innovation and the ability to assess ever-changing health technologies through a broad transdisciplinary approach to translate research into clinical routine seem more important. Therefore, the teaching of digital health should be as practice-based as possible and involve the educational cooperation of different institutions and academic disciplines. %M 33118935 %R 10.2196/22161 %U http://www.jmir.org/2020/10/e22161/ %U https://doi.org/10.2196/22161 %U http://www.ncbi.nlm.nih.gov/pubmed/33118935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e14783 %T Effects of Interactivity on Recall of Health Information: Experimental Study %A Pajor,Emília Margit %A Eggers,Sander Matthijs %A de Vries,Hein %A Oenema,Anke %+ Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Debijeplein 1, Maastricht, Netherlands, 31 43 3882131, a.oenema@maastrichtuniversity.nl %K Interactivity %K cognitive involvement %K active control %K cognitive load %K recall %K need for cognition %K health literacy %K online health information %K information processing %K dietary supplements %D 2020 %7 28.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information provided in an interactive way is believed to be engaging because users can actively explore the information. Yet empirical findings often contradict this assumption. Consequently, there is still little known about whether and how interactivity affects communication outcomes such as recall. Objective: The aim of this study was to investigate mechanisms through which interactivity affects recall of online health information. We tested whether and how cognitive involvement, perceived active control, and cognitive load mediate the effects of interactivity on recall. In addition, we examined need for cognition and health literacy as potential moderators of the mediation effects. Given the increasing popularity of dietary supplement use, our health website focused on this topic. Methods: In an online between-subjects experiment (n=983), participants were randomly assigned to control condition (no interactive features), moderate interactivity (dropdown menus), and high interactivity (dropdown menus and responsive infographics). Two weeks before the experiment, background characteristics and moderating variables were measured. During website visit, data on users’ online behavior were collected. Recall was measured postexposure. Results: Participants recalled significantly less information in the moderate (mean 3.48 [SD 2.71]) and high (mean 3.52 [SD 2.64]) interactivity conditions compared with the control condition (mean 5.63 [SD 2.18]). In the mediation analysis, we found direct, negative effects of moderate (b=–2.25, 95% CI –2.59 to –1.90) and high (b=–2.16, 95% CI –2.51 to –1.81) levels of interactivity on recall as well. In the relationship between interactivity and recall, cognitive involvement had a partial negative mediation effect (moderate interactivity: b=–.20; 95% CI –0.31 to –0.10; high interactivity: b=–.21, 95% CI –0.33 to –0.10) and perceived active control had a partial positive mediation effect (moderate interactivity: b=.28, 95% CI 0.18 to 0.40; high interactivity: b=.27, 95% CI 0.16 to 0.40). Conclusions: Interactivity decreased recall. In addition, through interactivity participants were less involved with the content of the information, yet they felt they had more control over the information. These effects were stronger in the high need for cognition and high health literate groups compared with their counterparts. %M 33112245 %R 10.2196/14783 %U https://www.jmir.org/2020/10/e14783 %U https://doi.org/10.2196/14783 %U http://www.ncbi.nlm.nih.gov/pubmed/33112245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20099 %T eHealth Literacy of German Physicians in the Pre–COVID-19 Era: Questionnaire Study %A Kirchberg,Johanna %A Fritzmann,Johannes %A Weitz,Jürgen %A Bork,Ulrich %+ Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307, Germany, 49 3514585400, ulrich.bork@ukdd.de %K eHealth %K electronic health %K mobile health %K health apps %K mobile health apps %K eHealth literacy %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. Objective: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. Methods: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. Results: Of the 93 German physicians who participated in the study, 97% (90/93) use a mobile phone. Medical apps are used by 42% (39/93). Half of the surveyed physicians (47/93, 50%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33%) of all participants. More than 80% (76/93, 82%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. Conclusions: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice. %M 33064102 %R 10.2196/20099 %U http://mhealth.jmir.org/2020/10/e20099/ %U https://doi.org/10.2196/20099 %U http://www.ncbi.nlm.nih.gov/pubmed/33064102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19684 %T Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens %A Li,Xiaojing %A Liu,Qinliang %+ Center for Health and Medical Communication, School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 13918611103, lixiaojing@sjtu.edu.cn %K social media %K media use %K COVID-19 %K pandemic %K disease knowledge %K eHealth literacy %K public health %K preventive behaviors %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. Objective: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. Methods: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (“netizens”) in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. Results: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income >¥5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (β=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (β=.11, P=.001) and eHealth literacy (β=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (β=.07) affected this relationship positively and disease knowledge (β=–.07) affected it negatively. Different social media types differed in predicting an individual’s preventive behaviors for COVID-19. Aggregated social media (β=.22, P<.001) was the best predictor, followed by public social media (β=.14, P<.001) and professional social media (β=.11, P=.002). However, official social media (β=.02, P=.597) was an insignificant predictor. Conclusions: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. %M 33006940 %R 10.2196/19684 %U http://www.jmir.org/2020/10/e19684/ %U https://doi.org/10.2196/19684 %U http://www.ncbi.nlm.nih.gov/pubmed/33006940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e14450 %T EHealth Literacy in UK Teenagers and Young Adults: Exploration of Predictors and Factor Structure of the eHealth Literacy Scale (eHEALS) %A Holch,Patricia %A Marwood,Jordan R %+ Psychology Department, Leeds School of Social Sciences, Leeds Beckett University, Room CL 815, Calverley Building, City Campus, Leeds Beckett University, Leeds, LS1 3HE, United Kingdom, 44 0113 81 ext 24950, t.holch@leedsbeckett.ac.uk %K eHealth literacy %K irrational health beliefs %K predictors %K self-efficacy %K teenagers and young adults %K need for cognition %K exploratory factor analysis %D 2020 %7 8.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasingly, teenagers and young adults (TYAs) seek out health information online; however, it is not clear whether they possess electronic health (eHealth) literacy, defined as “the ability to select, appraise, and utilize good quality health information from the internet.” A number of factors are included in the Lily model proposed by Norman and Skinner underpinning the development of eHealth literacy. It is important to understand which elements may influence the development of eHealth literacy in young people, as the current generation will continue to “Google it” when faced with a health problem throughout their lives. Objective: The objectives of this study are to explore potential factors influencing young people’s eHealth literacy and explore the underlying constructs of the eHealth Literacy Scale (eHEALS) in a population of UK university students. Methods: A total of 188 undergraduate psychology students from a large UK University were recruited as an opportunity sample. Of these, 88.8% (167/188) of participants were female with a mean age of 20.13 (SD 2.16) years and the majority were White British (159/188, 84.6%). Employing a cross-sectional design TYAs completed the following measures exploring eHealth literacy (eHEALS): Irrational Health Belief Scale; Newest Vital Sign (NVS), a measure of functional health literacy; Need for Cognition Scale, a preference for effortful cognitive activity; and General Self-Efficacy (GSE) Scale, exploring personal agency and confidence. The eHEALS was also subject to exploratory factor analysis (EFA), for which in addition to the total variance explained, the scree plot, eigenvalues, and factor loadings were assessed to verify the structure. Results: eHEALS and GSE were significantly positively correlated (r=0.28, P<.001) and hierarchical linear modeling revealed GSE as the significant predictor of scores on the eHEALS (F1,186=16.16, P<.001, R2=0.08), accounting for 8.0% of the variance. Other notable relationships were GSE and need for cognition (NFC) were also positively correlated (r=0.33, P<.001), and NFC and irrational health beliefs were significantly negatively correlated (r=–.14, P=.03). Using Spearman correlations, GSE and NVS (rs=0.14, P=.04) and NFC and NVS (rs=0.19, P=.003) were positively correlated. An EFA revealed the scale to be stable and identified a 2-factor structure related to information acquisition and information application. Conclusions: This is the first study in the UK to explore relationships between these key variables and verify the structure of the eHEALS in a TYA population in the UK. The findings that self-efficacy has a major influence firmly consolidate its status as fundamental to the development of eHealth literacy. Future studies will explore the influence of body image and the development of eHealth literacy in more diverse TYA populations. %M 32897230 %R 10.2196/14450 %U http://formative.jmir.org/2020/9/e14450/ %U https://doi.org/10.2196/14450 %U http://www.ncbi.nlm.nih.gov/pubmed/32897230 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21012 %T Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study %A Ghaddar,Suad %A Vatcheva,Kristina P %A Alvarado,Samantha G %A Mykyta,Laryssa %+ Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, EHABW 2.206, 1201 W. University Dr., Edinburg, TX, , United States, 1 956 665 5269, suad.ghaddar@utrgv.edu %K telehealth %K eHealth literacy %K health information technologies %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use. Objective: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention. Methods: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models. Results: Participants were primarily Hispanic (310/319, 97.2%) and female (261/322, 81.1%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below $20,000. Health-wise, 42.2% (136/322) self-rated their health as fair or poor, and 79.7% (255/320) were uninsured. The overwhelming majority (289/319, 90.6%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23% (OR 0.77, 95% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5%; OR 0.95, 95% CI 0.93-0.98; P<.001) via the increase in the score of telehealth attitudes. Conclusions: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use. %M 32880579 %R 10.2196/21012 %U https://www.jmir.org/2020/9/e21012 %U https://doi.org/10.2196/21012 %U http://www.ncbi.nlm.nih.gov/pubmed/32880579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19056 %T The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study %A Yang,Shu Ching %A Hsu,Wan-Chen %A Chiang,Chia-Hsun %+ National Sun Yat-Sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan, 886 75251521, d996050002@student.nsysu.edu.tw %K college student %K dietary supplement %K media literacy %K ehealth literacy %D 2020 %7 31.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The mass media have been condemned for encouraging young people to take dietary supplements (DS). Media literacy, which includes authors and audiences (AA), messages and meanings (MM), and representation and reality (RR) domains, is a new approach to teaching young adults to make better informed health decisions. However, it is not clear which domains are the most important for media literacy education. Objective: The purpose of this study is to investigate the associations among individual factors, media literacy, and DS use. Methods: The survey instrument included demographic items, the DS Media Literacy Scale (DSMLS), and DS use items (users or nonusers, types of DS, current use of DS, and intention to use DS in the future). The DSMLS is an 11-item instrument designed to assess college students’ AA, MM, and RR media literacy in relation to DS. A total of 467 Taiwanese college students participated in the study. Descriptive statistical analysis, logistic regression analysis, and multiple regression analysis were conducted. Results: A total of 338/467 (72.4%) participants reported using DS, and 176/467 (37.7%) consumed 3 or more supplements. Moreover, the MM media literacy domain was associated with having been a DS user (odds ratio 0.63, P=.002), current DS use (β=–.10, P=.02), and intention to use DS in the future (β=–.12, P=.011). Finally, perceived importance of health was positively related to current DS use (β=.18, P=.001) and intention to use DS in the future (β=.18, P=.001). Conclusions: This study showed that the majority of Taiwanese college students were DS users and used multiple types of supplements. Moreover, students with lower MM media literacy were more likely to be DS users, to take DS more frequently, and to have higher intentions for future frequent DS use. Finally, those who placed extreme importance on health were more likely to take DS frequently and have higher intentions for future frequent DS use. %M 32865500 %R 10.2196/19056 %U http://www.jmir.org/2020/8/e19056/ %U https://doi.org/10.2196/19056 %U http://www.ncbi.nlm.nih.gov/pubmed/32865500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19995 %T Chinese Public’s Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study %A Niu,Zhaomeng %A Wang,Tingting %A Hu,Pengwei %A Mei,Jing %A Tang,Zhihan %+ Hengyang Medical College, University of South China, 28 West Changsheng Road, Hengyang, 421001, China, 86 135 7478 0245, tangzhihan98@163.com %K COVID-19 %K China %K preventive health behaviors %K intervening health behaviors %K psychosocial %K health literacy %K behavior %K prevention %K cross-sectional %D 2020 %7 21.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People’s adoption of preventive and intervening behaviors is critical in curbing the spread of the virus. Objective: The aim of this study is to evaluate Chinese people’s adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement. Methods: An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors. Results: Out of 2949 participants, 55.3% (n=1629) reported frequent engagement in preventive health behaviors, and over 84% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news. Conclusions: Participants’ engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people’s adherence to coronavirus-related behavior guidelines. %M 32716897 %R 10.2196/19995 %U http://www.jmir.org/2020/8/e19995/ %U https://doi.org/10.2196/19995 %U http://www.ncbi.nlm.nih.gov/pubmed/32716897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19827 %T Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey %A Machleid,Felix %A Kaczmarczyk,Robert %A Johann,Doreen %A Balčiūnas,Justinas %A Atienza-Carbonell,Beatriz %A von Maltzahn,Finn %A Mosch,Lina %+ Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Charitéplatz 1, Berlin, 10117, Germany, 49 15757206906, lina.mosch@charite.de %K medical students %K medical education %K eHealth %K mixed method %K health workforce %K digital literacy %K curriculum %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective: We aimed to assess European medical students’ perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students’ most pressing needs. Methods: The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results: The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions: This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties. %M 32667899 %R 10.2196/19827 %U http://www.jmir.org/2020/8/e19827/ %U https://doi.org/10.2196/19827 %U http://www.ncbi.nlm.nih.gov/pubmed/32667899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18476 %T Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups %A Cheng,Christina %A Beauchamp,Alison %A Elsworth,Gerald R %A Osborne,Richard H %+ Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Room 907, Level 9, AMDC Building, 453/469-477 Burwood Road, Hawthorn, VIC 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K health literacy %K internet %K health care %K telecommunications %K digital divide %K health equity %D 2020 %7 13.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. Objective: This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. Methods: A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. Results: A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. Conclusions: The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity. %M 32788144 %R 10.2196/18476 %U http://www.jmir.org/2020/8/e18476/ %U https://doi.org/10.2196/18476 %U http://www.ncbi.nlm.nih.gov/pubmed/32788144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19661 %T Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study %A Knitza,Johannes %A Simon,David %A Lambrecht,Antonia %A Raab,Christina %A Tascilar,Koray %A Hagen,Melanie %A Kleyer,Arnd %A Bayat,Sara %A Derungs,Adrian %A Amft,Oliver %A Schett,Georg %A Hueber,Axel J %+ Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 913185 ext 35000, johannes.knitza@uk-erlangen.de %K mobile applications %K eHealth %K rheumatology %K mHealth %K eHEALS %K telemedicine %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. Objective: The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. Methods: Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. Results: Of the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. Conclusions: Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology. %M 32678796 %R 10.2196/19661 %U http://mhealth.jmir.org/2020/8/e19661/ %U https://doi.org/10.2196/19661 %U http://www.ncbi.nlm.nih.gov/pubmed/32678796 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19013 %T Exploring eHealth Literacy and Patient-Reported Experiences With Outpatient Care in the Hungarian General Adult Population: Cross-Sectional Study %A Zrubka,Zsombor %A Brito Fernandes,Óscar %A Baji,Petra %A Hajdu,Ottó %A Kovacs,Levente %A Kringos,Dionne %A Klazinga,Niek %A Gulácsi,László %A Brodszky,Valentin %A Rencz,Fanni %A Péntek,Márta %+ Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary, 36 30 202 9415, zsombor.zrubka@uni-corvinus.hu %K health literacy %K eHealth literacy, patient-reported experience measures %K patient-reported outcome measures %K ambulatory care %K shared decision making %K Hungary %K survey %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine toward people-centeredness. Thus, eHealth literacy, assisted by innovative digital health solutions, may support better experiences of care. Objective: The purpose of this study is to explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary. Methods: In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS). PREMs with outpatient care were measured with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD) for respondents who attended outpatient visit within 12 months preceding the survey. Bivariate relationships were explored via polychoric correlation, the Kruskal–Wallis test, and chi-square test. To capture nonlinear associations, after controlling covariates, we analyzed the relationship between eHEALS quartiles and PREMs using multivariate probit, ordinary least squares, ordered logit, and logistic regression models. Results: From 1000 survey respondents, 666 individuals (364 females, 54.7%) were included in the study with mean age of 48.9 (SD 17.6) years and mean eHEALS score of 29.3 (SD 4.9). Respondents with higher eHEALS scores were more likely to understand the health care professionals’ (HCPs’) explanations (χ29=24.2, P=.002) and to be involved in decision making about care and treatment (χ29=18.2, P=.03). In multivariate regression, respondents with lowest (first quartile) and moderately high (third quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.02) and experience fewer problems (P=.02). In addition, those respondents had better experiences in terms of how easy it was to understand the HCPs’ explanations (P<.001) and being able to ask questions during their last consultation (P=.04). Patient-reported experiences of individuals with highest (fourth quartile) and lowest (first quartile) eHEALS levels did not differ significantly in any items of the PREM instrument, and neither did composite PREM scores generated from the PREM items (P>.05 in all models). Conclusions: We demonstrated the association between eHealth literacy and PREMs. The potential patient-, physician-, and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation, which may contribute to the development of efficient eHealth literacy interventions. Further research is needed to establish causal relationship between eHealth literacy and patient-reported experiences. %M 32667891 %R 10.2196/19013 %U https://www.jmir.org/2020/8/e19013 %U https://doi.org/10.2196/19013 %U http://www.ncbi.nlm.nih.gov/pubmed/32667891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17312 %T Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study %A Brørs,Gunhild %A Wentzel-Larsen,Tore %A Dalen,Håvard %A Hansen,Tina B %A Norman,Cameron D %A Wahl,Astrid %A Norekvål,Tone M %A , %+ Department of Heart Disease, Haukeland University Hospital, Postbox 1400, Bergen, 5020, Norway, 47 99044635, tone.merete.norekval@helse-bergen.no %K eHealth literacy %K eHEALS %K health literacy %K percutaneous coronary intervention %K psychometric properties %K validation %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information. Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention. Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores. Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=–0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI –21.40 to –17.21, P<.001), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified. Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies. Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612 %M 32720900 %R 10.2196/17312 %U https://www.jmir.org/2020/7/e17312 %U https://doi.org/10.2196/17312 %U http://www.ncbi.nlm.nih.gov/pubmed/32720900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18831 %T Mapping of Health Literacy and Social Panic Via Web Search Data During the COVID-19 Public Health Emergency: Infodemiological Study %A Xu,Chenjie %A Zhang,Xinyu %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin, 300070, China, 86 13820046130, wangyg@tmu.edu.cn %K COVID-19 %K China %K Baidu %K infodemiology %K web search %K internet %K public health %K emergency %K outbreak %K infectious disease %K pandemic %K health literacy %D 2020 %7 2.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a type of pneumonia caused by a novel coronavirus that was discovered in 2019. As of May 6, 2020, 84,407 cases and 4643 deaths have been confirmed in China. The Chinese population has expressed great concern since the COVID-19 outbreak. Meanwhile, an average of 1 billion people per day are using the Baidu search engine to find COVID-19–related health information. Objective: The aim of this paper is to analyze web search data volumes related to COVID-19 in China. Methods: We conducted an infodemiological study to analyze web search data volumes related to COVID-19. Using Baidu Index data, we assessed the search frequencies of specific search terms in Baidu to describe the impact of COVID-19 on public health, psychology, behaviors, lifestyles, and social policies (from February 11, 2020, to March 17, 2020). Results: The search frequency related to COVID-19 has increased significantly since February 11th. Our heat maps demonstrate that citizens in Wuhan, Hubei Province, express more concern about COVID-19 than citizens from other cities since the outbreak first occurred in Wuhan. Wuhan citizens frequently searched for content related to “medical help,” “protective materials,” and “pandemic progress.” Web searches for “return to work” and “go back to school” have increased eight-fold compared to the previous month. Searches for content related to “closed community and remote office” have continued to rise, and searches for “remote office demand” have risen by 663% from the previous quarter. Employees who have returned to work have mainly engaged in the following web searches: “return to work and prevention measures,” “return to work guarantee policy,” and “time to return to work.” Provinces with large, educated populations (eg, Henan, Hebei, and Shandong) have been focusing on “online education” whereas medium-sized cities have been paying more attention to “online medical care.” Conclusions: Our findings suggest that web search data may reflect changes in health literacy, social panic, and prevention and control policies in response to COVID-19. %M 32540844 %R 10.2196/18831 %U https://www.jmir.org/2020/7/e18831 %U https://doi.org/10.2196/18831 %U http://www.ncbi.nlm.nih.gov/pubmed/32540844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18155 %T Association of eHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study %A Tsukahara,Saki %A Yamaguchi,Satoshi %A Igarashi,Futaba %A Uruma,Reiko %A Ikuina,Naomi %A Iwakura,Kaori %A Koizumi,Keisuke %A Sato,Yasunori %+ Collage of Liberal Arts and Sciences, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan, 81 43 251 1111, y-satoshi@mvb.biglobe.ne.jp %K college student %K ehealth literacy %K ehealth %K eHealth Literacy Scale %K health literacy %K lifestyle %K university student %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan. Objective: The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university. Methods: A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses. Results: The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001). Conclusions: The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines. %M 32579126 %R 10.2196/18155 %U http://www.jmir.org/2020/6/e18155/ %U https://doi.org/10.2196/18155 %U http://www.ncbi.nlm.nih.gov/pubmed/32579126 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17014 %T Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study %A Tariq,Amina %A Khan,Shanchita R %A Basharat,Amna %+ School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, O Block, D Wing, Victoria Park Road, Kelvin Grove, QLD 4059, Australia, 61 7 3138 5612, a.tariq@qut.edu.au %K internet %K digital health %K eHealth %K eHealth literacy %K internet use %K physical activity %K university students %K Pakistan %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy—the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision—is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries. Objective: The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non–health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake. Methods: Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant. Results: In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants. Conclusions: University students in non–health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries. %M 32519974 %R 10.2196/17014 %U http://www.jmir.org/2020/6/e17014/ %U https://doi.org/10.2196/17014 %U http://www.ncbi.nlm.nih.gov/pubmed/32519974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15171 %T Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons %A Witchel,Harry J %A Thompson,Georgina A %A Jones,Christopher I %A Westling,Carina E I %A Romero,Juan %A Nicotra,Alessia %A Maag,Bruno %A Critchley,Hugo D %+ Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre for Medical Research, Brighton, United Kingdom, 44 1273 873 549, h.witchel@bsms.ac.uk %K communication %K health communication %K persuasive communication %K online social networking %K trust %K trustworthiness %K credibility %K typographical errors %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The written format and literacy competence of screen-based texts can interfere with the perceived trustworthiness of health information in online forums, independent of the semantic content. Unlike in professional content, the format in unmoderated forums can regularly hint at incivility, perceived as deliberate rudeness or casual disregard toward the reader, for example, through spelling errors and unnecessary emphatic capitalization of whole words (online shouting). Objective: This study aimed to quantify the comparative effects of spelling errors and inappropriate capitalization on ratings of trustworthiness independently of lay insight and to determine whether these changes act synergistically or additively on the ratings. Methods: In web-based experiments, 301 UK-recruited participants rated 36 randomized short stimulus excerpts (in the format of information from an unmoderated health forum about multiple sclerosis) for trustworthiness using a semantic differential slider. A total of 9 control excerpts were compared with matching error-containing excerpts. Each matching error-containing excerpt included 5 instances of misspelling, or 5 instances of inappropriate capitalization (shouting), or a combination of 5 misspelling plus 5 inappropriate capitalization errors. Data were analyzed in a linear mixed effects model. Results: The mean trustworthiness ratings of the control excerpts ranged from 32.59 to 62.31 (rating scale 0-100). Compared with the control excerpts, excerpts containing only misspellings were rated as being 8.86 points less trustworthy, those containing inappropriate capitalization were rated as 6.41 points less trustworthy, and those containing the combination of misspelling and capitalization were rated as 14.33 points less trustworthy (P<.001 for all). Misspelling and inappropriate capitalization show an additive effect. Conclusions: Distinct indicators of incivility independently and additively penalize the perceived trustworthiness of online text independently of lay insight, eliciting a medium effect size. %M 32519676 %R 10.2196/15171 %U https://www.jmir.org/2020/6/e15171 %U https://doi.org/10.2196/15171 %U http://www.ncbi.nlm.nih.gov/pubmed/32519676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17519 %T Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study %A Vollbrecht,Hanna %A Arora,Vineet %A Otero,Sebastian %A Carey,Kyle %A Meltzer,David %A Press,Valerie G %+ Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC2007, Chicago, IL, 60637, United States, 1 773 702 5170, vpress@bsd.uchicago.edu %K health literacy %K digital literacy %K hospitalization %K technology %D 2020 %7 4.6.2020 %9 Short Paper %J J Med Internet Res %G English %X Background: Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. Although prior research studied the role of health literacy in technology access/use among outpatients, hospitalized patient populations have not been investigated in this context. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the digital literacy of hospitalized patients across health literacy levels is paramount. Objective: We sought to determine the relationship between health literacy level and technological access, use, and capability among hospitalized patients. Methods: Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality of care study. Participants’ health literacy level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses, and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed. Using Bonferroni correction for the 18 tests, the threshold P value for significance was <.003. Results: Among 502 enrolled participants, the mean age was 51 years, 71.3% (358/502) were African American, half (265/502, 52.8%) were female, and half (253/502, 50.4%) had at least some college education. Over one-third (191/502, 38.0%) of participants had low health literacy. The majority of participants owned devices (owned a smartphone: 116/173, 67.1% low health literacy versus 235/300, 78.3% adequate health literacy, P=.007) and had used the Internet previously (143/189, 75.7% low health literacy versus 281/309, 90.9% adequate health literacy, P<.001). Participants with low health literacy were more likely to report needing help performing online tasks (133/189, 70.4% low health literacy versus 135/303, 44.6% adequate health literacy, P<.001). In the multivariate analysis, when adjusting for age, race, gender, and education level, we found that low health literacy was not significantly associated with a lower likelihood of owning smartphones (OR: 0.8, 95% CI 0.5-1.4; P=.52) or using the internet ever (OR: 0.5, 95% CI 0.2-0.9; P=.02). However, low health literacy remained significantly associated with a higher likelihood of needing help performing any online task (OR: 2.2, 95% CI 1.3-3.6; P=.002). Conclusions: The majority of participants with low health literacy had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. The barriers patients face in using online health information and other health information technology may be more related to online capabilities rather than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across digital literacy levels can both understand and use them. %M 32496196 %R 10.2196/17519 %U https://www.jmir.org/2020/6/e17519 %U https://doi.org/10.2196/17519 %U http://www.ncbi.nlm.nih.gov/pubmed/32496196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e14670 %T The Role of Psychological Factors in Older Adults’ Readiness to Use eHealth Technology: Cross-Sectional Questionnaire Study %A Knapova,Lenka %A Klocek,Adam %A Elavsky,Steriani %+ Institute for Research on Children, Youth and Family, Masaryk University, Joštova 218/10, Brno, 60200, Czech Republic, 420 549498272, knapova@mail.muni.cz %K eHealth %K information technology %K need for cognitive closure %K elderly %D 2020 %7 28.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technology (ICT) use among older adults has been on the rise in recent years. However, the predictors and mechanisms behind older adults’ acceptance and use of ICT are not clear. Objective: This study aimed to systematically describe ICT usage among Czech older adults and to evaluate the factors influencing their ICT use and readiness to use digital technology to promote health (eHealth readiness). The primary focus was on psychological factors and the role of persons close to older adults. Methods: The research utilized cross-sectional survey data from a quota-based sample of Czech older adults (>50 years) and persons close to them further referred to as close persons (N=250 dyads). A structural equation modeling framework was used to evaluate relationships between psychological factors, ICT use, and eHealth readiness. Results: Czech older adults’ use of ICT is low with the exception of cell phone usage (cell phone usage by 173/250, 69.2%; other devices used by 50/250, 20.0% of older adults or less). Apart from age (β=−.21; P<.001), eHealth readiness was predicted by ICT use (β=.65; P<.001). eHealth readiness was also indirectly affected by the need for cognitive closure (NFCC): individuals with a high need for closure perceived more barriers to ICT (β=.23; P=.01) and more reported barriers were linked to lower ICT usage (β=−.21; P=.001). The expected positive relationships between eHealth readiness of persons close to older adults and ICT use and eHealth readiness of older adults were not significant, but the total effect of eHealth readiness of persons close to older adults on eHealth readiness of older adults was positive and significant (β=.18; P=.01), indicating some level of influence of persons close to them on older adults’ attitudes and behaviors. Conclusions: This study provided the first systematic examination of Czech older adults’ ICT usage and eHealth readiness. Novel predictors (NFCC and close persons’ variables) were evaluated and yielded actionable results. More research is needed to clarify the role of persons close to older adults. %M 32348251 %R 10.2196/14670 %U http://www.jmir.org/2020/5/e14670/ %U https://doi.org/10.2196/14670 %U http://www.ncbi.nlm.nih.gov/pubmed/32348251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16281 %T Internet-Based Health Information–Seeking Behavior of Students Aged 12 to 14 Years: Mixed Methods Study %A Maitz,Emanuel %A Maitz,Katharina %A Sendlhofer,Gerald %A Wolfsberger,Christina %A Mautner,Selma %A Kamolz,Lars-Peter %A Gasteiger-Klicpera,Barbara %+ Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz, A-8036, Austria, 43 6604756105, emanuel.maitz@stud.medunigraz.at %K internet-based health information–seeking behavior %K eHealth literacy %K children and adolescents %K mixed methods study %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Many children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents. Objective: The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored. Methods: A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS. Results: The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (rs=0.794, P=.002). Conclusions: Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed. %M 32209532 %R 10.2196/16281 %U https://www.jmir.org/2020/5/e16281 %U https://doi.org/10.2196/16281 %U http://www.ncbi.nlm.nih.gov/pubmed/32209532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16795 %T An Informatics Framework to Assess Consumer Health Language Complexity Differences: Proof-of-Concept Study %A Yu,Biyang %A He,Zhe %A Xing,Aiwen %A Lustria,Mia Liza A %+ Florida State University, School of Information, 142 Collegiate Loop, Tallahassee, FL, 32306, United States, 1 850 644 5775, zhe@fsu.edu %K consumer health informatics %K readability %K digital divide %K health literacy %D 2020 %7 21.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The language gap between health consumers and health professionals has been long recognized as the main hindrance to effective health information comprehension. Although providing health information access in consumer health language (CHL) is widely accepted as the solution to the problem, health consumers are found to have varying health language preferences and proficiencies. To simplify health documents for heterogeneous consumer groups, it is important to quantify how CHLs are different in terms of complexity among various consumer groups. Objective: This study aimed to propose an informatics framework (consumer health language complexity [CHELC]) to assess the complexity differences of CHL using syntax-level, text-level, term-level, and semantic-level complexity metrics. Specifically, we identified 8 language complexity metrics validated in previous literature and combined them into a 4-faceted framework. Through a rank-based algorithm, we developed unifying scores (CHELC scores [CHELCS]) to quantify syntax-level, text-level, term-level, semantic-level, and overall CHL complexity. We applied CHELCS to compare posts of each individual on online health forums designed for (1) the general public, (2) deaf and hearing-impaired people, and (3) people with autism spectrum disorder (ASD). Methods: We examined posts with more than 4 sentences of each user from 3 health forums to understand CHL complexity differences among these groups: 12,560 posts from 3756 users in Yahoo! Answers, 25,545 posts from 1623 users in AllDeaf, and 26,484 posts from 2751 users in Wrong Planet. We calculated CHELCS for each user and compared the scores of 3 user groups (ie, deaf and hearing-impaired people, people with ASD, and the public) through 2-sample Kolmogorov-Smirnov tests and analysis of covariance tests. Results: The results suggest that users in the public forum used more complex CHL, particularly more diverse semantics and more complex health terms compared with users in the ASD and deaf and hearing-impaired user forums. However, between the latter 2 groups, people with ASD used more complex words, and deaf and hearing-impaired users used more complex syntax. Conclusions: Our results show that the users in 3 online forums had significantly different CHL complexities in different facets. The proposed framework and detailed measurements help to quantify these CHL complexity differences comprehensively. The results emphasize the importance of tailoring health-related content for different consumer groups with varying CHL complexities. %M 32436849 %R 10.2196/16795 %U https://www.jmir.org/2020/5/e16795 %U https://doi.org/10.2196/16795 %U http://www.ncbi.nlm.nih.gov/pubmed/32436849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e13746 %T An Electronic Medication Module to Improve Health Literacy in Patients With Type 2 Diabetes Mellitus: Pilot Randomized Controlled Trial %A Seidling,Hanna Marita %A Mahler,Cornelia %A Strauß,Beate %A Weis,Aline %A Stützle,Marion %A Krisam,Johannes %A , %A Szecsenyi,Joachim %A Haefeli,Walter Emil %+ Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany, 49 6221 56 8740, walter.emil.haefeli@med.uni-heidelberg.de %K medication self-management %K patient empowerment %K health literacy %K chronic diseases %K type 2 diabetes mellitus %K electronic health record %K PEPA %K electronic medication module %K structured medication review %D 2020 %7 28.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In primary care, patients play a crucial role in managing care processes and handling drug treatment. A decisive factor for success is their health literacy, and several interventions have been introduced to support patients in fulfilling their responsibility. Objective: The aim of this study is to assess the influence of such an intervention (ie, a medication module) within a patient-led electronic health record on patients’ health literacy. Methods: We conducted a randomized controlled study among community-dwelling patients with type 2 diabetes mellitus. Patients were recruited from primary care practices. After randomization, patients either had access to an internet-based medication module allowing them to store their medication information, look up drug information, and print a medication schedule (intervention group), or they received an information brochure on the importance of medication schedules (control group). After 4-8 weeks, all patients were invited to attend a structured medication review (ie, follow-up visit). Data were collected via questionnaires before the start of the intervention and during the follow-up visit. The main outcome measure was the mean difference in health literacy between baseline and follow-up assessments of patients in the control and intervention groups. Results: Of 116 recruited patients, 107 (92.2%) completed the follow-up assessment and were eligible for intention-to-treat analyses. Only 73 patients, of which 29 were in the intervention group, followed the study protocol and were eligible for per-protocol analysis. No differences in overall health literacy were observed in either the intention-to-treat or in the per-protocol cohorts. Reasons for a null effect might be that the cohort was not particularly enriched with participants with low health literacy, thus precluding measurable improvement (ie, ceiling effect). Moreover, the success of implementation was considered poor because both the correct application of the study procedure (ie, randomization according to the protocol and dropout of 29 patients) and the actual interaction with the medication module was modest (ie, dropout of 9 patients). Conclusions: The conduct of this randomized controlled study was challenging, leaving it open whether inadequate implementation, too short of a duration, or insufficient efficacy of the intervention, as such, contributed to the null effect of this study. This clearly outlines the value of piloting complex interventions and the accompanying process evaluations. %M 32343246 %R 10.2196/13746 %U http://formative.jmir.org/2020/4/e13746/ %U https://doi.org/10.2196/13746 %U http://www.ncbi.nlm.nih.gov/pubmed/32343246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14134 %T Influence of Health Literacy on Effects of Patient Rating Websites: Survey Study Using a Hypothetical Situation and Fictitious Doctors %A Schulz,Peter Johannes %A Rothenfluh,Fabia %+ Università della Svizzera Italiana, Via G Buffi, 13, Lugano, 6900, Switzerland, 41 58 666 4724, schulzp@usi.ch %K physician rating websites %K warning messages %K experiment %K physician competence assessment %K patient feedback %D 2020 %7 6.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physician rating websites (PRWs) are a device people use actively and passively, although their objective capabilities are insufficient when it comes to judging the medical performance and qualification of physicians. PRWs are an innovation born of the potential of the Internet and boosted very much by the longstanding policy of improving and encouraging patient participation in medical decision-making. A mismatch is feared between patient motivations to participate and their capabilities of doing so well. Awareness of such a mismatch might contribute to some skepticism of patient-written physician reviews on PRWs. Objective: We intend to test whether health literacy is able to dampen the effects that a patient-written review of a physician’s performance might have on physician choice. Methods: An experiment was conducted within a survey interview. Participants were put into a fictitious decision situation in which they had to choose between two physicians on the basis of their profiles on a PRW. One of the physician profiles contained the experimental stimulus in the form of a friendly and a critical written review. The dependent variable was physician choice. An attitude differential, trust differential, and two measures of health literacy, the newest vital sign as an example of a performance-based measure and eHealth Literacy Scale as an example of a perception-based measure, were tested for roles as intermediary variables. Analysis traced the influence of the review tendency on the dependent variables and a possible moderating effect of health literacy on these influences. Results: Reviews of a physician’s competence and medical skill affected participant choice of a physician. High health literacy dampened these effects only in the case of the perception-based measure and only for the negative review. Correspondingly, the effect of the review tendency appeared to be stronger for the positive review. Attitudes and trust only affected physician choice when included as covariants, considerably increasing the variance explained by regression models. Conclusions: Findings sustain physician worries that even one negative PRW review can affect patient choice and damage doctors’ reputations. Hopes that health literacy might raise awareness of the poor basis of physician reviews and ratings given by patients have some foundation. %M 32250275 %R 10.2196/14134 %U https://www.jmir.org/2020/4/e14134 %U https://doi.org/10.2196/14134 %U http://www.ncbi.nlm.nih.gov/pubmed/32250275 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 1 %P e17163 %T Relationship Between Health Literacy and Social Support and the Quality of Life in Patients With Cancer: Questionnaire Study %A Kobayashi,Rei %A Ishizaki,Masato %+ Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 5925, rei-kobayashi@hotmail.co.jp %K health literacy %K social support %K quality of life %K neoplasms %K health communication %D 2020 %7 19.3.2020 %9 Original Paper %J J Participat Med %G English %X Background: Low health literacy is associated with factors such as not taking medication as prescribed as well as poor health status and increased hospitalization and mortality risk, and has been identified as a risk factor for decreased physical function in older individuals. Health literacy is becoming an increasingly important issue because of the increased number of people affected by cancer who must make complicated treatment decisions. Health literacy has been shown to be positively associated with quality of life (QOL), and social support has been identified as important for addressing health-related problems and reducing the relative risk of mortality in patients with cancer. However, few studies have examined the relationship between health literacy, social support, age, and QOL. Objective: The aim of this study is to examine the effects of health literacy, social support, and age on the QOL of patients with cancer. Methods: An anonymous, self-administered online questionnaire was conducted from March 28 to 30, 2017, in Japan on patients with lung, stomach, or colon cancer that were voluntarily registered with an internet survey company. The survey covered basic attributes, health literacy, social support, and QOL. The European Health Literacy Survey Questionnaire, a comprehensive measure of health literacy instrument, was used to measure health literacy; the Japanese version of the Social Support Scale was used to measure social support; and the Japanese version of the Functional Assessment of Cancer Therapy-General (7-item version) assessment tool was used to measure QOL. Results: A total of 735 survey invitations were randomly sent to patients with lung, stomach, or colorectal cancer, and responses were obtained from 619 (82.2% response rate). Significant effects on the QOL in patients with lung, stomach, or colon cancer were observed for health literacy, social support, and age, and for the interactions of health literacy and social support and of social support and age. Health literacy, social support, and the interaction between these variables also showed a significant effect on the QOL in patients 50 years or older, but not on those younger than 50 years. Conclusions: The results of this study revealed that higher health literacy, social support, and age were associated with the QOL in patients with cancer. In addition, the relationship with QOL was stronger for social support than for health literacy. These findings suggest the importance of health literacy and social support and indicate that social support has a greater effect on QOL than does health literacy, while the QOL in patients with cancer aged younger than 50 years was lower than that of those 50 years or older. Therefore, elucidating the needs of these patients and strengthening social support based on those needs may improve their QOL. %R 10.2196/17163 %U http://jopm.jmir.org/2020/1/e17163/ %U https://doi.org/10.2196/17163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e14492 %T Electronic Health Literacy in Swiss-German Parents: Cross-Sectional Study of eHealth Literacy Scale Unidimensionality %A Juvalta,Sibylle %A Kerry,Matthew J %A Jaks,Rebecca %A Baumann,Isabel %A Dratva,Julia %+ Institute of Health Sciences, Department of Health, Zurich University of Applied Sciences, Technikumstrasse 71, Winterthur, 8400, Switzerland, 41 58 934 41 79, matthewj.kerry@zhaw.ch %K health literacy %K eHealth %K eHEALS %K unidimensionality %K multidimensionality %K factor analysis %K item response theory (IRT) %K bifactor model %K validity %D 2020 %7 13.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents often use digital media to search for information related to their children’s health. As the quantity and quality of digital sources meant specifically for parents expand, parents’ digital health literacy is increasingly important to process the information they retrieve. One of the earliest developed and widely used instruments to assess digital health literacy is the self-reported eHealth Literacy Scale (eHEALS). However, the eHEALS has not been psychometrically validated in a sample of parents. Given the inconsistency of the eHEALS underlying factor structure across previous reports, it is particularly important for validation to occur. Objective: This study aimed to determine the factor structure of the German eHEALS measure in a sample of parents by adopting classic and modern psychometric approaches. In particular, this study sought to identify the eHEALS validity as a unidimensional index as well as the viability for potential subscales. Methods: A cross-sectional design was used across two purposive sampling frames: online and paper administrations. Responses were collected between January 2018 and May 2018 from 703 Swiss-German parents. In addition to determining the sampling characteristics, we conducted exploratory factor analysis of the eHEALS by considering its ordinal structure using polychoric correlations. This analysis was performed separately for online–based and paper–based responses to examine the general factor strength of the eHEALS as a unidimensional index. Furthermore, item response theory (IRT) analyses were conducted by fitting eHEALS to a bifactor model to further inspect its unidimensionality and subscale viability. Results: Parents in both samples were predominantly mothers (622/703, 88.5%), highly educated (538/703, 76.9%), of Swiss nationality (489/703, 71.8%), and living with a partner (692/703, 98.4%). Factor analyses of the eHEALS indicated the presence of a strong general factor across both paper and online samples, and the Wilcoxon rank-sum test indicated that the eHEALS total sum score was not significantly different between the paper and online samples (P=.12). Finally, the IRT analyses indicated negligible multidimensionality, insufficient subscale reliability after accounting for the eHEALS general factor, and a reduced subset of items that could serve as a unidimensional index of the eHEALS across the paper and online samples. Conclusions: The German eHEALS evidenced good psychometric properties in a parent-specific study sample. Factor analyses indicated a strong general factor across purposively distinct sample frames (online and paper). IRT analyses validated the eHEALS as a unidimensional index while failing to find support for subscale usage. %M 32167476 %R 10.2196/14492 %U https://www.jmir.org/2020/3/e14492 %U https://doi.org/10.2196/14492 %U http://www.ncbi.nlm.nih.gov/pubmed/32167476 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e16095 %T The Difficulty of German Information Booklets on Psoriasis and Psoriatic Arthritis: Automated Readability and Vocabulary Analysis %A Wiesner,Martin %A Zowalla,Richard %A Pobiruchin,Monika %+ Department of Medical Informatics, Heilbronn University, Max-Planck-Str 39, Heilbronn, 74081, Germany, 49 71315046947, martin.wiesner@hs-heilbronn.de %K readability %K psoriasis %K psoriatic arthritis %K health literacy %K health education %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: Information-seeking Psoriasis or Psoriatic Arthritis patients are confronted with numerous educational materials when looking through the internet. Literature suggests that only 17.0%-21.4% of (Psoriasis, Psoriatic Arthritis) patients have a good level of knowledge about psoriasis treatment and self-management. A study from 1994 found that English Psoriasis/Psoriatic Arthritis brochures required a reading level between grades 8-12 to be understandable, which was confirmed in a follow-up study 20 years later. As readability of written health-related text material should not exceed the sixth-grade level, Psoriasis/Psoriatic Arthritis material seems to be ill-suited to its target audience. However, no data is available on the readability levels of Psoriasis/Psoriatic Arthritis brochures for German-speaking patients, and both the volume and their scope are unclear. Objective: This study aimed to analyze freely available educational materials for Psoriasis/Psoriatic Arthritis patients written in German, quantifying their difficulty by assessing both the readability and the vocabulary used in the collected brochures. Methods: Data collection was conducted manually via an internet search engine for Psoriasis/Psoriatic Arthritis–specific material, published as PDF documents. Next, raw text was extracted, and a computer-based readability and vocabulary analysis was performed on each brochure. For the readability analysis, we applied the Flesch Reading Ease (FRE) metric adapted for the German language, and the fourth Vienna formula (WSTF). To assess the laymen-friendliness of the vocabulary, the computation of an expert level was conducted using a specifically trained Support Vector Machine classifier. A two-sided, two-sample Wilcoxon test was applied to test whether the difficulty of brochures of pair-wise topic groups was different from each other. Results: In total, 68 brochures were included for readability assessment, of which 71% (48/68) were published by pharmaceutical companies, 22% (15/68) by nonprofit organizations, and 7% (5/68) by public institutions. The collection was separated into four topic groups: basic information on Psoriasis/Psoriatic Arthritis (G1/G2), lifestyle, and behavior with Psoriasis/Psoriatic Arthritis (G3/G4), medication and therapy guidance (G5), and other topics (G6). On average, readability levels were comparatively low, with FRE=31.58 and WSTF=11.84. However, two-thirds of the educational materials (69%; 47/68) achieved a vocabulary score ≤4 (ie, easy, very easy) and were, therefore, suitable for a lay audience. Statistically significant differences between brochure groups G1 and G3 for FRE (P=.0001), WSTF (P=.003), and vocabulary measure (L) (P=.01) exist, as do statistically significant differences for G2 and G4 in terms of FRE (P=.03), WSTF (P=.03) and L (P=.03). Conclusions: Online Psoriasis/Psoriatic Arthritis patient education materials in German require, on average, a college or university education level. As a result, patients face barriers to understanding the available material, even though the vocabulary used seems appropriate. For this reason, publishers of Psoriasis/Psoriatic Arthritis brochures should carefully revise their educational materials to provide easier and more comprehensible information for patients with lower health literacy levels. %R 10.2196/16095 %U http://derma.jmir.org/2020/1/e16095/ %U https://doi.org/10.2196/16095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16316 %T The Swedish Version of the Electronic Health Literacy Scale: Prospective Psychometric Evaluation Study Including Thresholds Levels %A Wångdahl,Josefin %A Jaensson,Maria %A Dahlberg,Karuna %A Nilsson,Ulrica %+ Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, Huddinge, Sweden, 46 8 524 838 22, ulrica.nilsson@ki.se %K eHealth %K literacy %K internet %K psychometrics %D 2020 %7 24.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To enhance the efficacy of information and communication, health care has increasingly turned to digitalization. Electronic health (eHealth) is an important factor that influences the use and receipt of benefits from Web-based health resources. Consequently, the concept of eHealth literacy has emerged, and in 2006 Norman and Skinner developed an 8-item self-report instrument to measure these skills: the eHealth Literacy Scale (eHEALS). However, the eHEALS has not been tested for reliability and validity in the general Swedish population and no threshold values have been established. Objective: The aim of this study was to translate and adapt eHEALS into a Swedish version; evaluate convergent validity and psychometric properties; and determine threshold levels for inadequate, problematic, and sufficient eHealth literacy. Methods: Prospective psychometric evaluation study included 323 participants equally distributed between sexes with a mean age of 49 years recruited from 12 different arenas. Results: There were some difficulties translating the English concept health resources. This resulted in this concept being translated as health information (ie, Hälsoinformation in Swedish). The eHEALS total score was 29.3 (SD 6.2), Cronbach alpha .94, Spearman-Brown coefficient .96, and response rate 94.6%. All a priori hypotheses were confirmed, supporting convergent validity. The test-retest reliability indicated an almost perfect agreement, .86 (P<.001). An exploratory factor analysis found one component explaining 64% of the total variance. No floor or ceiling effect was noted. Thresholds levels were set at 8 to 20 = inadequate, 21 to 26 = problematic, and 27 to 40 = sufficient, and there were no significant differences in distribution of the three levels between the Swedish version of eHEALS and the HLS-EU-Q16. Conclusions: The Swedish version of eHEALS was assessed as being unidimensional with high internal consistency of the instrument, making the reliability adequate. Adapted threshold levels for inadequate, problematic, and sufficient levels of eHealth literacy seem to be relevant. However, there are some linguistic issues relating to the concept of health resources. %M 32130168 %R 10.2196/16316 %U https://mhealth.jmir.org/2020/2/e16316 %U https://doi.org/10.2196/16316 %U http://www.ncbi.nlm.nih.gov/pubmed/32130168 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14496 %T A Weekly, Evidence-Based Health Letter for Caregivers (90Second Caregiver): Usability Study %A Milios,Athena %A McGrath,Patrick %A Baillie,Hannah %+ Centre for Research in Family Health, IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, 1 9025790269, athena.milios1@gmail.com %K caregivers %K mental health %K usability %K depression %K anxiety %K stigma %K hope %K health information %K persuasive design %D 2020 %7 12.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers are family members or close friends who provide unpaid help to individuals with acute or chronic health conditions so that they can manage daily life tasks. The greatest source of health information is the internet for meeting the needs of caregivers. However, information on the internet may not be scientifically valid, it may be written in language that is difficult to read, and is often in very large doses. 90Second Caregiver is a health letter whose aim is to disseminate knowledge to caregivers in a user-friendly, weekly format, in order to improve their wellbeing. Objective: The main objective was to test a sample of 90Second Caregiver health letters in order to assess their usability and to optimize the design and content of the health letters. Methods: Usability research themes were assessed using semi-structured phone interviews, incorporating the Think Aloud method with retrospective questioning. Results: Usability was assessed in the context of five main themes: understandability and learnability, completeness, relevance, and quality and credibility of the health letter content, as well as design and format. Caregivers generally provided positive feedback regarding the usability of the letters. The usability feedback was used to refine 90Second Caregiver in order to improve the design and content of the series. Based on the results of this study, it may be of maximum benefit to target the series towards individuals who are new to caregiving or part-time caregivers, given that these caregivers of the sample found the letters more useful and relevant and had the most positive usability experiences. Conclusions: The findings assisted in the improvement of the 90Second Caregiver template, which will be used to create future health letters and refine the letters that have already been created. The findings have implications for who the 90Second Caregiver series should be targeting (ie, newer or part-time caregivers) in order to be maximally impactful in improving mental health and wellbeing-related outcomes for caregivers, such as self-efficacy and caregiving knowledge. The results of this study may be generalizable to the examination of other electronic health information formats, making them valuable to future researchers testing the usability of health information products. In addition, the methods used in this study are useful for usability hypothesis generation. Lastly, our 90Second delivery approach can generate information useful for a set of similar products (eg, weekly health letters targeted towards other conditions/populations). %M 32049064 %R 10.2196/14496 %U https://formative.jmir.org/2020/2/e14496 %U https://doi.org/10.2196/14496 %U http://www.ncbi.nlm.nih.gov/pubmed/32049064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13077 %T Digital Competencies and Attitudes Toward Digital Adherence Solutions Among Elderly Patients Treated With Novel Anticoagulants: Qualitative Study %A Herrmann,Maximilian %A Boehme,Philip %A Hansen,Arne %A Jansson,Katharina %A Rebacz,Patrick %A Ehlers,Jan P %A Mondritzki,Thomas %A Truebel,Hubert %+ Research & Development, Pharmaceuticals, Bayer Aktiengesellschaft, Apratherweg 18, Wuppertal, 42113, Germany, 49 202360, hubert.truebel@bayer.com %K medication adherence %K eHealth %K mHealth %K digital health %K smartphone %K elderly patients %K compliance %K digital device %K digital competencies %K grounded theory %K delivery of health care %K diffusion of innovation %D 2020 %7 24.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonadherence to medication is a driver of morbidity and mortality, and complex medication regimens in patients with chronic diseases foster the problem. Digital technology might help, but despite numerous solutions being developed, none are currently widely used, and acceptance rates remain low, especially among the elderly. Objective: This study aimed to better understand and operationalize how new digital solutions can be evaluated. Particularly, the goal was to identify factors that help digital approaches targeting adherence to become more widely accepted. Methods: A qualitative study using a conceptual grounded theory approach was conducted. We included patients aged 65 years and older who routinely took new oral anticoagulants. To generate theses about the digital competencies of the target group with daily medication intake, face-to-face interviews were conducted, recorded, and anonymized. After coding the interviews, categories were generated, discussed, and combined with several theses until saturation of the statements was reached. Results: The methodological approach led to the finding that after interviews in 20 of 77 potentially available patients, a saturation of statements was reached. The average patient’s age was 75 years, and 50% (10/20) of the subjects were female. The data identified five main coding categories—Diseases and medicine, Technology, Autonomy, Patient narrative, and Attitude toward technologies—each including positive and negative subcategories. Main categories and subcategories were summarized as Adherence Radar, which can be considered as a framework to assess the potential of adherence solutions in the process of prototyping and can be applied to all adherence tools in a holistic manner. Conclusions: The Adherence Radar can be used to increase the acceptance rate of digital solutions targeting adherence. For a patient-centric design, an app should be adapted to the individual patient’s needs. According to our results, this application should be based on gender and educational background as well as the individual physician-patient relationship. If used in a proper, individualized manner, digital adherence solutions could become a new cornerstone for the treatment of chronically ill individuals. %M 32012049 %R 10.2196/13077 %U http://www.jmir.org/2020/1/e13077/ %U https://doi.org/10.2196/13077 %U http://www.ncbi.nlm.nih.gov/pubmed/32012049 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e12504 %T Adapting the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) in a Sample of Greek and Cypriot Carers of People With Dementia: Reliability and Validation Study %A Efthymiou,Areti %A Middleton,Nicos %A Charalambous,Andreas %A Papastavrou,Evridiki %+ Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, ZT3, 3rd Floor, 15 Vragadinou Street, Limassol, 3041, Cyprus, 357 25002285, arefthymiou@yahoo.com %K eHealth %K literacy %K scales %K carers %K technology %K chronic disease %D 2019 %7 28.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills. Objective: This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers. Methods: The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored. Results: The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2). Conclusions: eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8080 %M 31778120 %R 10.2196/12504 %U http://www.jmir.org/2019/11/e12504/ %U https://doi.org/10.2196/12504 %U http://www.ncbi.nlm.nih.gov/pubmed/31778120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13140 %T Electronic Health Literacy and Dietary Behaviors in Taiwanese College Students: Cross-Sectional Study %A Yang,Shu Ching %A Luo,Yi Fang %A Chiang,Chia-Hsun %+ Institute of Education, National Sun Yat-Sen University, 70 Lienhai Rd, Kaohsiung, Taiwan, 886 7 5251521, d996050002@student.nsysu.edu.tw %K college %K dietary %K health literacy %K students %D 2019 %7 26.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the recognized importance of preventing poor dietary behaviors during adolescence, we need a better understanding of college students’ dietary behaviors. Studies have found that individual factors and electronic health (eHealth) literacy may affect one’s dietary behaviors. However, few studies have fully investigated the effect of the three levels of eHealth literacy (functional, interactive, and critical) and the interactive effect of individual factors (eg, gender, monthly expenses, and frequency of cooking) and the three levels of eHealth literacy on the four aspects of dietary behaviors (consumer health, balanced diet, regular eating habits, and unhealthy food intake). Objective: This study aimed to investigate whether individual differences and higher eHealth literacy are associated with more positive dietary behaviors and less unhealthy dietary intake. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Dietary Behaviors Scale is a 14-item instrument developed to measure four aspects of dietary behaviors of college students. A questionnaire was administered to collect background information about participants’ gender, monthly expenses, and frequency of cooking. A national sample of college students was surveyed, and 813 responses were obtained. We conducted a multiple regression analysis to examine the association among individual factors, eHealth literacy, and dietary behaviors. Results: This study found that functional eHealth literacy was negatively related to unhealthy food intake (beta=−.11; P=.01), and interactive eHealth literacy was positively related to balanced diet (beta=.25; P<.001) and consumer health (beta=.15; P=.02). Moreover, critical eHealth literacy was positively related to consumer health (beta=.30; P<.001) and regular eating habits (beta=.20; P=.002). Finally, the interactive effect between gender and interactive eHealth literacy was negatively related to balanced diet (beta=−.22; P<.001). The interactive effect between monthly expenses and functional eHealth literacy was positively related to balanced diet (beta=.07; P=.03), although the interactive effect between monthly expenses and critical eHealth literacy was negatively related to balanced diet (beta=−.10; P=.047). Conclusions: This study showed that Taiwanese college students with higher functional eHealth literacy were more likely to engage in fewer unhealthy food consumption practices. Those who had higher interactive and critical eHealth literacy were more likely to engage in positive dietary behaviors than those with functional eHealth literacy. Surprisingly, females with high interactive eHealth literacy were more likely to have a poor balanced diet. In contrast, students with higher monthly expenses and higher functional eHealth literacy were more likely to have a balanced diet. However, students with higher monthly expenses and higher critical eHealth literacy were less likely to maintain a balanced diet. %M 31769760 %R 10.2196/13140 %U http://www.jmir.org/2019/11/e13140/ %U https://doi.org/10.2196/13140 %U http://www.ncbi.nlm.nih.gov/pubmed/31769760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13786 %T A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study %A Therkildsen,Signe Bülow %A Hansen,Linda Houlind %A Jensen,Laura Emilie Dinesen %A Finderup,Jeanette %+ Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, 45 78452525, jeajee@rm.dk %K mobile phone %K app %K patient decision aid %K dialysis %K decisional conflict %K usability %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents’ average age. Thus, the applicability of the DG cannot be definitively determined. %M 31750836 %R 10.2196/13786 %U http://formative.jmir.org/2019/4/e13786/ %U https://doi.org/10.2196/13786 %U http://www.ncbi.nlm.nih.gov/pubmed/31750836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e15720 %T The Psychometric Properties of the Chinese eHealth Literacy Scale (C-eHEALS) in a Chinese Rural Population: Cross-Sectional Validation Study %A Ma,Zhihao %A Wu,Mei %+ Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Room 362, Zijin Building, Nanjing University (Xianlin Campus), 163 Xianlin Road, Qixia District, Jiangsu, Nanjing, 210023, China, 86 17561538460, redclass@163.com %K eHealth literacy %K eHEALS %K psychometrics %K classical test theory %K item response theory %D 2019 %7 22.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is the most widely used instrument in health studies to measure individual’s electronic health literacy. Nonetheless, despite the rapid development of the online medical industry and increased rural-urban disparities in China, very few studies have examined the characteristics of the eHEALS among Chinese rural people by using modern psychometric methods. This study evaluated the psychometric properties of eHEALS in a Chinese rural population by using both the classical test theory and item response theory methods. Objective: This study aimed to develop a simplified Chinese version of the eHEALS (C-eHEALS) and evaluate its psychometric properties in a rural population. Methods: A cross-sectional survey was conducted with 543 rural internet users in West China. The internal reliability was assessed using the Cronbach alpha coefficient. A one-factor structure of the C-eHEALS was obtained via principal component analysis, and fit indices for this structure were calculated using confirmatory factory analysis. Subsequently, the item discrimination, difficulty, and test information were estimated via the graded response model. Additionally, the criterion validity was confirmed through hypothesis testing. Results: The C-eHEALS has good reliability. Both principal component analysis and confirmatory factory analysis showed that the scale has a one-factor structure. The graded response model revealed that all items of the C-eHEALS have response options that allow for differentiation between latent trait levels and the capture of substantial information regarding participants’ ability. Conclusions: The findings indicate the high reliability and validity of the C-eHEALS and thus recommend its use for measuring eHealth literacy among the Chinese rural population. %M 31642811 %R 10.2196/15720 %U http://www.jmir.org/2019/10/e15720/ %U https://doi.org/10.2196/15720 %U http://www.ncbi.nlm.nih.gov/pubmed/31642811 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 4 %P e13295 %T Identification of Factors That Motivate People With Multiple Sclerosis to Participate in Digital Data Collection in Research: Sequential Mixed Methods Study %A Karnoe,Astrid %A Kayser,Lars %A Skovgaard,Lasse %+ Danish Multiple Sclerosis Patient Society, Poul Bungaardsvej 1, Valby, 2500, Denmark, 45 30436701, askn@sund.ku.dk %K health literacy %K computer literacy %K mobile apps %K patient participation %K research design %K multiple sclerosis %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital data collection has the potential to reduce participant burden in research projects that require extensive registrations from participants. To achieve this, a digital data collection tool needs to address potential barriers and motivations for participation. Objective: This study aimed to identify factors that may affect motivation for participation and adoption of a digital data collection tool in a research project on nutrition and multiple sclerosis (MS). Methods: The study was designed as a sequential mixed methods study with 3 phases. In phase 1, 15 semistructured interviews were conducted in a Danish population of individuals with MS. Interview guide frameworks were based on dimensions from the electronic health literacy framework and the Health Education Impact Questionnaire. Data from phase 1 were analyzed in a content analysis, and findings were used to inform the survey design in phase 2 that validates the results from the content analysis in a larger population. The survey consisted of 14 items, and it was sent to 1000 individuals with MS (response rate 42.5%). In phase 3, participants in 3 focus group interviews discussed how findings from phases 1 and 2 might affect motivation for participation and adoption of the digital tool. Results: The following 3 categories related to barriers and incentives for participation were identified in the content analysis of the 15 individual interviews: (1) life with MS, (2) use of technology, and (3) participation and incentives. Phase 1 findings were tested in phase 2’s survey in a larger population (n=1000). The majority of participants were comfortable using smartphone technologies and participated actively on social media platforms. MS symptoms did cause limitations in the use of Web pages and apps when the given pages had screen clutter, too many colors, or too small buttons. Life with MS meant that most participants had to ration their energy levels. Support from family and friends was important to participants, but support could also come in the form of physical aids (walking aids and similar) and digital aids (reminders, calendar functions, and medication management). Factors that could discourage participation were particularly related to the time it would take every day. The biggest motivations for participation were to contribute to research in MS, to learn more about one’s own MS and what affects it, and to be able to exchange experiences with other people with MS. Conclusions: MS causes limitations that put demands on tools developed for digital data collection. A digital data collection tool can increase chances of high adoption rates, but it needs to be supplemented with a clear and simple project design and continuous communication with participants. Motivational factors should be considered in both study design and the development of a digital data collection tool for research. %M 31599738 %R 10.2196/13295 %U https://humanfactors.jmir.org/2019/4/e13295 %U https://doi.org/10.2196/13295 %U http://www.ncbi.nlm.nih.gov/pubmed/31599738 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e14889 %T Deaf Adults’ Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study %A McKee,Michael M %A Hauser,Peter C %A Champlin,Sara %A Paasche-Orlow,Michael %A Wyse,Kelley %A Cuculick,Jessica %A Buis,Lorraine R %A Plegue,Melissa %A Sen,Ananda %A Fetters,Michael D %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7335, mmmckee@umich.edu %K deaf %K hearing loss %K consumer health information %K health literacy %D 2019 %7 9.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Deaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population. Objective: This study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions. Methods: This is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants’ ownership and use of computer and mobile devices and their level of Web-based information use, including health information. Results: Adaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals. Conclusions: The results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills. International Registered Report Identifier (IRRID): PRR1-10.2196/14889 %M 31599730 %R 10.2196/14889 %U https://www.researchprotocols.org/2019/10/e14889 %U https://doi.org/10.2196/14889 %U http://www.ncbi.nlm.nih.gov/pubmed/31599730 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 11 %N 2 %P e10149 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2019 %7 ..2019 %9 %J Online J Public Health Inform %G English %X Objectives: The purpose of current research is to assess the eHealth literacy level in the family caregivers of the elderly with hypertension and type-II diabetes.Methods: A total of 160 caregivers completed the eHEALS questionnaire. The effect of participants'' gender, education, and age on eHealth literacy was evaluated. For evaluation of the correlation between the accession of health information importance and the internet usefulness for decision-making, Spearman’s correlation coefficient was applied.Results: The participants eHealth literacy mean score was 26.163(SD=8.83). The age of participants had a meaningful impact on the level of eHealth literacy (t=6.074; P<0.001). Furthermore, among variant education levels in terms of eHealth literacy score significant differences existed (F=5.222; P=0.001).Discussion: Family caregivers have a poor level of eHealth literacy. eHealth information is more important for family caregivers with a higher eHealth literacy, which may be due to their higher skills in obtaining health and medical information from the internet. Caregivers'' age should be considered once recommending them for the internet using to obtain health information, as the age was an affecting factor.Conclusion: Health centers and authorities in charge of the elderly health are recommended to train caregivers with proper skills to use online health information, such that the elderly enjoy the benefits, including improved care conditions and savings in terms of treatment costs and time. %M 31632606 %R 10.5210/ojphi.v11i2.10149 %U %U https://doi.org/10.5210/ojphi.v11i2.10149 %U http://www.ncbi.nlm.nih.gov/pubmed/31632606 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14250 %T Assessing Mobile Phone Digital Literacy and Engagement in User-Centered Design in a Diverse, Safety-Net Population: Mixed Methods Study %A Nouri,Sarah S %A Avila-Garcia,Patricia %A Cemballi,Anupama Gunshekar %A Sarkar,Urmimala %A Aguilera,Adrian %A Lyles,Courtney Rees %+ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, Box 0320, San Francisco, CA, 94143, United States, 1 2149126555, sarah.nouri@ucsf.edu %K health information technology %K mHealth %K user-centered design %K health literacy %K digital literacy %K limited English proficiency %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care systems are rapidly deploying digital tools for disease management; however, few studies have evaluated their usability by vulnerable populations. To understand the barriers to app usage among vulnerable populations, we employed user-centered design (UCD) methods in the development of a new text messaging app. Objective: The study aimed to describe variations in patients’ engagement in the app design process, focusing on limited health literacy (LHL), limited English proficiency (LEP), and limited digital literacy (LDL). Methods: We conducted 20 in-depth semistructured interviews with primary care patients at a public health care system, used open-ended discussions and card sorting tasks to seek input about mobile phones and text messaging, and used open coding to categorize the patterns of mobile phone usage and to evaluate engagement in the card sorting process. We examined qualitative differences in engagement by examining the extensiveness of participant feedback on existing and novel text messaging content and calculated the proportion of patients providing extensive feedback on existing and novel content, overall and by health literacy, English proficiency, and digital literacy. Results: The average age of the 20 participants was 59 (SD 8) years; 13 (65%) were female, 18 (90%) were nonwhite, 16 (80%) had LHL, and 13 (65%) had LEP. All had depression, and 14 (70%) had diabetes. Most participants had smartphones (18/20, 90%) and regularly used text messaging (15/20, 75%), but 14 (70%) of them reported having difficulty texting because of inability to type, physical disability, and low literacy. We identified 10 participants as specifically having LDL; 7 of these participants had LEP, and all 10 had LHL. Half of the participants required a modification of the card sorting activity owing to not understanding it or not being able to read the cards in the allotted time. The proportion of participants who gave extensive feedback on existing content was lower in participants with limited versus adequate English proficiency (4/13, 30% vs 5/7, 71%), limited versus adequate health literacy (7/16, 44% vs 3/4, 75%), and limited versus adequate digital literacy (4/10, 40% vs 6/10, 60%); none of these differences were statistically significant. When examining the proportion of patients who gave extensive feedback for novel messaging content, those with LHL were less engaged than those with adequate health literacy (8/16, 50% vs 4/4, 100%); there were no statistical differences by any subgroup. Conclusions: Despite widespread mobile phone use, digital literacy barriers are common among vulnerable populations. Engagement in the card sorting activity varied among participants and appeared to be lower among those with LHL, LEP, and LDL. Researchers employing traditional UCD methods should routinely measure these communication domains among their end-user samples. Future work is needed to replicate our findings in larger samples, but augmentation of card sorting with direct observation and audiovisual cues may be more productive in eliciting feedback for those with communication barriers. %M 31469083 %R 10.2196/14250 %U http://mhealth.jmir.org/2019/8/e14250/ %U https://doi.org/10.2196/14250 %U http://www.ncbi.nlm.nih.gov/pubmed/31469083 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13423 %T Electronic Health Literacy Among Magnetic Resonance Imaging and Computed Tomography Medical Imaging Outpatients: Cluster Analysis %A Hyde,Lisa Lynne %A Boyes,Allison W %A Mackenzie,Lisa J %A Leigh,Lucy %A Oldmeadow,Christopher %A Riveros,Carlos %A Sanson-Fisher,Rob %+ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4913 8799, Lisa.L.Hyde@uon.edu.au %K internet %K health %K literacy %K cluster analysis %K medical imaging %D 2019 %7 28.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Variations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. Objective: The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership. Methods: Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. Results: Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007). Conclusions: The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences. %M 31464188 %R 10.2196/13423 %U http://www.jmir.org/2019/8/e13423/ %U https://doi.org/10.2196/13423 %U http://www.ncbi.nlm.nih.gov/pubmed/31464188 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e11998 %T Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway %A Tatara,Naoe %A Hammer,Hugo Lewi %A Mirkovic,Jelena %A Kjøllesdal,Marte Karoline Råberg %A Andreassen,Hege Kristin %+ Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Postboks 4, St. Olavs plass, Oslo, 0130, Norway, 47 67 23 86 79, naoe.tatara@oslomet.no %K immigrants %K type 2 diabetes %K self-care %K information-seeking behavior %K literacy %K language %D 2019 %7 16.08.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations’ diverse electronic health (eHealth) activities for self-care, especially in European countries. Objective: With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). Methods: Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. Results: Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227). Conclusions: This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. International Registered Report: RR2-DOI 10.2196/resprot.5468 %M 31420957 %R 10.2196/11998 %U http://publichealth.jmir.org/2019/3/e11998/ %U https://doi.org/10.2196/11998 %U http://www.ncbi.nlm.nih.gov/pubmed/31420957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13652 %T Information Literacy in Food and Activity Tracking Among Parkrunners, People With Type 2 Diabetes, and People With Irritable Bowel Syndrome: Exploratory Study %A McKinney,Pamela %A Cox,Andrew Martin %A Sbaffi,Laura %+ Information School, University of Sheffield, Regent Court, 211 Portobello Street, Sheffield, S1 4DP, United Kingdom, 44 0114 2222650, p.mckinney@sheffield.ac.uk %K activity logging %K food logging %K information literacy %K irritable bowel syndrome %K personal informatics %K quantified self %K running %K self-tracking %K type 2 diabetes %D 2019 %7 01.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The tracking, or logging, of food intake and physical activity is increasing among people, and as a result there is increasing evidence of a link to improvement in health and well-being. Crucial to the effective and safe use of logging is a user’s information literacy. Objective: The aim of this study was to analyze food and activity tracking from an information literacy perspective. Methods: An online survey was distributed to three communities via parkrun, diabetes.co.uk and the Irritable Bowel Syndrome Network. Results: The data showed that there were clear differences in the logging practices of the members of the three different communities, as well as differences in motivations for tracking and the extent of sharing of said tracked data. Respondents showed a good understanding of the importance of information accuracy and were confident in their ability to understand tracked data, however, there were differences in the extent to which food and activity data were shared and also a lack of understanding of the potential reuse and sharing of data by third parties. Conclusions: Information literacy in this context involves developing awareness of the issues of accurate information recording, and how tracked information can be applied to support specific health goals. Developing awareness of how and when to share data, as well as of data ownership and privacy, are also important aspects of information literacy. %M 31373277 %R 10.2196/13652 %U https://www.jmir.org/2019/8/e13652/ %U https://doi.org/10.2196/13652 %U http://www.ncbi.nlm.nih.gov/pubmed/31373277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12165 %T Association Between Health Literacy, Electronic Health Literacy, Disease-Specific Knowledge, and Health-Related Quality of Life Among Adults With Chronic Obstructive Pulmonary Disease: Cross-Sectional Study %A Stellefson,Michael %A Paige,Samantha R %A Alber,Julia M %A Chaney,Beth H %A Chaney,Don %A Apperson,Avery %A Mohan,Arjun %+ Department of Health Education and Promotion, East Carolina University, 3202 Carol G Belk Building, Greenville, NC, 27858, United States, 1 252 328 2105, stellefsonm17@ecu.edu %K COPD %K eHealth %K health-related quality of life %K health literacy %K patient education %K health status %K internet %D 2019 %7 06.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy–related skills that can uniquely influence patients’ health-related quality of life (HRQoL) outcomes. Objective: The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD. Methods: Adults from the COPD Foundation’s National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables. Results: After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=−.56, SE 0.29, 95% CI −1.22 to −0.004, P<.05) was inversely associated with lung-specific HRQoL. Conclusions: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL. %M 31172962 %R 10.2196/12165 %U https://www.jmir.org/2019/6/e12165/ %U https://doi.org/10.2196/12165 %U http://www.ncbi.nlm.nih.gov/pubmed/31172962 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11174 %T Assessing Electronic Health Literacy in the State of Kuwait: Survey of Internet Users From an Arab State %A Alhuwail,Dari %A Abdulsalam,Yousef %+ Department of Information Science, College of Computing Sciences and Engineering, Kuwait University, PO Box 5969, Al-Adailiya, Safat 13060, Kuwait, 965 24633274, dari.alhuwail@ku.edu.kw %K eHEALS %K literacy %K health information %K information-seeking %K informatics %K Arab %K Kuwait %D 2019 %7 24.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet and social media have become an important source for health information. In 2017, the State of Kuwait ranked first in mobile subscription penetration in the Arab world; nearly 90% of its population uses the internet. Electronic health (eHealth) literacy is important in populations that have easy and affordable access to internet resources to more effectively manage health conditions as well as improve general population health. Objective: The aim of this study was to assess eHealth literacy levels across internet users in Kuwait and identify demographic characteristics that influence eHealth literacy. Furthermore, the study aimed to identify the reasons and type of information that people seek online. Finally, this study examined the utilization of various social media channels for accessing online health information. The social media platforms considered were as follows: WhatsApp, Twitter, Instagram, YouTube, Facebook, and Snapchat. Methods: A cross-sectional anonymous Web-based survey was used to collect data about eHealth literacy and related information. The eHealth literacy scale (eHEALS), originally developed by Norman and Skinner, is measured using 8 Likert-type scales. A linear regression model estimates the effect of demographic variables such as age, gender, and education on eHealth literacy while controlling for participants’ perceived usefulness and importance of the internet. Participants were also surveyed about their frequency in using social media platforms for seeking health information. Results: Kuwait’s composite eHEALS, based on a sample of 386 participants, was 28.63, which is very similar to eHEALS observed among adult populations in other developed countries. Females in Kuwait demonstrated a higher average eHEALS compared with males. Among the social media platforms, the survey results indicated that YouTube is the most frequently used to seek health information, with Facebook being the least frequently used. Conclusions: Internet users in Kuwait appear confident in their ability to search for health-related information online compared with other populations, as indicated by aggregate eHEALS scores. Considering this finding, government and health care organizations should shift more efforts from traditional media toward online health information, focusing on the social media outlets that people in Kuwait find more useful for seeking health information. %M 31127723 %R 10.2196/11174 %U http://www.jmir.org/2019/5/e11174/ %U https://doi.org/10.2196/11174 %U http://www.ncbi.nlm.nih.gov/pubmed/31127723 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e11480 %T The Effect of Age on Electronic Health Literacy: Mixed-Method Study %A Hsu,Wan-Chen %+ Center for Teaching and Learning Development, National Kaohsiung University of Science and Technology, No 415, Jiangong Rd, Sanmin Dist, Kaohsiung, 80778, Taiwan, 886 73814526 ext 31171, wanchen@nkust.edu.tw %K eHealth literacy %K intergenerational relations %K traditional college students %K older adult students %K mixed method %D 2019 %7 21.4.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The world’s internet penetration rate is increasing yearly; approximately 25% of the world’s population are internet users. In Asia, Taiwan has the fifth highest internet usage, and has an internet penetration rate higher than the world average. Electronic health (eHealth) literacy is the ability to read, understand, and utilize Web health information. eHealth literacy is gaining attention worldwide. Objective: This study aimed compare the differences in eHealth literacy between traditional college students (aged between 18 and 22 years) and older adult students (aged between 55 and 72 years). It also summarizes the experiences and performances of these 2 groups in terms of searching online health-related information. Methods: A mixed-method approach was used, including questionnaire surveys and interviews. A total of 208 respondents were interviewed: 65 traditional college students (31.3%) and 143 older adult students (68.7%). The results of the interviews were used to compare the eHealth literacy scores of the 2 groups. Results: There were significant differences in the overall eHealth literacy scores (t207=2.98; P=.001) and the functional eHealth literacy dimension (t207=12.17; P<.001). The findings showed a significant gap in eHealth literacy between the 2 groups. Most participants believed that online health information could be largely read and understood. However, they were skeptical about the quality of the information and noted that it consisted of either subjective judgments or objective standards. Conclusions: Traditional college students preferred esthetically pleasing health information, whereas older adult students focused on its promotion. Furthermore, the first group often used websites for solving health problems, whereas the second group forwarded health information through communication software. %M 31066696 %R 10.2196/11480 %U http://humanfactors.jmir.org/2019/2/e11480/ %U https://doi.org/10.2196/11480 %U http://www.ncbi.nlm.nih.gov/pubmed/31066696 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e8423 %T Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients %A Holt,Kamila Adellund %A Karnoe,Astrid %A Overgaard,Dorthe %A Nielsen,Sidse Edith %A Kayser,Lars %A Røder,Michael Einar %A From,Gustav %+ Department of Nursing, Faculty of Health, University College Copenhagen, Tagensvej 86, Copenhagen N, 2200, Denmark, 45 26822657, kamh@kp.dk %K health literacy %K computer literacy %K questionnaires %K telemedicine %K consumer health informatics %D 2019 %7 05.04.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1% (234/246) of the participants used their personal digital ID (NemID), 57.7% (142/246) were in contact with their GPs electronically, and 54.0% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients’ eHL may provide clinicians an understanding of patients’ reasons for not using digital health services, better than sociodemographic data or self-rated health. %M 30950809 %R 10.2196/ijmr.8423 %U http://www.i-jmr.org/2019/2/e8423/ %U https://doi.org/10.2196/ijmr.8423 %U http://www.ncbi.nlm.nih.gov/pubmed/30950809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e10831 %T Online Health Information Seeking and eHealth Literacy Among Patients Attending a Primary Care Clinic in Hong Kong: A Cross-Sectional Survey %A Wong,David Ka-Ki %A Cheung,Man-Kuen %+ University Health Service, The University of Hong Kong, 2/F Meng Wah Complex, The University of Hong Kong, Pokfulam,, China (Hong Kong), 852 39172502, dkkw@hku.hk %K online health information seeking %K eHealth literacy %K primary care %K Hong Kong %D 2019 %7 27.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have suggested that patients’ online health information seeking affects their medical consultations and patient-doctor relationships. An up-to-date picture of patients’ online health information-seeking behaviors can inform and prepare frontline health care professionals to collaborate, facilitate, or empower their patients to access and manage health information found online. Objective: This study explores the prevalence, patterns, and predictors of online health information-seeking behaviors among primary care patients in Hong Kong, and the relations between online health information seeking and electronic health (eHealth) literacy. Methods: Patients attending a university primary care clinic in Hong Kong were asked to complete a questionnaire survey on their demographic backgrounds; health status; frequency and pattern of online health information seeking; contents, sources, and reasons for online health information seeking; and their eHealth literacy. eHealth literacy was measured by the validated eHealth Literacy Scale (eHEALS). Regression analyses explored various demographic and behavioral predictors to online health information seeking, and predictors to eHealth literacy. Results: In all, 97.32% (1162/1194) respondents used the internet, of which 87.44% (1016/1162) had used the internet to find health information. Most respondents (65.97%, 665/1008) searched once monthly or more. Few (26.88%, 271/1008) asked their doctor about health information found online, but most doctors (56.1%, 152/271) showed little or no interest at all. The most sought topic was symptom (81.59%, 829/1016), the top reason was noticing new symptoms or change in health (70.08%, 712/1016), the most popular source was online encyclopedia (69.98%, 711/1016), and the top reason for choosing a source was convenience (55.41%, 563/1016). Poisson regression analysis identified high eHEALS score, fair or poor self-rated health, having a chronic medical condition, and using the internet several times a day as significant predictors of online health information seeking. Multiple regression analysis identified lower age, better self-rated health, more frequent internet use, more frequent online health information seeking, and more types of health information sought as significant predictors to higher eHealth literacy. Conclusions: Online health information seeking is prevalent among primary care patients in Hong Kong, but only a minority shared the information with doctors. Websites were chosen more for convenience than for accuracy or authoritativeness. Doctors should recognize patients’ online health information-seeking behavior, and facilitate and empower them to search for high-quality online health information. %M 30916666 %R 10.2196/10831 %U http://www.jmir.org/2019/3/e10831/ %U https://doi.org/10.2196/10831 %U http://www.ncbi.nlm.nih.gov/pubmed/30916666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11386 %T The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial %A Abbott-Garner,Philip %A Richardson,Janet %A Jones,Ray B %+ School of Nursing and Midwifery, University of Plymouth, Rolle Building, University of Plymouth, Drake Circus, Plymouth,, United Kingdom, 44 1752661577, ray.jones@plymouth.ac.uk %K eHealth %K randomized controlled trial %K digital divide %K broadband implementation %K eHealth readiness %K eHealth inequalities %K tailored booklet %K cluster trial %D 2019 %7 11.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of “superfast” broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels. Objective: This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth. Methods: This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities. Results: eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t255=3.191; P=.002 and t258=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality. Conclusions: People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others. Trial Registration: ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x) %M 30855234 %R 10.2196/11386 %U http://www.jmir.org/2019/3/e11386/ %U https://doi.org/10.2196/11386 %U http://www.ncbi.nlm.nih.gov/pubmed/30855234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12525 %T QuikLitE, a Framework for Quick Literacy Evaluation in Medicine: Development and Validation %A Zheng,Jiaping %A Yu,Hong %+ Department of Computer Science, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, United States, 1 978 934 3620, yu_hong@uml.edu %K health literacy %K psychometrics %K crowdsourcing %D 2019 %7 22.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A plethora of health literacy instruments was developed over the decades. They usually start with experts curating passages of text or word lists, followed by psychometric validation and revision based on test results obtained from a sample population. This process is costly and it is difficult to customize for new usage scenarios. Objective: This study aimed to develop and evaluate a framework for dynamically creating test instruments that can provide a focused assessment of patients’ health literacy. Methods: A health literacy framework and scoring method were extended from the vocabulary knowledge test to accommodate a wide range of item difficulties and various degrees of uncertainty in the participant’s answer. Web-based tests from Amazon Mechanical Turk users were used to assess reliability and validity. Results: Parallel forms of our tests showed high reliability (correlation=.78; 95% CI 0.69-0.85). Validity measured as correlation with an electronic health record comprehension instrument was higher (.47-.61 among 3 groups) than 2 existing tools (Short Assessment of Health Literacy-English, .38-.43; Short Test of Functional Health Literacy in Adults, .34-.46). Our framework is able to distinguish higher literacy levels that are often not measured by other instruments. It is also flexible, allowing customizations to the test the designer’s focus on a particular interest in a subject matter or domain. The framework is among the fastest health literacy instrument to administer. Conclusions: We proposed a valid and highly reliable framework to dynamically create health literacy instruments, alleviating the need to repeat a time-consuming process when a new use scenario arises. This framework can be customized to a specific need on demand and can measure skills beyond the basic level. %M 30794206 %R 10.2196/12525 %U http://www.jmir.org/2019/2/e12525/ %U https://doi.org/10.2196/12525 %U http://www.ncbi.nlm.nih.gov/pubmed/30794206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10377 %T Development of the Multidimensional Readiness and Enablement Index for Health Technology (READHY) Tool to Measure Individuals’ Health Technology Readiness: Initial Testing in a Cancer Rehabilitation Setting %A Kayser,Lars %A Rossen,Sine %A Karnoe,Astrid %A Elsworth,Gerald %A Vibe-Petersen,Jette %A Christensen,Jesper Frank %A Ried-Larsen,Mathias %A Osborne,Richard H %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, DK-1014, Denmark, 45 28757291, lk@sund.ku.dk %K health technology readiness %K questionnaire %K eHealth literacy, enablement %D 2019 %7 12.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing digitization of health care services with enhanced access to fast internet connections, along with wide use of smartphones, offers the opportunity to get health advice or treatment remotely. For service providers, it is important to consider how consumers can take full advantage of available services and how this can create an enabling environment. However, it is important to consider the digital context and the attributes of current and future users, such as their readiness (ie, knowledge, skills, and attitudes, including trust and motivation). Objective: The objective of this study was to evaluate how the eHealth Literacy Questionnaire (eHLQ) combined with selected dimensions from the Health Education Impact Questionnaire (heiQ) and the Health Literacy Questionnaire (HLQ) can be used together as an instrument to characterize an individual’s level of health technology readiness and explore how the generated data can be used to create health technology readiness profiles of potential users of health technologies and digital health services. Methods: We administered the instrument and sociodemographic questions to a population of 305 patients with a recent cancer diagnosis referred to rehabilitation in a setting that plans to introduce various technologies to assist the individuals. We evaluated properties of the Readiness and Enablement Index for Health Technology (READHY) instrument using confirmatory factor analysis, convergent and discriminant validity analysis, and exploratory factor analysis. To identify different health technology readiness profiles in the population, we further analyzed the data using hierarchical and k-means cluster analysis. Results: The confirmatory factor analysis found a suitable fit for the 13 factors with only 1 cross-loading of 1 item between 2 dimensions. The convergent and discriminant validity analysis revealed many factor correlations, suggesting that, in this population, a more parsimonious model might be achieved. Exploratory factor analysis pointed to 5 to 6 constructs based on aggregates of the existing dimensions. The results were not satisfactory, so we performed an 8-factor confirmatory factor analysis, resulting in a good fit with only 1 item cross-loading between 2 dimensions. Cluster analysis showed that data from the READHY instrument can be clustered to create meaningful health technology readiness profiles of users. Conclusions: The 13 dimensions from heiQ, HLQ, and eHLQ can be used in combination to describe a user’s health technology readiness level and degree of enablement. Further studies in other populations are needed to understand whether the associations between dimensions are consistent and the number of dimensions can be reduced. %M 30747717 %R 10.2196/10377 %U http://www.jmir.org/2019/2/e10377/ %U https://doi.org/10.2196/10377 %U http://www.ncbi.nlm.nih.gov/pubmed/30747717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10986 %T Consumer Health Search on the Web: Study of Web Page Understandability and Its Integration in Ranking Algorithms %A Palotti,Joao %A Zuccon,Guido %A Hanbury,Allan %+ Institute for Information Systems Engineering, Technische Universität Wien, Favoritenstraße 9-11/194 04, Vienna, 1040, Austria, 43 158801188310, allan.hanbury@tuwien.ac.at %K readability %K literacy %K comprehension %K patients %K machine learning %D 2019 %7 30.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Understandability plays a key role in ensuring that people accessing health information are capable of gaining insights that can assist them with their health concerns and choices. The access to unclear or misleading information has been shown to negatively impact the health decisions of the general public. Objective: The aim of this study was to investigate methods to estimate the understandability of health Web pages and use these to improve the retrieval of information for people seeking health advice on the Web. Methods: Our investigation considered methods to automatically estimate the understandability of health information in Web pages, and it provided a thorough evaluation of these methods using human assessments as well as an analysis of preprocessing factors affecting understandability estimations and associated pitfalls. Furthermore, lessons learned for estimating Web page understandability were applied to the construction of retrieval methods, with specific attention to retrieving information understandable by the general public. Results: We found that machine learning techniques were more suitable to estimate health Web page understandability than traditional readability formulae, which are often used as guidelines and benchmark by health information providers on the Web (larger difference found for Pearson correlation of .602 using gradient boosting regressor compared with .438 using Simple Measure of Gobbledygook Index with the Conference and Labs of the Evaluation Forum eHealth 2015 collection). Conclusions: The findings reported in this paper are important for specialized search services tailored to support the general public in seeking health advice on the Web, as they document and empirically validate state-of-the-art techniques and settings for this domain application. %M 30698536 %R 10.2196/10986 %U http://www.jmir.org/2019/1/e10986/ %U https://doi.org/10.2196/10986 %U http://www.ncbi.nlm.nih.gov/pubmed/30698536 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 10 %N 3 %P e9487 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2018 %7 ..2018 %9 %J Online J Public Health Inform %G English %X Objectives: The aim of the study is to explore the eHealth literacy and general interest in using eHealth information among patients with dental diseases.Methods: A total of 171 patients with dental diseases completed the survey including the eHEALS. The effect of participants'' age, gender and education on eHealth literacy was assessed. Spearman’s correlation coefficient was also used to assess the correlation between the importance of access to health information and the usefulness of the internet for decision-making.Results: The mean score of eHealth literacy in the participants was 30.55 (SD=4.069). The participants'' age has significant effect on eHealth literacy level (t=3.573, P-value=0.002). Moreover, there was a significant correlation between the total score of eHealth literacy and the importance of access to eHealth information (r=0.33, n=171, P<0.s001). The difference in eHealth literacy in terms of educational background showed no statistically significant differences (F=1.179, P-value=0.322).Discussion: the participants had a high level of eHealth literacy. Determining eHealth literacy among dental patients leads to a better understanding of their problems in health decision-making.Conclusion: Dental institutions efforts should aim to raise awareness on online health information quality and to encourage patients to use evaluation tools, especially among low electronic health literate patients. %M 30680052 %R 10.5210/ojphi.v10i3.9487 %U %U https://doi.org/10.5210/ojphi.v10i3.9487 %U http://www.ncbi.nlm.nih.gov/pubmed/30680052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10273 %T Health Literacy in Web-Based Health Information Environments: Systematic Review of Concepts, Definitions, and Operationalization for Measurement %A Huhta,Anna-Maija %A Hirvonen,Noora %A Huotari,Maija-Leena %+ Department of Information Studies, Faculty of Humanities, University of Oulu, PO Box 1000, Oulu, FI-90014, Finland, 358 504285175, anna-maija.huhta@oulu.fi %K health literacy %K consumer health information %K internet %K review, systematic %D 2018 %7 19.12.2018 %9 Review %J J Med Internet Res %G English %X Background: Health literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts. Objective: This study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments. Methods: A systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures. Results: On the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified. Conclusions: The results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting. %M 30567690 %R 10.2196/10273 %U http://www.jmir.org/2018/12/e10273/ %U https://doi.org/10.2196/10273 %U http://www.ncbi.nlm.nih.gov/pubmed/30567690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e281 %T Correlation Between eHealth Literacy and Health Literacy Using the eHealth Literacy Scale and Real-Life Experiences in the Health Sector as a Proxy Measure of Functional Health Literacy: Cross-Sectional Web-Based Survey %A Del Giudice,Pietro %A Bravo,Giulia %A Poletto,Marco %A De Odorico,Anna %A Conte,Alessandro %A Brunelli,Laura %A Arnoldo,Luca %A Brusaferro,Silvio %+ Department of Medicine, University of Udine, Piazzale M Kolbe, 4, Udine, 33100, Italy, 39 0432559601, giulia.bravo@uniud.it %K eHealth literacy %K health literacy %K effect size %K eHEALS %K lily model %D 2018 %7 31.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a tool for the self-assessment of perceived comfort and skills in using the internet as a source for health-related information. Although evidence exists of the reliability and construct and structural validity of the scale, there is a lack of evidence in relation to what is proposed by Norman and Skinner in their theoretical lily model of eHealth literacy; in particular it is not clear whether having a higher level of health literacy can positively influence electronic health (eHealth) literacy as measured by the eHEALS. Objective: Our study aim was to assess whether real-life experiences from studying or working in the health field, as a proxy of higher functional health literacy, correlate with self-referred eHealth literacy as measured by the eHEALS. Methods: A Web-based survey was conducted among adults living in Northeast Italy using an Italian version of the eHEALS (IT-eHEALS). In order to be able to measure the effect of higher functional health literacy on eHealth literacy, we divided our sample into two groups, respectively characterized by studying or working experience in the health sector and by lack thereof. Mean differences between eHEALS were calculated using t test and effect size evaluated using Cohen d. To ensure the validity of the IT-eHEALS, we evaluated its psychometric properties (internal consistency and dimensionality) and construct validity (by evaluating its correlation with respondents age, gender, educational attainment, self-rated health, use of internet for health-related purposes, and working status). Results: A total of 868 respondents that completed the IT-eHEALS were included for analysis, of which 259 had working or studying experience in the health field. Mean (SD) eHEALS total score was 28.2 (6.2) for the whole sample, with statistically significant differences (P<.001) between the two groups, with the higher health literate group scoring significantly better (31.9 (5.9) vs 26.7 (5.6), respectively), with a standardized mean difference (Cohen d) of 0.9. Interestingly, we found a weak, yet significant, correlation between eHealth literacy and respondent characteristics for the higher health literate group only, as measured by positive Spearman correlation coefficients for age (0.11, P=.001), educational attainment (0.19, P=.002) and self-rated health (0.14, P=.024). Also, in line with current literature, correlation of eHEALS score with frequency of internet use for health-related purposes was significant for both groups (0.32, P<.001 and 0.15, P<.001 for higher and lower health literacy group, respectively). In our study we could not find any difference related to gender, while a significant difference for working status was only present when considering the sample as a whole (P=.03). Conclusions: Our study demonstrates a sizeable effect of higher levels of functional health literacy on the eHEALS score, corroborating what was initially proposed by Norman and Skinner in the lily model of eHealth literacy. %M 30381283 %R 10.2196/jmir.9401 %U http://www.jmir.org/2018/10/e281/ %U https://doi.org/10.2196/jmir.9401 %U http://www.ncbi.nlm.nih.gov/pubmed/30381283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e283 %T Associations of eHealth Literacy With Health Services Utilization Among College Students: Cross-Sectional Study %A Luo,Yi Fang %A Yang,Shu Ching %A Chen,An-Sing %A Chiang,Chia-Hsun %+ Institute of Education, National Sun Yat-sen University, 70 Lien-hai Road, Kaohsiung, 80424, Taiwan, 886 47612346, d996050002@student.nsysu.edu.tw %K eHealth %K health literacy %K health services %K student %K utilization %D 2018 %7 25.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) literacy has become an important topic in health fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physicians. In addition, previous studies have revealed a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the effect of the three levels of eHealth literacy (functional, interactive, and critical levels) on the four aspects of health services utilization (type, site, purpose, and time interval). It is unclear whether the associations between these three levels of eHealth literacy and the four aspects of health services utilization among college students are positive or negative. Objective: The objective of this study was to investigate the associations among gender, eHealth literacy, and health services utilization. Methods: We used the eHealth Literacy Scale, a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy, and the Health Services Utilization Scale, which is a 10-item instrument developed to measure the four aspects of health services utilization by college students. A nationally representative sample of 489 college students in Taiwan was surveyed. We conducted multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. Results: The study found that being female was negatively related to the purpose aspect of health services utilization (t487=−2.85, P<.01). However, the R2 value of gender on the purpose aspect was low enough to be ignored. Critical (t484=2.98-4.23, P<.01) and interactive eHealth literacy (t484=2.43-2.89, P<.05) were related to three aspects of the health services utilization, and functional eHealth literacy was related to the purpose aspect (t484=−4.99, P<.001). Conclusions: This study showed that Taiwanese college students with interactive eHealth literacy were more likely to have a higher rate of outpatient care use. Moreover, Taiwanese college students with critical eHealth literacy were more likely to make full use of health services than those with functional eHealth literacy. Finally, the educated and age-restricted sample may attenuate gender disparities in health services utilization among Taiwanese college students. %M 30361201 %R 10.2196/jmir.8897 %U http://www.jmir.org/2018/10/e283/ %U https://doi.org/10.2196/jmir.8897 %U http://www.ncbi.nlm.nih.gov/pubmed/30361201 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10175 %T Proposing a Transactional Model of eHealth Literacy: Concept Analysis %A Paige,Samantha R %A Stellefson,Michael %A Krieger,Janice L %A Anderson-Lewis,Charkarra %A Cheong,JeeWon %A Stopka,Christine %+ STEM Translational Communication Center, College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611, United States, 1 352 294 0421, paigesr190@ufl.edu %K eHealth literacy %K Transactional Model of Communication %K interpersonal communication %K social media %K mobile phone %D 2018 %7 02.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective: The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods: Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results: Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions: The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply). %M 30279155 %R 10.2196/10175 %U https://www.jmir.org/2018/10/e10175/ %U https://doi.org/10.2196/10175 %U http://www.ncbi.nlm.nih.gov/pubmed/30279155 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e64 %T eHealth Literacy in People Living with HIV: Systematic Review %A Han,Hae-Ra %A Hong,Hyejeong %A Starbird,Laura E %A Ge,Song %A Ford,Athena D %A Renda,Susan %A Sanchez,Michael %A Stewart,Jennifer %+ School of Nursing, The Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD,, United States, 1 410 614 2669, hhan@son.jhmi.edu %K eHealth literacy %K HIV %K systematic review %K mobile phones %D 2018 %7 10.09.2018 %9 Review %J JMIR Public Health Surveill %G English %X Background: In the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome. Objective: The objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH. Methods: This systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable. Results: We identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed. Conclusions: Understanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures. %M 30201600 %R 10.2196/publichealth.9687 %U http://publichealth.jmir.org/2018/3/e64/ %U https://doi.org/10.2196/publichealth.9687 %U http://www.ncbi.nlm.nih.gov/pubmed/30201600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10434 %T Electronic Health Literacy Across the Lifespan: Measurement Invariance Study %A Paige,Samantha R %A Miller,M David %A Krieger,Janice L %A Stellefson,Michael %A Cheong,JeeWon %+ STEM Translational Communication Center, University of Florida, PO Box 118400, Gainesville, FL, 32611, United States, 1 352 392 9961, paigesr190@ufl.edu %K eHealth literacy %K eHealth %K aging %K measurement invariance %D 2018 %7 09.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan. Objective: The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds). Methods: Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, Δχ2=P>.05, ΔCFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001). Results: Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, Δχ2=P>.05, ΔCFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001). Conclusions: The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users’ awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth. %M 29986848 %R 10.2196/10434 %U http://www.jmir.org/2018/7/e10434/ %U https://doi.org/10.2196/10434 %U http://www.ncbi.nlm.nih.gov/pubmed/29986848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e178 %T Assessing Competencies Needed to Engage With Digital Health Services: Development of the eHealth Literacy Assessment Toolkit %A Karnoe,Astrid %A Furstrand,Dorthe %A Christensen,Karl Bang %A Norgaard,Ole %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 30436701, askn@sund.ku.dk %K health literacy %K computer literacy %K questionnaires %K telemedicine %K consumer health informatics %D 2018 %7 10.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: To achieve full potential in user-oriented eHealth projects, we need to ensure a match between the eHealth technology and the user’s eHealth literacy, described as knowledge and skills. However, there is a lack of multifaceted eHealth literacy assessment tools suitable for screening purposes. Objective: The objective of our study was to develop and validate an eHealth literacy assessment toolkit (eHLA) that assesses individuals’ health literacy and digital literacy using a mix of existing and newly developed scales. Methods: From 2011 to 2015, scales were continuously tested and developed in an iterative process, which led to 7 tools being included in the validation study. The eHLA validation version consisted of 4 health-related tools (tool 1: “functional health literacy,” tool 2: “health literacy self-assessment,” tool 3: “familiarity with health and health care,” and tool 4: “knowledge of health and disease”) and 3 digitally-related tools (tool 5: “technology familiarity,” tool 6: “technology confidence,” and tool 7: “incentives for engaging with technology”) that were tested in 475 respondents from a general population sample and an outpatient clinic. Statistical analyses examined floor and ceiling effects, interitem correlations, item-total correlations, and Cronbach coefficient alpha (CCA). Rasch models (RM) examined the fit of data. Tools were reduced in items to secure robust tools fit for screening purposes. Reductions were made based on psychometrics, face validity, and content validity. Results: Tool 1 was not reduced in items; it consequently consists of 10 items. The overall fit to the RM was acceptable (Anderson conditional likelihood ratio, CLR=10.8; df=9; P=.29), and CCA was .67. Tool 2 was reduced from 20 to 9 items. The overall fit to a log-linear RM was acceptable (Anderson CLR=78.4, df=45, P=.002), and CCA was .85. Tool 3 was reduced from 23 to 5 items. The final version showed excellent fit to a log-linear RM (Anderson CLR=47.7, df=40, P=.19), and CCA was .90. Tool 4 was reduced from 12 to 6 items. The fit to a log-linear RM was acceptable (Anderson CLR=42.1, df=18, P=.001), and CCA was .59. Tool 5 was reduced from 20 to 6 items. The fit to the RM was acceptable (Anderson CLR=30.3, df=17, P=.02), and CCA was .94. Tool 6 was reduced from 5 to 4 items. The fit to a log-linear RM taking local dependency (LD) into account was acceptable (Anderson CLR=26.1, df=21, P=.20), and CCA was .91. Tool 7 was reduced from 6 to 4 items. The fit to a log-linear RM taking LD and differential item functioning into account was acceptable (Anderson CLR=23.0, df=29, P=.78), and CCA was .90. Conclusions: The eHLA consists of 7 short, robust scales that assess individual’s knowledge and skills related to digital literacy and health literacy. %M 29748163 %R 10.2196/jmir.8347 %U http://www.jmir.org/2018/5/e178/ %U https://doi.org/10.2196/jmir.8347 %U http://www.ncbi.nlm.nih.gov/pubmed/29748163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e138 %T The Korean eHealth Literacy Scale (K-eHEALS): Reliability and Validity Testing in Younger Adults Recruited Online %A Chung,SeonYoon %A Park,Bu Kyung %A Nahm,Eun-Shim %+ College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 640 Gukchaebosang-ro Jung-gu, Daegu, 41944, Republic Of Korea, 82 53 420 4929, bukpark@knu.ac.kr %K eHEALS %K eHealth %K literacy %K reliability %K validity %D 2018 %7 20.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In this digital era, eHealth literacy is an essential skill set to leverage health information available online to promote health outcomes. South Korea has an advanced health information technology infrastructure, including widespread use of the internet and mobile phones. A few studies have explored eHealth literacy in South Korea using translated versions of the eHEALS; however, they were not fully validated. A unified reliable and valid assessment tool is critical to assess and enhance the eHealth literacy level across the population. Objective: The aim was to develop a Korean version of eHealth Literacy Scale (K-eHEALS) and evaluate its reliability and validity employing healthy young adults in Korea. Methods: The K-eHEALS was developed based on eHEALS, a widely used tool that measures eHealth literacy, and was validated using a sample of 500 young adults recruited from a pool of a Korean internet survey panel. Content validity was assessed using the content validity index (CVI) for individual items and for scale. Construct validity was examined using exploratory factor analysis and hypothesis testing. The Cronbach alpha coefficient was used to determine the internal consistency and the Pearson correlation coefficient was used to evaluable the stability of the measure (n=55). Results: Both individual and scale CVIs were acceptable (individual CVIs>0.67; scale CVI=0.83). Single factors accounting for 50.3% of the variance in the scales were extracted revealing the unidimensional latent structure of K-eHEALS. Hypothesis testing showed significant association between eHealth literacy and hours of internet use per day, supporting the construct validity. Items of the K-eHEALS were internally consistent (Cronbach alpha=.88) and stable over a 1-month period (r=.754, P<.001). Conclusions: The findings of this study suggest that K-eHEALS is a valid and reliable measure of eHealth literacy in Korean young adults. Additional studies are needed with more diverse groups of adults in Korea. %M 29678800 %R 10.2196/jmir.8759 %U http://www.jmir.org/2018/4/e138/ %U https://doi.org/10.2196/jmir.8759 %U http://www.ncbi.nlm.nih.gov/pubmed/29678800 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e17 %T Assessing the Readability of Medical Documents: A Ranking Approach %A Zheng,Jiaping %A Yu,Hong %+ Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 2000, hong.yu@umassmed.edu %K electronic health records %K readability %K comprehension %K machine learning %D 2018 %7 23.03.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The use of electronic health record (EHR) systems with patient engagement capabilities, including viewing, downloading, and transmitting health information, has recently grown tremendously. However, using these resources to engage patients in managing their own health remains challenging due to the complex and technical nature of the EHR narratives. Objective: Our objective was to develop a machine learning–based system to assess readability levels of complex documents such as EHR notes. Methods: We collected difficulty ratings of EHR notes and Wikipedia articles using crowdsourcing from 90 readers. We built a supervised model to assess readability based on relative orders of text difficulty using both surface text features and word embeddings. We evaluated system performance using the Kendall coefficient of concordance against human ratings. Results: Our system achieved significantly higher concordance (.734) with human annotators than did a baseline using the Flesch-Kincaid Grade Level, a widely adopted readability formula (.531). The improvement was also consistent across different disease topics. This method’s concordance with an individual human user’s ratings was also higher than the concordance between different human annotators (.658). Conclusions: We explored methods to automatically assess the readability levels of clinical narratives. Our ranking-based system using simple textual features and easy-to-learn word embeddings outperformed a widely used readability formula. Our ranking-based method can predict relative difficulties of medical documents. It is not constrained to a predefined set of readability levels, a common design in many machine learning–based systems. Furthermore, the feature set does not rely on complex processing of the documents. One potential application of our readability ranking is personalization, allowing patients to better accommodate their own background knowledge. %M 29572199 %R 10.2196/medinform.8611 %U http://medinform.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/medinform.8611 %U http://www.ncbi.nlm.nih.gov/pubmed/29572199 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e6 %T Three-Factor Structure of the eHealth Literacy Scale Among Magnetic Resonance Imaging and Computed Tomography Outpatients: A Confirmatory Factor Analysis %A Hyde,Lisa L %A Boyes,Allison W %A Evans,Tiffany-Jane %A Mackenzie,Lisa J %A Sanson-Fisher,Rob %+ Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Public Health/HBRC, HMRI Building, University of Newcastle, Callaghan, 2308, Australia, 61 249138799, Lisa.L.Hyde@uon.edu.au %K eHealth %K literacy %K factor analysis %K measures %K psychometrics %D 2018 %7 19.02.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health (eHealth) literacy is needed to effectively engage with Web-based health resources. The 8-item eHealth literacy scale (eHEALS) is a commonly used self-report measure of eHealth literacy. Accumulated evidence has suggested that the eHEALS is unidimensional. However, a recent study by Sudbury-Riley and colleagues suggested that a theoretically-informed three-factor model fit better than a one-factor model. The 3 factors identified were awareness (2 items), skills (3 items), and evaluate (3 items). It is important to determine whether these findings can be replicated in other populations. Objective: The aim of this cross-sectional study was to verify the three-factor eHEALS structure among magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients. Methods: MRI and CT outpatients were recruited consecutively in the waiting room of one major public hospital. Participants self-completed a touchscreen computer survey, assessing their sociodemographic, scan, and internet use characteristics. The eHEALS was administered to internet users, and the three-factor structure was tested using structural equation modeling. Results: Of 405 invited patients, 87.4% (354/405) were interested in participating in the study, and of these, 75.7% (268/354) were eligible. Of the eligible participants, 95.5% (256/268) completed all eHEALS items. Factor loadings were 0.80 to 0.94 and statistically significant (P<.001). All reliability measures were acceptable (indicator reliability: awareness=.71-.89, skills=.78-.80, evaluate=.64-.79; composite reliability: awareness=.89, skills=.92, evaluate=.89; variance extracted estimates: awareness=.80, skills=.79, evaluate=.72). Two out of three goodness-of-fit indices were adequate (standardized root mean square residual (SRMR)=.038; comparative fit index (CFI)=.944; root mean square error of approximation (RMSEA)=.156). Item 3 was removed because of its significant correlation with item 2 (Lagrange multiplier [LM] estimate 104.02; P<.001) and high loading on 2 factors (LM estimate 91.11; P<.001). All 3 indices of the resulting 7-item model indicated goodness of fit (χ211=11.3; SRMR=.013; CFI=.999; RMSEA=.011). Conclusions: The three-factor eHEALS structure was supported in this sample of MRI and CT medical imaging outpatients. Although further factorial validation studies are needed, these 3 scale factors may be used to identify individuals who could benefit from interventions to improve eHealth literacy awareness, skill, and evaluation competencies. %M 29459356 %R 10.2196/humanfactors.9039 %U http://humanfactors.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/humanfactors.9039 %U http://www.ncbi.nlm.nih.gov/pubmed/29459356 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e36 %T A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ) %A Kayser,Lars %A Karnoe,Astrid %A Furstrand,Dorthe %A Batterham,Roy %A Christensen,Karl Bang %A Elsworth,Gerald %A Osborne,Richard H %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, DK-1014, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth %K health literacy %K computer literacy %K questionnaire design %D 2018 %7 12.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: For people to be able to access, understand, and benefit from the increasing digitalization of health services, it is critical that services are provided in a way that meets the user’s needs, resources, and competence. Objective: The objective of the study was to develop a questionnaire that captures the 7-dimensional eHealth Literacy Framework (eHLF). Methods: Draft items were created in parallel in English and Danish. The items were generated from 450 statements collected during the conceptual development of eHLF. In all, 57 items (7 to 9 items per scale) were generated and adjusted after cognitive testing. Items were tested in 475 people recruited from settings in which the scale was intended to be used (community and health care settings) and including people with a range of chronic conditions. Measurement properties were assessed using approaches from item response theory (IRT) and classical test theory (CTT) such as confirmatory factor analysis (CFA) and reliability using composite scale reliability (CSR); potential bias due to age and sex was evaluated using differential item functioning (DIF). Results: CFA confirmed the presence of the 7 a priori dimensions of eHLF. Following item analysis, a 35-item 7-scale questionnaire was constructed, covering (1) using technology to process health information (5 items, CSR=.84), (2) understanding of health concepts and language (5 items, CSR=.75), (3) ability to actively engage with digital services (5 items, CSR=.86), (4) feel safe and in control (5 items, CSR=.87), (5) motivated to engage with digital services (5 items, CSR=.84), (6) access to digital services that work (6 items, CSR=.77), and (7) digital services that suit individual needs (4 items, CSR=.85). A 7-factor CFA model, using small-variance priors for cross-loadings and residual correlations, had a satisfactory fit (posterior productive P value: .27, 95% CI for the difference between the observed and replicated chi-square values: −63.7 to 133.8). The CFA showed that all items loaded strongly on their respective factors. The IRT analysis showed that no items were found to have disordered thresholds. For most scales, discriminant validity was acceptable; however, 2 pairs of dimensions were highly correlated; dimensions 1 and 5 (r=.95), and dimensions 6 and 7 (r=.96). All dimensions were retained because of strong content differentiation and potential causal relationships between these dimensions. There is no evidence of DIF. Conclusions: The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool based on a well-defined a priori eHLF framework with robust properties. It has satisfactory evidence of construct validity and reliable measurement across a broad range of concepts (using both CTT and IRT traditions) in various groups. It is designed to be used to understand and evaluate people’s interaction with digital health services. %M 29434011 %R 10.2196/jmir.8371 %U https://www.jmir.org/2018/2/e36/ %U https://doi.org/10.2196/jmir.8371 %U http://www.ncbi.nlm.nih.gov/pubmed/29434011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e392 %T eHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association %A Britt,Rebecca Katherine %A Collins,William Bart %A Wilson,Kari %A Linnemeier,Georgiann %A Englebert,Andrew Mark %+ Department of Journalism and Mass Communication, South Dakota State University, 236 Yeager Hall, Brookings, SD,, United States, 1 605 688 4171, rebecca.britt@sdstate.edu %K eHealth literacy %K eHEALS, college student health %K online health behaviors %D 2017 %7 19.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students’ maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions. Objective: The goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study. Methods: Data were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future. Results: eHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on vaccinations, and maintaining a balanced diet. Conclusions: These results suggest several areas that may be targeted for future health campaigns toward college students. In addition, eHEALS was found to be a useful instrument for college students in the United States. Lastly, these results point to a need to deliver targeted information to college students, particularly since eHEALS captures literacy based on positively phrased items. %M 29258979 %R 10.2196/jmir.3100 %U https://www.jmir.org/2017/12/e392/ %U https://doi.org/10.2196/jmir.3100 %U http://www.ncbi.nlm.nih.gov/pubmed/29258979 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e221 %T The Association of Health Literacy and Electronic Health Literacy With Self-Efficacy, Coping, and Caregiving Perceptions Among Carers of People With Dementia: Research Protocol for a Descriptive Correlational Study %A Efthymiou,Areti %A Middleton,Nicos %A Charalambous,Andreas %A Papastavrou,Evridiki %+ Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, ZT3/3rd Floor, Vragadinou 15, Limassol, 3041, Cyprus, +357 25002285, arefthymiou@yahoo.com %K health literacy %K carers %K dementia %K ehealth %D 2017 %7 13.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers’ needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored. Objective: The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions. Methods: A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer’s associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures. Results: As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017. Conclusions: Carers’ eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers’ perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers’ eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research. %M 29133284 %R 10.2196/resprot.8080 %U http://www.researchprotocols.org/2017/11/e221/ %U https://doi.org/10.2196/resprot.8080 %U http://www.ncbi.nlm.nih.gov/pubmed/29133284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e374 %T Understanding Older Adult's Technology Adoption and Withdrawal for Elderly Care and Education: Mixed Method Analysis from National Survey %A Chiu,Ching-Ju %A Liu,Chia-Wen %+ Institute of Gerontology, College of Medicine, National Cheng Kung University, No 1, University Road, Tainan, 70101, Taiwan, 886 62353535 ext 5739, cjchiu@mail.ncku.edu.tw %K Internet adoption %K Internet withdrawal %K digital opportunity %K information literacy %K middle-aged and older adults %K Taiwan %D 2017 %7 03.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Elderly adults have comprised the fastest growing population adopting the Internet and computer technology over the past decade. However, how their experiences can shed light on elderly learning theory has not been examined much in the literature. Objective: This study investigated the factors and reasons associated with Internet adoption and withdrawal among older adults in Taiwan, and if any gender differences exist in this context. Methods: Data on participants aged 50 years and older from the nationally representative “Digital Opportunity Survey on Individuals and Households in Taiwan,” who did not use the Internet in 2005 but adopted it in 2007 (n=1548), and those who reported using Internet in 2011 but then withdrew (n=1575), were analyzed. Factors and reasons associated with Internet adoption and withdrawal were examined using both quantitative and qualitative data. Results: Education level independently predicted Internet adoption behavior. With regard to the reasons for adoption, 66% (62/94) of participants indicated they started using the Internet to meet certain “needs”; for example, “keeping up with the world” (40.4%, 38/94) was listed as the most critical reason, followed by “job needs” (25.5%, 24/94). Older adults with a positive attitude toward the Internet with regard to increasing employment opportunities (OR 2.0, 95% CI 1.0-3.9, P=.04) and the amount of information obtained (OR 0.5, 95% CI 0.3-0.9, P=.01), as well as enriching recreation and entertainment (OR 0.6, 95% CI 0.4-0.9, P=.02), were less likely to withdraw from the Internet. The most common reason for Internet withdrawal was “psychological barriers” (eg, no available time, no meaningful use, or nothing worth reading/watching; 66.3%, 193/291), followed by “health barriers” (eg, eyes or body deteriorate with Internet use; 21.0%, 61/291). Although psychological barriers were the most important factor for Internet withdrawal for both men (72.5%, 100/138) and women (62%, 93/150), women were more likely than men to be affected by health barriers (26.0%, 39/150 vs 15.9%, 22/138; P=.004) and anthropic factors or accidental barriers (7.3%, 11/150 vs 2.9%, 4/138; P=.02). Conclusions: Our findings that the need to keep up with the world associated with Internet adoption, and gender differences in reasons behind Internet withdrawal, such that women reported more health and anthropic factors or accidental barriers than man, may provide a new perspective that help health educators understand strategies that encourage older adults to keep learning, an important component of active aging. %M 29101093 %R 10.2196/jmir.7401 %U http://www.jmir.org/2017/11/e374/ %U https://doi.org/10.2196/jmir.7401 %U http://www.ncbi.nlm.nih.gov/pubmed/29101093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e362 %T Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey %A Stellefson,Michael %A Paige,Samantha R %A Tennant,Bethany %A Alber,Julia M %A Chaney,Beth H %A Chaney,Don %A Grossman,Suzanne %+ Department of Health Education and Promotion, East Carolina University, 3104 Carol Belk Building, Greenville, NC, 27858, United States, 1 252 328 2105, stellefsonm17@ecu.edu %K social media %K aging %K health literacy %K Web 2.0 %K Internet %D 2017 %7 26.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than –2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations. %M 29074471 %R 10.2196/jmir.8481 %U http://www.jmir.org/2017/10/e362/ %U https://doi.org/10.2196/jmir.8481 %U http://www.ncbi.nlm.nih.gov/pubmed/29074471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e331 %T Ill Literates or Illiterates? Investigating the eHealth Literacy of Users of Online Health Communities %A Petrič,Gregor %A Atanasova,Sara %A Kamin,Tanja %+ Centre for Methodology and Informatics, Faculty of Social Sciences, University of Ljubljana, Kardeljeva ploscad 5, Ljubljana, 1000, Slovenia, 386 15805361, gregor.petric@fdv.uni-lj.si %K health literacy %K online health community %K user types %K weights and measures %K survey methods %D 2017 %7 04.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) literacy is an important skill that allows patients to navigate intelligibly through the vast, often misleading Web-based world. Although eHealth literacy has been investigated in general and specific demographic populations, it has not yet been analyzed on users of online health communities (OHCs). Evidence shows that OHCs are important Web 2.0 applications for patients for managing their health, but at the same time, warnings have been expressed regarding the quality and relevance of shared information. No studies exist that investigate levels of eHealth literacy among users of OHCs and differences in eHealth literacy between different types of users. Objective: The study aimed to investigate eHealth literacy across different types of users of OHCs based on a revised and extended eHealth literacy scale (eHEALS). Methods: The study was based on a cross-sectional Web survey on a simple random sample of 15,000 registered users of the most popular general OHC in Slovenia. The final sample comprised 644 users of the studied OHC. An extended eHEALS (eHEALS-E) was tested with factor analytical procedures, whereas user types were identified with a hierarchical clustering algorithm. The research question was analyzed with analysis of variance (ANOVA) procedure and pairwise comparison tests. Results: Factor analysis of the revised and extended eHEALS revealed six dimensions: awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information, and being smart on the Net. The factor solution demonstrates a good fit to the data (root mean square error of approximation [RMSEA]=.059). The most developed dimension of eHEALS-E is awareness of different Internet sources (mean=3.98, standard deviation [SD]=0.61), whereas the least developed is understanding information (mean=3.11, SD=0.75). Clustering resulted in four user types: active help-seekers (48.3%, 311/644), lurkers (31.8%, 205/644), core relational users (16.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups. Conclusions: Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices. %M 28978496 %R 10.2196/jmir.7372 %U https://www.jmir.org/2017/10/e331/ %U https://doi.org/10.2196/jmir.7372 %U http://www.ncbi.nlm.nih.gov/pubmed/28978496 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e260 %T Readability of Wikipedia Pages on Autoimmune Disorders: Systematic Quantitative Assessment %A Watad,Abdulla %A Bragazzi,Nicola Luigi %A Brigo,Francesco %A Sharif,Kassem %A Amital,Howard %A McGonagle,Dennis %A Shoenfeld,Yehuda %A Adawi,Mohammad %+ Department of Medicine B, Sheba Medical Centre, Tel-Hashomer, 52621, Tel Aviv,, Israel, 972 3 530 2435, watad.abdulla@gmail.com %K autoimmune diseases %K eHealth %K telemedicine %K readability %K Wikipedia %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In the era of new information and communication technologies, the Internet is being increasingly accessed for health-related information. Indeed, recently published patient surveys of people with autoimmune disorders confirmed that the Internet was reported as one of the most important health information sources. Wikipedia, a free online encyclopedia launched in 2001, is generally one of the most visited websites worldwide and is often consulted for health-related information. Objective: The main objective of this investigation was to quantitatively assess whether the Wikipedia pages related to autoimmune disorders can be easily accessed by patients and their families, in terms of readability. Methods: We obtained and downloaded a list of autoimmune disorders from the American Autoimmune Related Diseases Association (AARDA) website. We analyzed Wikipedia articles for their overall level of readability with 6 different quantitative readability scales: (1) the Flesch Reading Ease, (2) the Gunning Fog Index, (3) the Coleman-Liau Index, (4) the Flesch-Kincaid Grade Level, (5) the Automated Readability Index (ARI), and (6) the Simple Measure of Gobbledygook (SMOG). Further, we investigated the correlation between readability and clinical, pathological, and epidemiological parameters. Moreover, each Wikipedia analysis was assessed according to its content, breaking down the readability indices by main topic of each part (namely, pathogenesis, treatment, diagnosis, and prognosis plus a section containing paragraphs not falling into any of the previous categories). Results: We retrieved 134 diseases from the AARDA website. The Flesch Reading Ease yielded a mean score of 24.34 (SD 10.73), indicating that the sites were very difficult to read and best understood by university graduates, while mean Gunning Fog Index and ARI scores were 16.87 (SD 2.03) and 14.06 (SD 2.12), respectively. The Coleman-Liau Index and the Flesch-Kincaid Grade Level yielded mean scores of 14.48 (SD 1.57) and 14.86 (1.95), respectively, while the mean SMOG score was 15.38 (SD 1.37). All the readability indices confirmed that the sites were suitable for a university graduate reading level. We found no correlation between readability and clinical, pathological, and epidemiological parameters. Differences among the different sections of the Wikipedia pages were statistically significant. Conclusions: Wikipedia pages related to autoimmune disorders are characterized by a low level of readability. The onus is, therefore, on physicians and health authorities to improve the health literacy skills of patients and their families and to create, together with patients themselves, disease-specific readable sites, disseminating highly accessible health-related online information, in terms of both clarity and conciseness. %M 28720555 %R 10.2196/jmir.8225 %U http://www.jmir.org/2017/7/e260/ %U https://doi.org/10.2196/jmir.8225 %U http://www.ncbi.nlm.nih.gov/pubmed/28720555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e166 %T Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis %A Schulz,Peter Johannes %A Fitzpatrick,Mary Anne %A Hess,Alexandra %A Sudbury-Riley,Lynn %A Hartung,Uwe %+ Institute of Communication and Health, Faculty of Communication Science, Università della Svizzera italiana, Via Giuseppe Buffi 13, Lugano, 6900, Switzerland, 41 58 666 4724, peter.schulz@usi.ch %K health literacy %K eHealth literacy %K health empowerment %K information seeking %K health care utilization %K baby boomers %D 2017 %7 16.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. Objective: We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Methods: Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis. Results: We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. Conclusions: The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary. %M 28512081 %R 10.2196/jmir.6317 %U http://www.jmir.org/2017/5/e166/ %U https://doi.org/10.2196/jmir.6317 %U http://www.ncbi.nlm.nih.gov/pubmed/28512081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e114 %T A Psychometric Analysis of the Italian Version of the eHealth Literacy Scale Using Item Response and Classical Test Theory Methods %A Diviani,Nicola %A Dima,Alexandra Lelia %A Schulz,Peter Johannes %+ Department of Health Sciences & Health Policy, Faculty of Humanities and Social Sciences, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland, 41 41 229 56 34, nicola.diviani@unilu.ch %K eHealth literacy %K eHEALS %K item response theory %K classical test theory %K validation %K Italian %D 2017 %7 11.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a tool to assess consumers’ comfort and skills in using information technologies for health. Although evidence exists of reliability and construct validity of the scale, less agreement exists on structural validity. Objective: The aim of this study was to validate the Italian version of the eHealth Literacy Scale (I-eHEALS) in a community sample with a focus on its structural validity, by applying psychometric techniques that account for item difficulty. Methods: Two Web-based surveys were conducted among a total of 296 people living in the Italian-speaking region of Switzerland (Ticino). After examining the latent variables underlying the observed variables of the Italian scale via principal component analysis (PCA), fit indices for two alternative models were calculated using confirmatory factor analysis (CFA). The scale structure was examined via parametric and nonparametric item response theory (IRT) analyses accounting for differences between items regarding the proportion of answers indicating high ability. Convergent validity was assessed by correlations with theoretically related constructs. Results: CFA showed a suboptimal model fit for both models. IRT analyses confirmed all items measure a single dimension as intended. Reliability and construct validity of the final scale were also confirmed. The contrasting results of factor analysis (FA) and IRT analyses highlight the importance of considering differences in item difficulty when examining health literacy scales. Conclusions: The findings support the reliability and validity of the translated scale and its use for assessing Italian-speaking consumers’ eHealth literacy. %M 28400356 %R 10.2196/jmir.6749 %U http://www.jmir.org/2017/4/e114/ %U https://doi.org/10.2196/jmir.6749 %U http://www.ncbi.nlm.nih.gov/pubmed/28400356 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 3 %P e50 %T Get+Connected: Development and Pilot Testing of an Intervention to Improve Computer and Internet Attitudes and Internet Use Among Women Living With HIV %A Seplovich,Gabriela %A Horvath,Keith J %A Haughton,Lorlette J %A Blackstock,Oni J %+ Montefiore Medical Center/Albert Einstein College of Medicine, Division of General Internal Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States, 1 7189205090, oblackst@montefiore.org %K women and HIV %K Internet literacy %K technology intervention %K digital divide %K information seeking behavior %K access to health information %D 2017 %7 31.03.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: For persons living with chronic medical conditions, the Internet can be a powerful tool for health promotion, and allow for immediate access to medical information and social support. However, women living with human immunodeficiency virus (HIV) in the United States face numerous barriers to computer and Internet use. Health behavior change models suggest that the first step towards adopting a new health behavior is to improve attitudes towards that behavior. Objective: To develop and pilot test Get+Connected, an intervention to improve computer and Internet attitudes and Internet use among women living with HIV. Methods: To develop Get+Connected, we reviewed the extant literature, adapted an existing curriculum, and conducted a focus group with HIV-positive women (n=20) at a community-based organization in the Bronx, New York. Get+Connected was comprised of five weekly sessions covering the following topics: basic computer knowledge and skills, identifying reliable health-related websites, setting up and using email and Facebook accounts, and a final review session. We recruited 12 women to participate in pilot testing. At baseline, we collected data about participants’ sociodemographic information, clinical characteristics, and technology device ownership and use. At baseline, intervention completion, and three months postintervention, we collected data regarding attitudes towards computers and the Internet (Attitudes Towards Computers and the Internet Questionnaire [ATCIQ]; possible scores range from 5-50) as well as frequency of Internet use (composite measure). To examine changes in ATCIQ scores and Internet use over time, we used generalized estimating equations. We also collected qualitative data during intervention delivery. Results: Among women in our sample, the median age was 56 years (interquartile range=52-63). All participants were black/African American and/or Latina. Seven participants (7/12, 58%) had a high school diploma (or equivalent) or higher degree. Ten participants (10/12, 83%) reported owning a mobile phone, while only one (1/12, 8%) reported owning a computer or tablet. Only one participant (1/12, 8%) reported having ever used the Internet or email. Internet nonusers cited lack of computer/Internet knowledge (6/11, 54%) and lack of access to a computer or similar device (4/11, 36%) as the main barriers to use. Over time, we observed an improvement in attitudes towards computers and the Internet (ATCIQ scores: 33.5 at baseline, 35 at intervention completion, and 36 at three months postintervention; P=.008). No significant increase in Internet use was observed (P=.61). Qualitative findings indicated excitement and enthusiasm for the intervention. Conclusions: In our sample of urban, technology-inexperienced HIV-positive women, participation in Get+Connected was associated with an improvement in attitudes towards computers and the Internet, but not Internet use. Changing attitudes is the first step in many health behavior change models, indicating that with improved access to computer and Internet resources, frequency of Internet use may also have increased. Future studies should consider addressing issues of access to technology in conjunction with Get+Connected. %M 28363879 %R 10.2196/resprot.6391 %U http://www.researchprotocols.org/2017/3/e50/ %U https://doi.org/10.2196/resprot.6391 %U http://www.ncbi.nlm.nih.gov/pubmed/28363879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e98 %T With Some Help From My Network: Supplementing eHealth Literacy With Social Ties %A Hayat,Tsahi (Zack) %A Brainin,Esther %A Neter,Efrat %+ Interdisciplinary Center, PO Box 167, Herzliya, 4610101, Israel, 972 99602821, tsahi.hayat@gmail.com %K eHealth literacy %K consumer health information %K outcomes assessment %K ethnicity %D 2017 %7 30.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply knowledge gained to addressing or solving a health problem. Previous research has shown high reliance on both online and face-to-face interpersonal sources when sharing and receiving health information. Objective: In this paper, we examine these interpersonal sources and their interplay with respondents’ eHealth literacy and perceived health outcomes. Specifically, we look at how the relationship between eHealth literacy and health outcomes is moderated by (1) finding help while performing online activities, (2) finding others with similar health concerns online, and (3) the importance of finding others with similar health concerns for people from ethnic minorities, specifically Palestinian citizens of Israel versus Israeli Jews. Methods: We used a nationally representative random-digit dial telephone household survey of an Israeli adult population (age ≥21 years, N=819). The collected data were analyzed using two regression models. The first examined how the correlation between eHealth literacy and perceived outcomes was moderated by the availability of help. The second examined how the correlation between eHealth literacy and perceived outcomes was moderated by finding others with similar health concerns and by ethnicity. Results: Respondents with low eHealth literacy who were able to recruit help when performing online activities demonstrated higher perceived health outcomes compared to similar respondents who did not find help. Respondents with low eHealth literacy, who were able to find others with similar health concerns (online), demonstrated higher perceived health outcomes when compared to similar respondents who did not find others with similar health concerns. Finally, finding similar others online was more helpful in enhancing health outcomes for ethnic minorities; Palestinian citizens of Israel gained more health benefits by finding similar others compared to Israeli Jews. Conclusions: Although the availability of help and the notion of ethnicity have been discussed extensively within the context of social capital and health, our findings offer initial evidence for the relevancy of these concepts when studying individuals’ eHealth literacy. Specifically, our findings enable a better understanding of the role of social ties and ethnicity in moderating the interplay between eHealth literacy and perceived health outcomes. Given the increased importance of eHealth information, our findings enhance understanding of how social ties can potentially compensate for low eHealth literacy. %M 28360024 %R 10.2196/jmir.6472 %U http://www.jmir.org/2017/3/e98/ %U https://doi.org/10.2196/jmir.6472 %U http://www.ncbi.nlm.nih.gov/pubmed/28360024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e59 %T Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study %A Zheng,Jiaping %A Yu,Hong %+ College of Information and Computer Sciences, University of Massachusetts, 140 Governors Dr, Amherst, MA,, United States, 1 4135452744, jzheng@cs.umass.edu %K electronic health records %K readability %K patients %D 2017 %7 02.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients’ comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. Objective: The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople’s perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas’ appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. Methods: We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople’s perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. Results: The distributions of both readability formulas’ scores (P<.001) and laypeople’s perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople’s perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001). Conclusions: Our findings suggested that the readability formulas’ predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers’ perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes. %M 28254738 %R 10.2196/jmir.6962 %U http://www.jmir.org/2017/3/e59/ %U https://doi.org/10.2196/jmir.6962 %U http://www.ncbi.nlm.nih.gov/pubmed/28254738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e53 %T Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance %A Sudbury-Riley,Lynn %A FitzPatrick,Mary %A Schulz,Peter J %+ Management School, University of Liverpool, Chatham Street, Liverpool, L697ZH, United Kingdom, 44 151795 ext 2553, l.sudbury-riley@liverpool.ac.uk %K health literacy %K eHealth literacy %K eHEALS %K baby boomers %K health information %K measurement invariance %D 2017 %7 27.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is one of only a few available measurement scales to assess eHealth literacy. Perhaps due to the relative paucity of such measures and the rising importance of eHealth literacy, the eHEALS is increasingly a choice for inclusion in a range of studies across different groups, cultures, and nations. However, despite its growing popularity, questions have been raised over its theoretical foundations, and the factorial validity and multigroup measurement properties of the scale are yet to be investigated fully. Objective: The objective of our study was to examine the factorial validity and measurement invariance of the eHEALS among baby boomers (born between 1946 and 1964) in the United States, United Kingdom, and New Zealand who had used the Internet to search for health information in the last 6 months. Methods: Online questionnaires collected data from a random sample of baby boomers from the 3 countries of interest. The theoretical underpinning to eHEALS comprises social cognitive theory and self-efficacy theory. Close scrutiny of eHEALS with analysis of these theories suggests a 3-factor structure to be worth investigating, which has never before been explored. Structural equation modeling tested a 3-factor structure based on the theoretical underpinning to eHEALS and investigated multinational measurement invariance of the eHEALS. Results: We collected responses (N=996) to the questionnaires using random samples from the 3 countries. Results suggest that the eHEALS comprises a 3-factor structure with a measurement model that falls within all relevant fit indices (root mean square error of approximation, RMSEA=.041, comparative fit index, CFI=.986). Additionally, the scale demonstrates metric invariance (RMSEA=.040, CFI=.984, ΔCFI=.002) and even scalar invariance (RMSEA=.042, CFI=.978, ΔCFI=.008). Conclusions: To our knowledge, this is the first study to demonstrate multigroup factorial equivalence of the eHEALS, and did so based on data from 3 diverse nations and random samples drawn from an increasingly important cohort. The results give increased confidence to researchers using the scale in a range of eHealth assessment applications from primary care to health promotions. %M 28242590 %R 10.2196/jmir.5998 %U http://www.jmir.org/2017/2/e53/ %U https://doi.org/10.2196/jmir.5998 %U http://www.ncbi.nlm.nih.gov/pubmed/28242590 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e4 %T eHealth Literacy: Predictors in a Population With Moderate-to-High Cardiovascular Risk %A Richtering,Sarah S %A Hyun,Karice %A Neubeck,Lis %A Coorey,Genevieve %A Chalmers,John %A Usherwood,Tim %A Peiris,David %A Chow,Clara K %A Redfern,Julie %+ The George Institute for Global Health, 83/117 Missenden Road, Camperdown, Sydney, 2050, Australia, 61 299934500, jredfern@georgeinstitute.org.au %K eHealth %K socioeconomic factors %K health literacy %K cardiovascular system %K chronic disease %K Internet %D 2017 %7 27.01.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health (eHealth) literacy is a growing area of research parallel to the ongoing development of eHealth interventions. There is, however, little and conflicting information regarding the factors that influence eHealth literacy, notably in chronic disease. We are similarly ill-informed about the relationship between eHealth and health literacy, 2 related yet distinct health-related literacies. Objective: The aim of our study was to investigate the demographic, socioeconomic, technology use, and health literacy predictors of eHealth literacy in a population with moderate-to-high cardiovascular risk. Methods: Demographic and socioeconomic data were collected from 453 participants of the CONNECT (Consumer Navigation of Electronic Cardiovascular Tools) study, which included age, gender, education, income, cardiovascular-related polypharmacy, private health care, main electronic device use, and time spent on the Internet. Participants also completed an eHealth Literacy Scale (eHEALS) and a Health Literacy Questionnaire (HLQ). Univariate analyses were performed to compare patient demographic and socioeconomic characteristics between the low (eHEALS<26) and high (eHEALS≥26) eHealth literacy groups. To then determine the predictors of low eHealth literacy, multiple-adjusted generalized estimating equation logistic regression model was used. This technique was also used to examine the correlation between eHealth literacy and health literacy for 4 predefined literacy themes: navigating resources, skills to use resources, usefulness for oneself, and critical evaluation. Results: The univariate analysis showed that patients with lower eHealth literacy were older (68 years vs 66 years, P=.01), had lower level of education (P=.007), and spent less time on the Internet (P<.001). However, multiple-adjusted generalized estimating equation logistic regression model demonstrated that only the time spent on the Internet (P=.01) was associated with the level of eHealth literacy. Regarding the comparison between the eHEALS items and HLQ scales, a positive linear relationship was found for the themes “usefulness for oneself” (P=.049) and “critical evaluation” (P=.01). Conclusions: This study shows the importance of evaluating patients’ familiarity with the Internet as reflected, in part, by the time spent on the Internet. It also shows the importance of specifically assessing eHealth literacy in conjunction with a health literacy assessment in order to assess patients’ navigational knowledge and skills using the Internet, specific to the use of eHealth applications. %M 28130203 %R 10.2196/humanfactors.6217 %U http://humanfactors.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/humanfactors.6217 %U http://www.ncbi.nlm.nih.gov/pubmed/28130203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e27 %T Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills %A van der Vaart,Rosalie %A Drossaert,Constance %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 053 489 6049, c.h.c.drossaert@utwente.nl %K digital health literacy skills %K eHealth literacy %K measurement %K validity %K performance-based instrument %D 2017 %7 24.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P<.001), education (ρ=.14, P=.047), Internet use (ρ=.39, P<.001), health-related Internet use (ρ=.27, P<.001), health status (ρ range .17-.27, P<.001), health literacy (ρ=.31, P<.001), and the eHEALS (ρ=.51, P<.001). Conclusions: This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations. %M 28119275 %R 10.2196/jmir.6709 %U http://www.jmir.org/2017/1/e27/ %U https://doi.org/10.2196/jmir.6709 %U http://www.ncbi.nlm.nih.gov/pubmed/28119275 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e2 %T Perceived and Performed eHealth Literacy: Survey and Simulated Performance Test %A Neter,Efrat %A Brainin,Esther %+ Department of Behavioral Sciences, Ruppin Academic Center, Beit 3, Emeq Hefer, 4025000, Israel, 972 546462677, neter@ruppin.ac.il %K eHealth %K literacy %K performance %D 2017 %7 17.01.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health (eHealth) literacy of consumers is essential in order to improve information and communication technology (ICT) use for health purposes by ordinary citizens. However, performed eHealth literacy is seldom studied. Therefore, the present study assessed perceived and performed eHealth literacy using the recent conceptualization of health literacy skills. Objective: The aim of this paper was to examine the association between perceived and performed eHealth literacies. Methods: In total, 82 Israeli adults participated in the study, all 50 years and older, with a mean age of 67 (SD 11). Of the participants, 60% (49/82) were women and 72% (59/82) had a post-secondary education. The participants were first surveyed and then tested in a computer simulation of health-related Internet tasks. Performed, perceived (eHealth Literacy Scale, eHEALS), and evaluated eHealth literacy were assessed, and performed eHealth literacy was also recorded and re-evaluated later. Performance was scored for successful completion of tasks, and was also assessed by two researchers for motivation, confidence, and amount of help provided. Results: The skills of accessing, understanding, appraising, applying, and generating new information had decreasing successful completion rates. Generating new information was least correlated with other skills. Perceived and performed eHealth literacies were moderately correlated (r=.34, P=.01) while facets of performance (ie, digital literacy and eHealth literacy) were highly correlated (r=.82, P<.001). Participants low and high in performed eHealth literacy were significantly different: low performers were older and had used the Internet for less time, required more assistance, and were less confident in their conduct than high performers. Conclusions: The moderate association between perceived and performed eHealth literacy indicates that the latter should be assessed separately. In as much, the assessment of performed eHealth literacy in clinical settings should entail the structuring of tasks as well as shortening and automatizing the assessment. %M 28096068 %R 10.2196/humanfactors.6523 %U http://humanfactors.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/humanfactors.6523 %U http://www.ncbi.nlm.nih.gov/pubmed/28096068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e15 %T The Associations Among Individual Factors, eHealth Literacy, and Health-Promoting Lifestyles Among College Students %A Yang,Shu-Ching %A Luo,Yi-Fang %A Chiang,Chia-Hsun %+ Institute of Education, National Sun Yat-Sen University, 70 Lienhai Road, Kaohsiung, 80424, Taiwan, 886 4 761 2346, d996050002@student.nsysu.edu.tw %K individual factors %K health-promoting lifestyle %K eHealth literacy %D 2017 %7 10.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is gaining importance for maintaining and promoting health. Studies have found that individuals with high eHealth literacy are more likely to adopt healthy eating, exercise, and sleep behaviors. In addition, previous studies have shown that various individual factors (eg, frequency of seeking information on health issues, degree of health concern, frequency of eating organic food, and students’ college major) are associated with eHealth literacy and health-promoting lifestyles. Nevertheless, few studies have explored the associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. Moreover, there is a lack of studies that focus on eHealth literacy as a predictor of psychological health behaviors. Objective: To examine the associations among various individual factors, eHealth literacy, and health-promoting lifestyles. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Health-promoting Lifestyle Scale is a 23-item instrument developed to measure college students’ self-actualization, health responsibility, interpersonal support, exercise, nutrition, and stress management. A nationally representative sample of 556 valid college students in Taiwan was surveyed. A questionnaire was administered to gather the respondents’ background information, including the frequency of seeking information on health issues, the frequency of eating organic food, the degree of health concern, and the students’ major. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health-promoting lifestyles. Results: The study found that factors such as medical majors (t550=2.47-7.55, P<.05) and greater concern with health (t550=2.15-9.01, P<.05) predicted college students’ 4-6 health-promoting lifestyle dimensions and the 3 dimensions of eHealth literacy. Moreover, critical eHealth literacy positively predicted all 6 health-promoting lifestyle dimensions (t547=2.66-7.28, P<.01), functional literacy positively predicted 2 dimensions (t547=2.32-2.98, P<.05), and interactive literacy predicted only the self-actualization dimension (t547=2.81, P<.01). Conclusions: This study found that participants who majored in medical fields had greater concern with their health and frequently sought health information, exhibited better eHealth literacy, and had a positive health-promoting lifestyle. Moreover, this study showed that college students with a higher critical eHealth literacy engaged better in health-promoting activities than those with functional and interactive literacy. %M 28073739 %R 10.2196/jmir.5964 %U http://www.jmir.org/2017/1/e15/ %U https://doi.org/10.2196/jmir.5964 %U http://www.ncbi.nlm.nih.gov/pubmed/28073739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e267 %T Education-Based Gaps in eHealth: A Weighted Logistic Regression Approach %A Amo,Laura %+ State University of New York at Buffalo, 259 Jacobs Hall, Buffalo, NY, 14260, United States, 1 716 645 5346, lccasey@buffalo.edu %K information storage and retrieval %K eHealth %K models, statistical %D 2016 %7 12.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Persons with a college degree are more likely to engage in eHealth behaviors than persons without a college degree, compounding the health disadvantages of undereducated groups in the United States. However, the extent to which quality of recent eHealth experience reduces the education-based eHealth gap is unexplored. Objective: The goal of this study was to examine how eHealth information search experience moderates the relationship between college education and eHealth behaviors. Methods: Based on a nationally representative sample of adults who reported using the Internet to conduct the most recent health information search (n=1458), I evaluated eHealth search experience in relation to the likelihood of engaging in different eHealth behaviors. I examined whether Internet health information search experience reduces the eHealth behavior gaps among college-educated and noncollege-educated adults. Weighted logistic regression models were used to estimate the probability of different eHealth behaviors. Results: College education was significantly positively related to the likelihood of 4 eHealth behaviors. In general, eHealth search experience was negatively associated with health care behaviors, health information-seeking behaviors, and user-generated or content sharing behaviors after accounting for other covariates. Whereas Internet health information search experience has narrowed the education gap in terms of likelihood of using email or Internet to communicate with a doctor or health care provider and likelihood of using a website to manage diet, weight, or health, it has widened the education gap in the instances of searching for health information for oneself, searching for health information for someone else, and downloading health information on a mobile device. Conclusion: The relationship between college education and eHealth behaviors is moderated by Internet health information search experience in different ways depending on the type of eHealth behavior. After controlling for college education, it was found that persons who experienced more fruitful Internet health information searches are generally less likely to engage in eHealth behaviors. %M 27733329 %R 10.2196/jmir.5188 %U http://www.jmir.org/2016/10/e267/ %U https://doi.org/10.2196/jmir.5188 %U http://www.ncbi.nlm.nih.gov/pubmed/27733329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e264 %T Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide %A Mackert,Michael %A Mabry-Flynn,Amanda %A Champlin,Sara %A Donovan,Erin E %A Pounders,Kathrynn %+ Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, 300 West Dean Keeton A1200, BMC 4.338, Austin, TX, 78712, United States, 1 512 471 8558, mackert@utexas.edu %K health literacy %K personal health information %K biomedical technology %K medical informatics %D 2016 %7 04.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. Objective: The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. Methods: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. Results: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). Conclusions: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust. %M 27702738 %R 10.2196/jmir.6349 %U http://www.jmir.org/2016/10/e264/ %U https://doi.org/10.2196/jmir.6349 %U http://www.ncbi.nlm.nih.gov/pubmed/27702738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e192 %T Associations of eHealth Literacy With Health Behavior Among Adult Internet Users %A Mitsutake,Seigo %A Shibata,Ai %A Ishii,Kaori %A Oka,Koichiro %+ Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo,, Japan, 81 3 3964 3241 ext 4229, mitsu@tmig.or.jp %K health literacy %K ehealth literacy %K epatients %K Internet %K health behavior %K cross-sectional studies %D 2016 %7 18.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In the rapidly developing use of the Internet in society, eHealth literacy—having the skills to utilize health information on the Internet—has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users. Objective: The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan. Methods: The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N=10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses. Results: We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy. Conclusions: We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users. %M 27432783 %R 10.2196/jmir.5413 %U http://www.jmir.org/2016/7/e192/ %U https://doi.org/10.2196/jmir.5413 %U http://www.ncbi.nlm.nih.gov/pubmed/27432783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e161 %T Being an Informed Consumer of Health Information and Assessment of Electronic Health Literacy in a National Sample of Internet Users: Validity and Reliability of the e-HLS Instrument %A Seçkin,Gül %A Yeatts,Dale %A Hughes,Susan %A Hudson,Cassie %A Bell,Valarie %+ University of North Texas, 1155 Union Circle #311157, Denton, TX, 76203, United States, 1 (940) 565 2296, gul.seckin@unt.edu %K health literacy %K health information technology %K Internet %K information %K ehealth %D 2016 %7 11.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet, with its capacity to provide information that transcends time and space barriers, continues to transform how people find and apply information to their own lives. With the current explosion in electronic sources of health information, including thousands of websites and hundreds of mobile phone health apps, electronic health literacy is gaining an increasing prominence in health and medical research. An important dimension of electronic health literacy is the ability to appraise the quality of information that will facilitate everyday health care decisions. Health information seekers explore their care options by gathering information from health websites, blogs, Web-based forums, social networking websites, and advertisements, despite the fact that information quality on the Internet varies greatly. Nonetheless, research has lagged behind in establishing multidimensional instruments, in part due to the evolving construct of health literacy itself. Objective: The purpose of this study was to examine psychometric properties of a new electronic health literacy (ehealth literacy) measure in a national sample of Internet users with specific attention to older users. Our paper is motivated by the fact that ehealth literacy is an underinvestigated area of inquiry. Methods: Our sample was drawn from a panel of more than 55,000 participants maintained by Knowledge Networks, the largest national probability-based research panel for Web-based surveys. We examined the factor structure of a 19-item electronic Health Literacy Scale (e-HLS) through exploratory factor analysis (EFA) and confirmatory factor analysis, internal consistency reliability, and construct validity on sample of adults (n=710) and a subsample of older adults (n=194). The AMOS graphics program 21.0 was used to construct a measurement model, linking latent factors obtained from EFA with 19 indicators to determine whether this factor structure achieved a good fit with our entire sample and the subsample (age ≥ 60 years). Linear regression analyses were performed in separate models to examine: (1) the construct validity of the e-HLS and (2) its association with respondents’ demographic characteristics and health variables. Results: The EFA produced a 3-factor solution: communication (2 items), trust (4 items), and action (13 items). The 3-factor structure of the e-HLS was found to be invariant for the subsample. Fit indices obtained were as follows: full sample: χ2 (710)=698.547, df=131, P<.001, comparative fit index (CFI)=0.94, normed fit index (NFI)=0.92, root mean squared error of approximation (RMSEA)=0.08; and for the older subsample (age ≥ 60 years): χ2 (194)=275.744, df=131, P<.001, CFI=0.95, NFI=0.90, RMSEA=0.08. Conclusions: The analyses supported the e-HLS validity and internal reliability for the full sample and subsample. The overwhelming majority of our respondents reported a great deal of confidence in their ability to appraise the quality of information obtained from the Internet, yet less than half reported performing quality checks contained on the e-HLS. %M 27400726 %R 10.2196/jmir.5496 %U http://www.jmir.org/2016/7/e161/ %U https://doi.org/10.2196/jmir.5496 %U http://www.ncbi.nlm.nih.gov/pubmed/27400726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e104 %T Consumers’ Patient Portal Preferences and Health Literacy: A Survey Using Crowdsourcing %A Zide,Mary %A Caswell,Kaitlyn %A Peterson,Ellen %A Aberle,Denise R %A Bui,Alex AT %A Arnold,Corey W %+ Department of Bioengineering, University of California, Los Angeles, 924 Westwood Blvd, Suite 420, Los Angeles, CA, 90024, United States, 1 5102075012, mmcnamara@ucla.edu %K consumer health information %K health literacy %K eHealth %K patient portal %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: eHealth apps have the potential to meet the information needs of patient populations and improve health literacy rates. However, little work has been done to document perceived usability of portals and health literacy of specific topics. Objective: Our aim was to establish a baseline of lung cancer health literacy and perceived portal usability. Methods: A survey based on previously validated instruments was used to assess a baseline of patient portal usability and health literacy within the domain of lung cancer. The survey was distributed via Amazon’s Mechanical Turk to 500 participants. Results: Our results show differences in preferences and literacy by demographic cohorts, with a trend of chronically ill patients having a more positive reception of patient portals and a higher health literacy rate of lung cancer knowledge (P<.05). Conclusions: This article provides a baseline of usability needs and health literacy that suggests that chronically ill patients have a greater preference for patient portals and higher level of health literacy within the domain of lung cancer. %M 27278634 %R 10.2196/resprot.5122 %U http://www.researchprotocols.org/2016/2/e104/ %U https://doi.org/10.2196/resprot.5122 %U http://www.ncbi.nlm.nih.gov/pubmed/27278634 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e113 %T Web-based Discussion Forums on Pregnancy Complaints and Maternal Health Literacy in Norway: A Qualitative Study %A Fredriksen,Eva Haukeland %A Harris,Janet %A Moland,Karen Marie %+ Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Bergen University College, Inndalsveien 28, Bergen, Postbox 7030, 5020 Bergen, Norway, 47 55585607, eva.haukeland.fredriksen@hib.no %K qualitative research %K Internet %K pregnancy %K health literacy %K web-based discussion forums %K pelvic girdle pain %D 2016 %7 26.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is one of the fastest growing information sources for pregnant women and seems to be used across social and economic strata. However, we still lack knowledge on how interaction in Web-based discussion forums influence maternal health literacy, in terms of how pregnant women access, appraise, and apply information to promote and maintain good health. Objective: The aim of this study was to understand how Web-based discussion forums influence maternal health literacy; hence, we explored the role of interactions in Web-based discussion forums among women who experienced health problems during pregnancy. More specifically, we explored why media-literate women experiencing the medically unexplained condition, pelvic girdle pain (PGP), during pregnancy participated in Web-based discussion forums and how they appraised and applied the information and advice that they gained from the Web-based interaction with other women. Methods: Women were invited to participate in the study via postings on 3 different open websites for pregnant women and mothers. The sample included 11 Norwegian women who participated in open Web-based discussion forums when experiencing PGP in pregnancy. The data were collected using synchronous qualitative email interviews and were analyzed using thematic analysis. Results: In our study sample, interaction in Web-based discussion forums influenced maternal health literacy in terms of increased health-related knowledge and competencies, increased awareness of health promotion and health protection, and increased system navigation. The women appraised and selectively applied information and advice that resonated with their own experiences. For many, the information provided online by other women in the same situation was valued more highly than advice from health professionals. Women reported that they used their knowledge and competency in encounters with health professionals but hesitated to disclose the origin of their knowledge. Those with a high level of education in medicine-related fields raised a concern about the Internet as a source of horror stories and erroneous information and were actively engaged in trying to minimize potential negative effects, by providing biomedical information. Conclusions: The popularity of Web-based discussion forums among pregnant women suggests that this group needs additional sources of information and support to complement traditional consultations with the health professionals. The professionals need to recognize that pregnant women access Web-based discussion forums for support and information to increase their ability to take better health decisions for themselves. This is a potential resource that health professionals may find useful in consultations with pregnant women. %M 27230094 %R 10.2196/jmir.5270 %U http://www.jmir.org/2016/5/e113/ %U https://doi.org/10.2196/jmir.5270 %U http://www.ncbi.nlm.nih.gov/pubmed/27230094 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e16 %T eHealth Literacy: In the Quest of the Contributing Factors %A Xesfingi,Sofia %A Vozikis,Athanassios %+ Department of Economics, University of Piraeus, 5th Floor., 80, Karaoli & Dimitriou Str., Piraeus, 18534, Greece, 30 2104142280, xesfingi@unipi.gr %K eHealth literacy %K health information %K Internet %K demographic factors %K life-style habits %D 2016 %7 25.05.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Understanding the factors that influence eHealth in a country is particularly important for health policy decision makers and the health care market, as it provides critical information to develop targeted and tailored interventions for relevant patient–consumer segments, and further suggests appropriate strategies for training the health illiterate part of the population. Objective: The objective of the study is to assess the eHealth literacy level of Greek citizens, using the eHealth Literacy Scale (eHEALS), and further explore the factors that shape it and are associated with it. Methods: This empirical study relies on a unique sample of 1064 citizens in Greece in the year 2013. The participants were requested to answer various questions about their ability to solve health-related issues using the Internet, and to provide information about their demographic characteristics and life-style habits. Ordered logit models were used to describe a certain citizen’s likelihood of being eHealth literate. Results: The demographic factors show that the probability of an individual being eHealth literate decreases by 23% (P=.001) when the individual ages and increases by 53% (P<.001) when he or she acquires higher level of education. Among the life-style variables, physical exercise appears to be strongly and positively associated with the level of eHealth literacy (P=.001). Additionally, other types of technology literacies, such as computer literacy and information literacy, further enhance the eHealth performance of citizens and have the greatest impact among all factors. Conclusions: The factors influencing eHealth literacy are complex and interdependent. However, the Internet is a disruptive factor in the relationship between health provider and health consumer. Further research is needed to examine how several factors associate with eHealth literacy, since, the latter is not only related to health care outcomes but also can be a tool for disseminating social inequalities. %M 27226146 %R 10.2196/ijmr.4749 %U http://www.i-jmr.org/2016/2/e16/ %U https://doi.org/10.2196/ijmr.4749 %U http://www.ncbi.nlm.nih.gov/pubmed/27226146 %0 Journal Article %@ 2369-2960 %I Gunther Eysenbach %V 2 %N 1 %P e24 %T Construct Validity of the eHealth Literacy Scale (eHEALS) Among Two Adult Populations: A Rasch Analysis %A Nguyen,Jennifer %A Moorhouse,Michael %A Curbow,Barbara %A Christie,Juliette %A Walsh-Childers,Kim %A Islam,Sabrina %+ Minority Cancer Research and Training (MiCaRT) Center, University of Florida Health Cancer Center, 6550 Sanger Road, Orlando, FL, 32827, United States, 1 4043137109, jennifernguyen@cop.ufl.edu %K eHealth %K eHEALS %K internet %K measurement %K rasch %K public health %D 2016 %7 20.05.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Internet has become a ubiquitous venue for information seeking, especially for health information. Public health practitioners have noticed the promise and potential of the Internet, however, little is known about individuals' skills of their eHealth literacy. The eHealth Literacy Scale, eHEALS, was designed to measure perceptions of individuals' eHealth literacy skills. Objective: The objective of the study was to examine the psychometric validity and reliability of the eHEALS with two adult populations using the Rasch Model. Methods: A college-aged sample and an Internet-based sample (Amazon's MTurk) were recruited to complete the eHEALS, demographic questions, and a health literacy scale. Using WINSTEPS and SPSS, unidimensionality, item fit, rating scale, item hierarchy, person ability-item match, and reliability were analyzed, compared, and contrasted against each sample and to other samples found in the literature. Results: An exploratory factor analysis supported unidimensionality in both samples. More than 90% of respondents from both samples fit the model. No items were outright misfitting. Both samples separated into three distinct groups. Conclusions: Based on the results, the eHEALS is a reliable and consistent measurement tool for a college sample and an Internet-based sample. As these individuals are most likely to use the Internet as a health resource, it is necessary to learn and know their skills versus perceiving that they can critically and successfully navigate the Internet. Further analyses are necessary to ensure that the eHEALS can serve as a standard eHealth literacy measure for public health. %M 27244771 %R 10.2196/publichealth.4967 %U http://publichealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/publichealth.4967 %U http://www.ncbi.nlm.nih.gov/pubmed/27244771 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 4 %N 2 %P e5 %T Harnessing the Web: How E-Health and E-Health Literacy Impact Young Adults’ Perceptions of Online Health Information %A Briones,Rowena %+ Virginia Commonwealth University, Richard T. Robertson School of Media & Culture, 901 W. Main St., Richmond, VA, 23284, United States, 1 804 827 2048, rlbriones@vcu.edu %K e-health literacy %K young adults %K online information seeking %K online health information %D 2015 %7 31.12.2015 %9 Original Paper %J Med 2.0 %G English %X Background: The rise of technology has changed how people take control of their health, enabling individuals to choose to live healthier lives and make better treatment decisions. With this said, the Internet has emerged as the channel used by individuals for actively seeking or passively receiving health information. Objective: To explore how young adults assess the quality of health information, and how they construct meaning of online health information in general. Through 50 in-depth interviews, this study aims to examine how and why young adults turn to the Web for health information, and what strategies they employ to ensure that they are getting credible information. Methods: A total of 50 in-depth interviews were conducted with young adults to explore how they make meaning of online health information. Depending on the geographic area of the participant, the interview took place face-to-face at a location convenient for them, over Skype, or over the telephone and lasted on average 40 minutes. The interviews were transcribed verbatim, fully retaining the speech style of the moderator and the participants. Data were analyzed using techniques from the grounded theory approach, using a constant comparative method to allow for themes to emerge from the transcripts. Results: The participants shared several benefits to this mode of health information seeking, claiming that it made for more productive visits with doctors and made health information more readily accessible through a variety of different formats. Additionally, the participants demonstrated their e-health literacy levels by discussing how they assessed online health information, engaging in a series of strategies that encompassed different aspects of e-health literacy. Social media channels were brought up by the participants as relatively new tools that can be used to assist in the seeking, understanding, and sharing of health information. However, participants also cautioned about the use of social media in regards to its informal nature, warning users to evaluate sources accordingly and to use these channels as supplementary outlets of information for more traditional channels. Conclusions: The use of the Internet and technology for health purposes is a growing area for both scholarship and practice that has strong implications for health consumers, medical professionals, and communicators alike. The findings that emerged from this research demonstrated that the online space is an acceptable channel through which young adults can find and share information. However, in spite of the rising usage of social media by this particular group, the findings showed that they were hesitant and wary of the channel, not seeing it as a resource for health information but more of a channel for networking and entertainment. In spite of this, this study shows that the online health information seeking behaviors is an area that warrants further exploration. %M 26721292 %R 10.2196/med20.4327 %U http://www.medicine20.com/2015/2/e5/ %U https://doi.org/10.2196/med20.4327 %U http://www.ncbi.nlm.nih.gov/pubmed/26721292 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e261 %T The Association Between Online Health Information–Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study %A Lee,Young Ji %A Boden-Albala,Bernadette %A Jia,Haomiao %A Wilcox,Adam %A Bakken,Suzanne %+ Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, United States, 1 412 624 7886, leeyoung@pitt.edu %K Internet %K information-seeking behavior %K health behavior %K consumer health information %K Hispanic Americans %D 2015 %7 26.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics. Objective: The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. Methods: Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use. Results: Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors. Conclusions: Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance. %M 26611438 %R 10.2196/jmir.4368 %U http://www.jmir.org/2015/11/e261/ %U https://doi.org/10.2196/jmir.4368 %U http://www.ncbi.nlm.nih.gov/pubmed/26611438 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e230 %T Views of People With High and Low Levels of Health Literacy About a Digital Intervention to Promote Physical Activity for Diabetes: A Qualitative Study in Five Countries %A Rowsell,Alison %A Muller,Ingrid %A Murray,Elizabeth %A Little,Paul %A Byrne,Christopher D %A Ganahl,Kristin %A Müller,Gabriele %A Gibney,Sarah %A Lyles,Courtney R %A Lucas,Antonia %A Nutbeam,Don %A Yardley,Lucy %+ Department of Psychology, Faculty of Social and Human Sciences, University of Southampton, Highfield Campus, Highfield, Southampton, SO17 1BJ, United Kingdom, 44 02380 592581, I.Muller@soton.ac.uk %K health literacy, digital intervention, diabetes, qualitative, physical activity %D 2015 %7 12.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Low health literacy is associated with poor health-related knowledge, illness self-management, health service use, health, and survival, and thus addressing issues related to low health literacy has been highlighted as a pressing international priority. Objective: To explore views of a digital health promotion intervention designed to be accessible to people with lower levels of health literacy, in particular examining reactions to the interactive and audiovisual elements of the intervention. Methods: Qualitative think-aloud interviews were carried out with 65 adults with type 2 diabetes in the UK, Ireland, USA, Germany, and Austria, with purposive sampling to ensure representation of people with lower levels of health literacy. Inductive thematic analysis was used to identify common themes. We then systematically compared views in subgroups based on country, health literacy level, age, gender, and time since diagnosis. Results: Most participants from the chosen countries expressed positive views of most elements and features of the intervention. Some interactive and audiovisual elements required modification to increase their usability and perceived credibility and relevance. There were some differences in views based on age and gender, but very few differences relating to health literacy level or time since diagnosis. Conclusions: In general, participants found the intervention content and format accessible, appropriate, engaging, and motivating. Digital interventions can and should be designed to be accessible and engaging for people with a wide range of health literacy levels. %M 26459743 %R 10.2196/jmir.4999 %U http://www.jmir.org/2015/10/e230/ %U https://doi.org/10.2196/jmir.4999 %U http://www.ncbi.nlm.nih.gov/pubmed/26459743 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e19 %T Third Molars on the Internet: A Guide for Assessing Information Quality and Readability %A Hanna,Kamal %A Brennan,David %A Sambrook,Paul %A Armfield,Jason %+ PhD Candidate, Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry, The University of Adelaide, ARCPOH, 122 Frome Street, Adelaide, South Australia, 5005, Australia, 61 883135626, kamal.hanna@adelaide.edu.au %K DISCERN %K health information online %K Health on the Net Code %K readability %K Scientific Information Quality Scale %K website affiliation %K website content analysis %K wisdom teeth %D 2015 %7 06.10.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. Objectives: This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. Methods: A cross-sectional sample of websites was retrieved using certain keywords and phrases such as “impacted wisdom tooth problems” using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). Results: Websites’ mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. Conclusion: The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures. %M 26443470 %R 10.2196/ijmr.4712 %U http://www.i-jmr.org/2015/4/e19/ %U https://doi.org/10.2196/ijmr.4712 %U http://www.ncbi.nlm.nih.gov/pubmed/26443470 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e8 %T Response Across the Health-Literacy Spectrum of Kidney Transplant Recipients to a Sun-Protection Education Program Delivered on Tablet Computers: Randomized Controlled Trial %A Robinson,June K %A Friedewald,John J %A Desai,Amishi %A Gordon,Elisa J %+ Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1260, Chicago, IL, 60611, United States, 1 312 926 7449, june-robinson@northwestern.edu %K culturally sensitive %K electronic health intervention %K kidney transplant recipients %K post-transplant outcomes %K skin cancer %K squamous cell carcinoma %K sun protection %K tablet computer %K patient education %K mobile health %D 2015 %7 18.08.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Sun protection can reduce skin cancer development in kidney transplant recipients, who have a greater risk of developing squamous cell carcinoma than the general population. Objective: A culturally sensitive sun-protection program (SunProtect) was created in English and Spanish with the option of choosing audio narration provided by the tablet computer (Samsung Galaxy Tab 2 10.1). The intervention, which showed skin cancer on patients with various skin tones, explained the following scenarios: skin cancer risk, the ability of sun protection to reduce this risk, as well as offered sun-protection choices. The length of the intervention was limited to the time usually spent waiting during a visit to the nephrologist. Methods: The development of this culturally sensitive, electronic, interactive sun-protection educational program, SunProtect, was guided by the “transtheoretical model,” which focuses on decision making influenced by perceptions of personal risk or vulnerability to a health threat, importance (severity) of the disease, and benefit of sun-protection behavior. Transportation theory, which holds that narratives can have uniquely persuasive effects in overcoming preconceived beliefs and cognitive biases because people transported into a narrative world will alter their beliefs based on information, claims, or events depicted, guided the use of testimonials. Participant tablet use was self-directed. Self-reported responses to surveys were entered into the database through the tablet. Usability was tested through interviews. A randomized controlled pilot trial with 170 kidney transplant recipients was conducted, where the educational program (SunProtect) was delivered through a touch-screen tablet to 84 participants. Results: The study involved 62 non-Hispanic white, 60 non-Hispanic black, and 48 Hispanic/Latino kidney transplant recipients. The demographic survey data showed no significant mean differences between the intervention and control groups in age, sex, income, or time since transplantation. The mean duration of program use varied by the ethnic/racial group, with non-Hispanic whites having the shortest use (23 minutes) and Hispanic/Latinos having the longest use (42 minutes). Knowledge, awareness of skin cancer risk, willingness to change sun protection, and use of sun protection increased from baseline to 2 weeks after the program in participants from all ethnic/racial groups in comparison with controls (P<.05). Kidney transplant recipients with inadequate (47/170, 28%) and marginal functional health literacy (59/170, 35%) listened to either Spanish or English audio narration accompanying the text and graphics. After completion of the program, Hispanic/Latino patients with initially inadequate health literacy increased their knowledge more than non-Hispanic white and black patients with adequate health literacy (P<.05). Sun protection implemented 2 weeks after education varied by the ethnic/racial group. Outdoor activities were reduced by Hispanics/Latinos, non-Hispanic blacks sought shade, Hispanic/Latinos and non-Hispanic blacks wore clothing, and non-Hispanic whites wore sunscreen (P<.05). Conclusion: Educational program with a tablet computer during the kidney transplant recipients’ 6- or 12-month follow-up visits to the transplant nephrologist improved sun protection in all racial/ethnic groups. Tablets may be used to provide patient education and reduce the physician’s burden of educating and training patients. Trial Registration: ClinicalTrials.gov NCT01646099; https://clinicaltrials.gov/ct2/show/NCT01646099 %M 28410176 %R 10.2196/cancer.4787 %U http://cancer.jmir.org/2015/2/e8/ %U https://doi.org/10.2196/cancer.4787 %U http://www.ncbi.nlm.nih.gov/pubmed/28410176 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e14 %T Readability of Information Related to the Parenting of a Child With a Cleft %A De Felippe,Nanci %A Kar,Farnaz %+ School of Dentistry, Division of Orthodontics, University of Minnesota, Rm 6-320A, Moos Tower, 515 Delaware St SE, Minneapolis, MN, 55455, United States, 1 612 625 3652, farah049@umn.edu %K cleft lip %K cleft palate %K parenting %K readability %K literacy %D 2015 %7 08.07.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Many parents look to various sources for information about parenting when their child has a cleft lip and/or palate. More than 8 million Americans perform health-related searches every day on the World Wide Web. Furthermore, a significant number of them report feeling “overwhelmed” by the language and content of the information. Objective: The purpose of this study is to determine the readability of information related to parenting a child with cleft lip and/or palate. It was hypothesized that the readability of such materials would be at a level higher than 6th grade. Methods: In February of 2012, a Web-based search was conducted using the search engine Google for the terms “parenting cleft lip and palate.” Results: A total of 15 websites, 7 books, and 8 booklets/factsheets (N=30) entered the readability analysis. Flesch-Kincaid Grade Level, Fog Scale Level, and Simple Measure of Gobbledygook (SMOG) index scores were calculated. The reading level of the websites and books ranged from 8th to 9th and 9th to10th grade, respectively. The average reading level of the booklets/factsheets was 10th grade. Overall, the mean readability of the media resources analyzed was considered “hard to read.” No statistically significant mean difference was found for the readability level across websites, books, and booklets/factsheets (Kruskal-Wallis test, significance level .05). Conclusions: When considering websites, books, booklets, and factsheets analyzed, the average readability level was between 8th and 10th grade. With the US national reading level average at 8th grade and the general recommendation that health-related information be written at a 6th grade level, many parents may find the text they are reading too difficult to comprehend. Therefore, many families might be missing out on the opportunity to learn parenting practices that foster optimal psychosocial development of their children. %M 26155814 %R 10.2196/ijmr.4210 %U http://www.i-jmr.org/2015/3/e14/ %U https://doi.org/10.2196/ijmr.4210 %U http://www.ncbi.nlm.nih.gov/pubmed/26155814 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e9 %T Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs %A Kayser,Lars %A Kushniruk,Andre %A Osborne,Richard H %A Norgaard,Ole %A Turner,Paul %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth literacy %K requirements %K user involvement %D 2015 %7 20.05.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective: The objective of this paper is to propose how users’ needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users’ competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users’ needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions: Developing effective eHealth products requires complete understanding of the end-users’ needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users’ needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. %M 27025228 %R 10.2196/humanfactors.3696 %U http://humanfactors.jmir.org/2015/1/e9/ %U https://doi.org/10.2196/humanfactors.3696 %U http://www.ncbi.nlm.nih.gov/pubmed/27025228 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e122 %T Older People Going Online: Its Value and Before-After Evaluation of Volunteer Support %A Jones,Ray B %A Ashurst,Emily J %A Atkey,Jo %A Duffy,Barbara %+ Plymouth University, School of Nursing and Midwifery, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 7972563340, ray.jones@plymouth.ac.uk %K digital inclusion %K health informatics %K social return on investment %K older people %D 2015 %7 18.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although Internet usage can benefit older people by reducing social isolation, increasing access to services, and improving health and well-being, only a minority are online. Barriers to Internet uptake include attitude and a lack of knowledge and help. We have evaluated volunteer support in helping older people go online. Knowing what value the Internet has been to older people who have just gone online should guide how it is “sold” to those remaining offline. Objective: Objectives of this study are (1) to assess the feasibility of recruiting volunteers aged 50 years and older and supporting them in helping people (ie, beneficiaries) aged 65 years and older go online, (2) to assess the impact of beneficiaries using the Internet on contacts with others, loneliness, and mental health, and (3) to assess the perceived value to beneficiaries of going online. Methods: Beneficiaries received help in using the Internet from 32 volunteers in one of two ways: (1) one-on-one in their own homes, receiving an average of 12 hours of help over eight visits, or (2) in small group sessions, receiving 12 hours of help over six visits. We assessed, at registration and follow-up, the number of contacts with others, using Lubben’s 6-item Lubben Social Network Scale (LBNS-6), loneliness, using De Jong Gierveld’s 6-item De Jong Gierveld loneliness scale (DJG-6), and mental well-being, using Tennant’s Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also assessed how beneficiaries valued going online using a Social Return on Investment (SROI) approach by postal survey. Results: A total of 144 beneficiaries were recruited with the aim of helping them go online via one-on-one (n=58) or small group (n=86) sessions. Data through to follow-up were available on 76.4% (110/144) of participants. From baseline to follow-up, the number of contacts with others was significantly increased—LBNS-6, mean 13.7 to mean 17.6—loneliness scores were reduced—DJG-6, mean 2.38 to mean 1.80—and mental well-being improved—SWEMWBS, mean 24.06 to mean 24.96. Out of six options, beneficiaries valued better communication with family and friends most and better health care least as a benefit of using the Internet. Out of nine options, having the Internet was valued less than having TV, but more than, for example, having a weekly visit from a cleaner. There were no associations between values placed on Internet use or volunteer help and psychological improvements. Conclusions: Volunteer help to go online seemed to result in increased social contacts, reduced loneliness, and improved mental well-being and was valued quite highly by beneficiaries. Although the use of the Internet for health care was the least valued, improved social contact can improve health. Contacting family is likely to be the best “selling point” of the Internet for older people. %M 25986724 %R 10.2196/jmir.3943 %U http://www.jmir.org/2015/5/e122/ %U https://doi.org/10.2196/jmir.3943 %U http://www.ncbi.nlm.nih.gov/pubmed/25986724 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e112 %T Low Health Literacy and Evaluation of Online Health Information: A Systematic Review of the Literature %A Diviani,Nicola %A van den Putte,Bas %A Giani,Stefano %A van Weert,Julia CM %+ Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, Amsterdam, 1001 NG, Netherlands, 31 6 15254105, N.Diviani@uva.nl %K health information seeking %K online health information %K information quality %K health literacy %D 2015 %7 07.05.2015 %9 Review %J J Med Internet Res %G English %X Background: Recent years have witnessed a dramatic increase in consumer online health information seeking. The quality of online health information, however, remains questionable. The issue of information evaluation has become a hot topic, leading to the development of guidelines and checklists to design high-quality online health information. However, little attention has been devoted to how consumers, in particular people with low health literacy, evaluate online health information. Objective: The main aim of this study was to review existing evidence on the association between low health literacy and (1) people’s ability to evaluate online health information, (2) perceived quality of online health information, (3) trust in online health information, and (4) use of evaluation criteria for online health information. Methods: Five academic databases (MEDLINE, PsycINFO, Web of Science, CINAHL, and Communication and Mass-media Complete) were systematically searched. We included peer-reviewed publications investigating differences in the evaluation of online information between people with different health literacy levels. Results: After abstract and full-text screening, 38 articles were included in the review. Only four studies investigated the specific role of low health literacy in the evaluation of online health information. The other studies examined the association between educational level or other skills-based proxies for health literacy, such as general literacy, and outcomes. Results indicate that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Evidence on the association with perceived quality of online health information and use of evaluation criteria is inconclusive. Conclusions: The findings indicate that low health literacy (and related skills) play a role in the evaluation of online health information. This topic is therefore worth more scholarly attention. Based on the results of this review, future research in this field should (1) specifically focus on health literacy, (2) devote more attention to the identification of the different criteria people use to evaluate online health information, (3) develop shared definitions and measures for the most commonly used outcomes in the field of evaluation of online health information, and (4) assess the relationship between the different evaluative dimensions and the role played by health literacy in shaping their interplay. %M 25953147 %R 10.2196/jmir.4018 %U http://www.jmir.org/2015/5/e112/ %U https://doi.org/10.2196/jmir.4018 %U http://www.ncbi.nlm.nih.gov/pubmed/25953147 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e104 %T The Effect of Modality and Narration Style on Recall of Online Health Information: Results From a Web-Based Experiment %A Bol,Nadine %A van Weert,Julia CM %A de Haes,Hanneke CJM %A Loos,Eugene F %A Smets,Ellen MA %+ Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 205252113, n.bol@uva.nl %K instructional films and videos %K narration %K personal narratives %K age groups %K consumer health information %K memory %K mental recall %K patient education %D 2015 %7 24.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults are increasingly using the Internet for health information; however, they are often not able to correctly recall Web-based information (eHealth information). Recall of information is crucial for optimal health outcomes, such as adequate disease management and adherence to medical regimes. Combining effective message strategies may help to improve recall of eHealth information among older adults. Presenting information in an audiovisual format using conversational narration style is expected to optimize recall of information compared to other combinations of modality and narration style. Objective: The aim of this paper is to investigate the effect of modality and narration style on recall of health information, and whether there are differences between younger and older adults. Methods: We conducted a Web-based experiment using a 2 (modality: written vs audiovisual information) by 2 (narration style: formal vs conversational style) between-subjects design (N=440). Age was assessed in the questionnaire and included as a factor: younger (<65 years) versus older (≥65 years) age. Participants were randomly assigned to one of four experimental webpages where information about lung cancer treatment was presented. A Web-based questionnaire assessed recall of eHealth information. Results: Audiovisual modality (vs written modality) was found to increase recall of information in both younger and older adults (P=.04). Although conversational narration style (vs formal narration style) did not increase recall of information (P=.17), a synergistic effect between modality and narration style was revealed: combining audiovisual information with conversational style outperformed combining written information with formal style (P=.01), as well as written information with conversational style (P=.045). This finding suggests that conversational style especially increases recall of information when presented audiovisually. This combination of modality and narration style improved recall of information among both younger and older adults. Conclusions: We conclude that combining audiovisual information with conversational style is the best way to present eHealth information to younger and older adults. Even though older adults did not proportionally recall more when audiovisual information was combined with conversational style than younger adults, this study reveals interesting implications for improving eHealth information that is effective for both younger and older adults. %M 25910416 %R 10.2196/jmir.4164 %U http://www.jmir.org/2015/4/e104/ %U https://doi.org/10.2196/jmir.4164 %U http://www.ncbi.nlm.nih.gov/pubmed/25910416 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e70 %T eHealth Literacy and Web 2.0 Health Information Seeking Behaviors Among Baby Boomers and Older Adults %A Tennant,Bethany %A Stellefson,Michael %A Dodd,Virginia %A Chaney,Beth %A Chaney,Don %A Paige,Samantha %A Alber,Julia %+ Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, , United States, 1 352 294 1805, mstellefson@ufl.edu %K social media %K aging %K health literacy %K Web 2.0 %D 2015 %7 17.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. Objective: The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. Methods: A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. Results: Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R2 =.17, R2adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information. Conclusions: Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making. %M 25783036 %R 10.2196/jmir.3992 %U http://www.jmir.org/2015/3/e70/ %U https://doi.org/10.2196/jmir.3992 %U http://www.ncbi.nlm.nih.gov/pubmed/25783036 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e18 %T Social Media in Adolescent Health Literacy Education: A Pilot Study %A Tse,Carrie KW %A Bridges,Susan M %A Srinivasan,Divya Parthasarathy %A Cheng,Brenda SS %+ The University of Hong Kong, Center for the Enhancement for Teaching and Learning/Faculty of Education, CPD.1.79, Centennial Campus, Pokfulam Road, Hong Kong, 00000, China (Hong Kong), 852 39714771, sbridges@hku.hk %K social media %K health literacy %K oral health literacy %K dentistry %K adolescents %K oral health %K health informatics %D 2015 %7 09.03.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: While health literacy has gained notice on a global stage, the initial focus on seeking associations with medical conditions may have overlooked its impact across generations. Adolescent health literacy, specifically in dentistry, is an underexplored area despite the significance of this formative stage on an individual’s approach to healthy lifestyles and behaviors. Objective: The aim is to conduct a pilot study to evaluate the efficacy of three major social media outlets - Twitter, Facebook, and YouTube - in supporting adolescents’ oral health literacy (OHL) education. Methods: A random sample of 22 adolescents (aged 14-16 years) from an English-medium international school in Hong Kong provided informed consent. Sociodemographic information, including English language background, social media usage, and dental experience were collected via a questionnaire. A pre- and post-test of OHL (REALD-30) was administered by two trained, calibrated examiners. Following pre-test, participants were randomly assigned to one of three social media outlets: Twitter, Facebook, or YouTube. Participants received alerts posted daily for 5 consecutive days requiring online accessing of modified and original OHL education materials. One-way ANOVA ( analysis of variance) was used to compare the mean difference between the pre- and the post-test results among the three social media. Results: No associations were found between the social media allocated and participants’ sociodemographics, including English language background, social media usage, and dental experience. Of the three social media, significant differences in literacy assessment scores were evident for participants who received oral health education messages via Facebook (P=.02) and YouTube (P=.005). Conclusions: Based on the results of the pilot study, Facebook and YouTube may be more efficient media outlets for OHL promotion and education among adolescent school children when compared to Twitter. Further analyses with a larger study group is warranted. %M 25757670 %R 10.2196/resprot.3285 %U http://www.researchprotocols.org/2015/1/e18/ %U https://doi.org/10.2196/resprot.3285 %U http://www.ncbi.nlm.nih.gov/pubmed/25757670 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e11 %T The Effectiveness of Health Animations in Audiences With Different Health Literacy Levels: An Experimental Study %A Meppelink,Corine S %A van Weert,Julia CM %A Haven,Carola J %A Smit,Edith G %+ Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, Nieuwe Achtergracht 166, PO Box 15793, 1001 NG, Amsterdam, , Netherlands, 31 20 525 7337, c.s.meppelink@uva.nl %K health literacy %K animation %K medical illustration %K reading %K audiovisual media %K cancer screening %K colorectal cancer %K prevention %K memory %K attitudes %D 2015 %7 13.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Processing Web-based health information can be difficult, especially for people with low health literacy. Presenting health information in an audiovisual format, such as animation, is expected to improve understanding among low health literate audiences. Objective: The aim of this paper is to investigate what features of spoken health animations improve information recall and attitudes and whether there are differences between health literacy groups. Methods: We conducted an online experiment among 231 participants aged 55 years or older with either low or high health literacy. A 2 (spoken vs written text) x 2 (illustration vs animation) design was used. Participants were randomly exposed to one of the four experimental messages, all providing the same information on colorectal cancer screening. Results: The results showed that, among people with low health literacy, spoken messages about colorectal cancer screening improved recall (P=.03) and attitudes (P=.02) compared to written messages. Animations alone did not improve recall, but when combined with spoken text, they significantly improved recall in this group (P=.02). When exposed to spoken animations, people with low health literacy recalled the same amount of information as their high health literate counterparts (P=.12), whereas in all other conditions people with high health literacy recalled more information compared to low health literate individuals. For people with low health literacy, positive attitudes mediated the relationship between spoken text and the intention to have a colorectal cancer screening (b=.12; 95% CI 0.02-0.25). Conclusions: We conclude that spoken animation is the best way to communicate complex health information to people with low health literacy. This format can even bridge the information processing gap between audiences with low and high health literacy as the recall differences between the two groups are eliminated. As animations do not negatively influence high health literate audiences, it is concluded that information adapted to audiences with low health literacy suits people with high health literacy as well. %M 25586711 %R 10.2196/jmir.3979 %U http://www.jmir.org/2015/1/e11/ %U https://doi.org/10.2196/jmir.3979 %U http://www.ncbi.nlm.nih.gov/pubmed/25586711 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e287 %T The Effect of Individual Factors on Health Behaviors Among College Students: The Mediating Effects of eHealth Literacy %A Hsu,WanChen %A Chiang,ChiaHsun %A Yang,ShuChing %+ Graduate Institute of Education, National Sun Yat-sen University, 70 Lienhai Road, Kaohsiung 80424, Taiwan, ROC, Kaohsiung, , Taiwan, 886 752 515 21, shyang@mail.nsysu.edu.tw %K demographic %K health behavior %K mediation %K eHealth literacy %K quantitative evaluation %D 2014 %7 12.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: College students’ health behavior is a topic that deserves attention. Individual factors and eHealth literacy may affect an individual’s health behaviors. The integrative model of eHealth use (IMeHU) provides a parsimonious account of the connections among the digital divide, health care disparities, and the unequal distribution and use of communication technologies. However, few studies have explored the associations among individual factors, eHealth literacy, and health behaviors, and IMeHU has not been empirically investigated. Objective: This study examines the associations among individual factors, eHealth literacy, and health behaviors using IMeHU. Methods: The Health Behavior Scale is a 12-item instrument developed to measure college students’ eating, exercise, and sleep behaviors. The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. A nationally representative sample of 525 valid college students in Taiwan was surveyed. A questionnaire was administered to collect background information about participants’ health status, degree of health concern, major, and the frequency with which they engaged in health-related discussions. This study used Amos 6.0 to conduct a confirmatory factor analysis to identify the best measurement models for the eHealth Literacy Scale and the Health Behavior Scale. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health behaviors. Additionally, causal steps approach was used to explore indirect (mediating) effects and Sobel tests were used to test the significance of the mediating effects. Results: The study found that perceptions of better health status (t520=2.14-6.12, P<.001-.03) and greater concern for health (t520=2.58-6.95, P<.001-.003) influenced college students’ development of 3 dimensions of eHealth literacy and adoption of healthy eating, exercise, and sleep behaviors. Moreover, eHealth literacy played an intermediary role in the association between individual factors and health behaviors (Sobel test=2.09-2.72, P<.001-.03). Specifically, higher levels of critical eHealth literacy promoted students’ health status and their practice of multiple positive health behaviors, including eating, exercise, and sleep behaviors. Conclusions: Because this study showed that eHealth literacy mediates the association between individual factors and health behaviors, schools should aim to enhance students’ eHealth literacy and promote their health behaviors to help them achieve high levels of critical eHealth literacy. Although some of the study’s hypotheses were not supported in this study, the factors that influence health behaviors are complex and interdependent. Therefore, a follow-up study should be conducted to further explore how these factors influence one another. %M 25499086 %R 10.2196/jmir.3542 %U http://www.jmir.org/2014/12/e287/ %U https://doi.org/10.2196/jmir.3542 %U http://www.ncbi.nlm.nih.gov/pubmed/25499086 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e262 %T Dr Google and the Consumer: A Qualitative Study Exploring the Navigational Needs and Online Health Information-Seeking Behaviors of Consumers With Chronic Health Conditions %A Lee,Kenneth %A Hoti,Kreshnik %A Hughes,Jeffery David %A Emmerton,Lynne %+ School of Pharmacy, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 7352, lynne.emmerton@curtin.edu.au %K online health information seeking %K health information search %K health seeking behavior %K consumer health information %K information needs %K Internet %K chronic disease %K patients %K qualitative research %K interview %D 2014 %7 02.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers’ needs. Objective: Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers’ online health information-seeking behaviors. Potential barriers to online navigation were also identified. Methods: Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified. Results: We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants’ online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance. Conclusions: This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers’ online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted. %M 25470306 %R 10.2196/jmir.3706 %U http://www.jmir.org/2014/12/e262/ %U https://doi.org/10.2196/jmir.3706 %U http://www.ncbi.nlm.nih.gov/pubmed/25470306 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e225 %T eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature %A Watkins,Ivan %A Xie,Bo %+ School of Information, The University of Texas at Austin, 1616 Guadalupe St, Austin, TX, 78701, United States, 1 410 507 6039, iwatkins@utexas.edu %K health literacy %K aging %K computers %D 2014 %7 10.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources. Objective: This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults. Methods: A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles. Results: Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design. Conclusions: Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population. %M 25386719 %R 10.2196/jmir.3318 %U http://www.jmir.org/2014/11/e225/ %U https://doi.org/10.2196/jmir.3318 %U http://www.ncbi.nlm.nih.gov/pubmed/25386719 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e187 %T Numeracy and Literacy Independently Predict Patients’ Ability to Identify Out-of-Range Test Results %A Zikmund-Fisher,Brian J %A Exe,Nicole L %A Witteman,Holly O %+ Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States, 1 7349369179, bzikmund@umich.edu %K numeracy %K literacy %K patient education as topic %K electronic health records %D 2014 %7 08.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing numbers of patients have direct access to laboratory test results outside of clinical consultations. This offers increased opportunities for both self-management of chronic conditions and advance preparation for clinic visits if patients are able to identify test results that are outside the reference ranges. Objective: Our objective was to assess whether adults can identify laboratory blood test values outside reference ranges when presented in a format similar to some current patient portals implemented within electronic health record (EHR) systems. Methods: In an Internet-administered survey, adults aged 40-70 years, approximately half with diabetes, were asked to imagine that they had type 2 diabetes. They were shown laboratory test results displayed in a standard tabular format. We randomized hemoglobin A1c values to be slightly (7.1%) or moderately (8.4%) outside the reference range and randomized other test results to be within or outside their reference ranges (ie, multiple deviations). We assessed (1) whether respondents identified the hemoglobin A1c level as outside the reference range, (2) how respondents rated glycemic control, and (3) whether they would call their doctor. We also measured numeracy and health literacy. Results: Among the 1817 adult participants, viewing test results with multiple deviations increased the probability of identifying hemoglobin A1c values as outside the reference range (participants with diabetes: OR 1.47, 95% CI 1.12-1.92, P=.005; participants without diabetes: OR 1.50, 95% CI 1.13-2.00, P=.005). Both numeracy and health literacy were significant predictors of correctly identifying out-of-range values. For participants with diabetes, numeracy OR 1.32 per unit on a 1-6 scale (95% CI 1.15-1.51, P<.001) and literacy OR 1.59 per unit of a 1-5 scale (95% CI 1.35-1.87, P<.001); for participants without diabetes, numeracy OR 1.36 per unit (95% CI 1.17-1.58, P<.001) and literacy OR 1.33 per unit (95% CI 1.12-1.58, P=.001). Predicted probabilities suggested 77% of higher numeracy and health literacy participants, but only 38% of lower numeracy and literacy participants, could correctly identify the hemoglobin A1c levels as outside the reference range. Correct identification reduced perceived blood glucose control (mean difference 1.68-1.71 points on a 0-10 scale, P<.001). For participants with diabetes, increased health literacy reduced the likelihood of calling one’s doctor when hemoglobin A1c=7.1% (OR 0.66 per unit, 95% CI 0.52-0.82, P<.001) and increased numeracy increased intention to call when hemoglobin A1c=8.4% (OR 1.36 per unit, 95% CI 1.10-1.69, P=.005). Conclusions: Limited health literacy and numeracy skills are significant barriers to basic use of laboratory test result data as currently presented in some EHR portals. Regarding contacting their doctor, less numerate and literate participants with diabetes appear insensitive to the hemoglobin A1c level shown, whereas highly numerate and literate participants with diabetes appear very sensitive. Alternate approaches appear necessary to make test results more meaningful. %M 25135688 %R 10.2196/jmir.3241 %U http://www.jmir.org/2014/8/e187/ %U https://doi.org/10.2196/jmir.3241 %U http://www.ncbi.nlm.nih.gov/pubmed/25135688 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e125 %T Cognitive Factors of Using Health Apps: Systematic Analysis of Relationships Among Health Consciousness, Health Information Orientation, eHealth Literacy, and Health App Use Efficacy %A Cho,Jaehee %A Park,Dongjin %A Lee,H Erin %+ School of Communication, Hallym University, #10222 Dasan Building, 39 Hallymdaehak-gil, Chuncheon, Gangwon-do, , Republic of Korea, 82 33 248 1929, dongjinpark@hallym.ac.kr %K health apps %K health consciousness %K health information orientation %K eHealth literacy %K health app use efficacy %D 2014 %7 09.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in smartphone health apps has been increasing recently. However, we have little understanding of the cognitive and motivational factors that influence the extent of health-app use. Objective: This study aimed to examine the effects of four cognitive factors—health consciousness, health information orientation, eHealth literacy, and health-app use efficacy—on the extent of health-app use. It also explored the influence of two different use patterns—information and information-behavior use of health apps—with regard to the relationships among the main study variables. Methods: We collected and analyzed 765 surveys in South Korea. According to the results, there was a negligible gender difference: males (50.6%, 387/765) and females (49.4%, 378/765). All participants were adults whose ages ranged from 19 to 59. In order to test the proposed hypotheses, we used a path analysis as a specific form of structural equation modeling. Results: Through a path analysis, we discovered that individuals’ health consciousness had a direct effect on their use of health apps. However, unlike the initial expectations, the effects of health information orientation and eHealth literacy on health-app use were mediated by health-app use efficacy. Conclusions: The results from the path analysis addressed a significant direct effect of health consciousness as well as strong mediating effects of health-app use efficacy. These findings contribute to widening our comprehension of the new, digital dimensions of health management, particularly those revolving around mobile technology. %M 24824062 %R 10.2196/jmir.3283 %U http://www.jmir.org/2014/5/e125/ %U https://doi.org/10.2196/jmir.3283 %U http://www.ncbi.nlm.nih.gov/pubmed/24824062 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e144 %T User Evaluation of the Effects of a Text Simplification Algorithm Using Term Familiarity on Perception, Understanding, Learning, and Information Retention %A Leroy,Gondy %A Endicott,James E %A Kauchak,David %A Mouradi,Obay %A Just,Melissa %+ Information Systems and Technology, Claremont Graduate University, ACB 225, 130 E Ninth Street, Claremont, CA, 91711, United States, 1 909 607 3270, gondy.leroy@cgu.edu %K text simplification %K health literacy %K consumer health information %K natural language processing %K evaluation study %D 2013 %7 31.07.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Adequate health literacy is important for people to maintain good health and manage diseases and injuries. Educational text, either retrieved from the Internet or provided by a doctor’s office, is a popular method to communicate health-related information. Unfortunately, it is difficult to write text that is easy to understand, and existing approaches, mostly the application of readability formulas, have not convincingly been shown to reduce the difficulty of text. Objective: To develop an evidence-based writer support tool to improve perceived and actual text difficulty. To this end, we are developing and testing algorithms that automatically identify difficult sections in text and provide appropriate, easier alternatives; algorithms that effectively reduce text difficulty will be included in the support tool. This work describes the user evaluation with an independent writer of an automated simplification algorithm using term familiarity. Methods: Term familiarity indicates how easy words are for readers and is estimated using term frequencies in the Google Web Corpus. Unfamiliar words are algorithmically identified and tagged for potential replacement. Easier alternatives consisting of synonyms, hypernyms, definitions, and semantic types are extracted from WordNet, the Unified Medical Language System (UMLS), and Wiktionary and ranked for a writer to choose from to simplify the text. We conducted a controlled user study with a representative writer who used our simplification algorithm to simplify texts. We tested the impact with representative consumers. The key independent variable of our study is lexical simplification, and we measured its effect on both perceived and actual text difficulty. Participants were recruited from Amazon’s Mechanical Turk website. Perceived difficulty was measured with 1 metric, a 5-point Likert scale. Actual difficulty was measured with 3 metrics: 5 multiple-choice questions alongside each text to measure understanding, 7 multiple-choice questions without the text for learning, and 2 free recall questions for information retention. Results: Ninety-nine participants completed the study. We found strong beneficial effects on both perceived and actual difficulty. After simplification, the text was perceived as simpler (P<.001) with simplified text scoring 2.3 and original text 3.2 on the 5-point Likert scale (score 1: easiest). It also led to better understanding of the text (P<.001) with 11% more correct answers with simplified text (63% correct) compared to the original (52% correct). There was more learning with 18% more correct answers after reading simplified text compared to 9% more correct answers after reading the original text (P=.003). There was no significant effect on free recall. Conclusions: Term familiarity is a valuable feature in simplifying text. Although the topic of the text influences the effect size, the results were convincing and consistent. %M 23903235 %R 10.2196/jmir.2569 %U http://www.jmir.org/2013/7/e144/ %U https://doi.org/10.2196/jmir.2569 %U http://www.ncbi.nlm.nih.gov/pubmed/23903235 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e108 %T Crowdsourcing Participatory Evaluation of Medical Pictograms Using Amazon Mechanical Turk %A Yu,Bei %A Willis,Matt %A Sun,Peiyuan %A Wang,Jun %+ School of Information Studies, Syracuse University, Hinds Hall, Syracuse University, Syracuse, NY, 13244, United States, 1 3154433614, byu@syr.edu %K crowdsourcing %K Amazon Mechanical Turk %K participatory design %K medical instruction %K pictogram %K patient communication %K readability %K health literacy %D 2013 %7 03.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Consumer and patient participation proved to be an effective approach for medical pictogram design, but it can be costly and time-consuming. We proposed and evaluated an inexpensive approach that crowdsourced the pictogram evaluation task to Amazon Mechanical Turk (MTurk) workers, who are usually referred to as the “turkers”. Objective: To answer two research questions: (1) Is the turkers’ collective effort effective for identifying design problems in medical pictograms? and (2) Do the turkers’ demographic characteristics affect their performance in medical pictogram comprehension? Methods: We designed a Web-based survey (open-ended tests) to ask 100 US turkers to type in their guesses of the meaning of 20 US pharmacopeial pictograms. Two judges independently coded the turkers’ guesses into four categories: correct, partially correct, wrong, and completely wrong. The comprehensibility of a pictogram was measured by the percentage of correct guesses, with each partially correct guess counted as 0.5 correct. We then conducted a content analysis on the turkers’ interpretations to identify misunderstandings and assess whether the misunderstandings were common. We also conducted a statistical analysis to examine the relationship between turkers’ demographic characteristics and their pictogram comprehension performance. Results: The survey was completed within 3 days of our posting the task to the MTurk, and the collected data are publicly available in the multimedia appendix for download. The comprehensibility for the 20 tested pictograms ranged from 45% to 98%, with an average of 72.5%. The comprehensibility scores of 10 pictograms were strongly correlated to the scores of the same pictograms reported in another study that used oral response–based open-ended testing with local people. The turkers’ misinterpretations shared common errors that exposed design problems in the pictograms. Participant performance was positively correlated with their educational level. Conclusions: The results confirmed that crowdsourcing can be used as an effective and inexpensive approach for participatory evaluation of medical pictograms. Through Web-based open-ended testing, the crowd can effectively identify problems in pictogram designs. The results also confirmed that education has a significant effect on the comprehension of medical pictograms. Since low-literate people are underrepresented in the turker population, further investigation is needed to examine to what extent turkers’ misunderstandings overlap with those elicited from low-literate people. %M 23732572 %R 10.2196/jmir.2513 %U http://www.jmir.org/2013/6/e108/ %U https://doi.org/10.2196/jmir.2513 %U http://www.ncbi.nlm.nih.gov/pubmed/23732572 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e80 %T Evaluation of a Web-Based Social Network Electronic Game in Enhancing Mental Health Literacy for Young People %A Li,Tim MH %A Chau,Michael %A Wong,Paul WC %A Lai,Eliza SY %A Yip,Paul SF %+ School of Business, The University of Hong Kong, 8/F K K Leung Building, Pokfulam Road, Hong Kong, , China (Hong Kong), 852 39171014, mchau@business.hku.hk %K digital game-based learning %K mental health literacy %K social networking sites %K motivation %D 2013 %7 15.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based learning programs provide people with massive health care information and self-help guidelines on improving their health. The advent of Web 2.0 and social networks renders significant flexibility to embedding highly interactive components, such as games, to foster learning processes. The effectiveness of game-based learning on social networks has not yet been fully evaluated. Objectives: The aim of this study was to assess the effectiveness of a fully automated, Web-based, social network electronic game on enhancing mental health knowledge and problem-solving skills of young people. We investigated potential motivational constructs directly affecting the learning outcome. Gender differences in learning outcome and motivation were also examined. Methods: A pre/posttest design was used to evaluate the fully automated Web-based intervention. Participants, recruited from a closed online user group, self-assessed their mental health literacy and motivational constructs before and after completing the game within a 3-week period. The electronic game was designed according to cognitive-behavioral approaches. Completers and intent-to-treat analyses, using multiple imputation for missing data, were performed. Regression analysis with backward selection was employed when examining the relationship between knowledge enhancement and motivational constructs. Results: The sample included 73 undergraduates (42 females) for completers analysis. The gaming approach was effective in enhancing young people’s mental health literacy (d=0.65). The finding was also consistent with the intent-to-treat analysis, which included 127 undergraduates (75 females). No gender differences were found in learning outcome (P=.97). Intrinsic goal orientation was the primary factor in learning motivation, whereas test anxiety was successfully alleviated in the game setting. No gender differences were found on any learning motivation subscales (P>.10). We also found that participants’ self-efficacy for learning and performance, as well as test anxiety, significantly affected their learning outcomes, whereas other motivational subscales were statistically nonsignificant. Conclusions: Electronic games implemented through social networking sites appear to effectively enhance users’ mental health literacy. %M 23676714 %R 10.2196/jmir.2316 %U http://www.jmir.org/2013/5/e80/ %U https://doi.org/10.2196/jmir.2316 %U http://www.ncbi.nlm.nih.gov/pubmed/23676714 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 2 %P e27 %T Measuring Actual eHealth Literacy Among Patients With Rheumatic Diseases: a Qualitative Analysis of Problems Encountered Using Health 1.0 and Health 2.0 Applications %A van der Vaart,Rosalie %A Drossaert,Constance HC %A de Heus,Miriam %A Taal,Erik %A van de Laar,Mart AFJ %+ University of Twente, Department of Psychology, Health & Technology, Drienerlolaan 5, PO Box 217, Enschede, 7500 AE, Netherlands, 31 53 489 6099, r.vandervaart@utwente.nl %K eHealth %K literacy %K Internet %K online %K health information %K Health 2.0 %K skills %K health care %D 2013 %7 11.02.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet offers diverse opportunities for disease management, through information websites (Health 1.0) and interactive applications such as peer support forums, online consults, and insight into electronic medical records (Health 2.0). However, various skills are required to benefit from Health 1.0 and Health 2.0 applications for one’s own health, known as eHealth literacy. Objective: To study the eHealth literacy of patients with rheumatic diseases and the types of problems they encounter when using the Internet in relation to their disease. Methods: In two studies, patients were asked about their current disease-related Internet use and their eHealth literacy was observed during performance tests. In study 1, 15 patients (aged 39-74) performed 6 information-retrieval tasks on the Internet (Health 1.0). In study 2, 16 patients (aged 24-72) performed 3 Health 2.0 tasks on a hospital-based online Web portal and 2 Health 2.0 tasks on interactive websites. Participants were asked to think aloud while performing the assignments, and screen activities were recorded. Types and frequency of problems were identified by 2 independent researchers and coded into categories using inductive analysis. Results: Almost all patients in our studies had searched the Internet for information about rheumatic diseases in the past. Fewer patients had used Health 2.0 applications, but many were nevertheless enthusiastic about the possibilities from Health 2.0 applications after finishing the assignments. However, nearly all participants experienced difficulties, and a substantial number of participants were not able to complete all of the assignments. Encountered problems could be divided into 6 sequential categories: (1) operating the computer and Internet browser, (2) navigating and orientating on the Web, (3) utilizing search strategies, (4) evaluating relevance and reliability, (5) adding content to the Web, and (6) protecting and respecting privacy. Most severe difficulties occurred in levels 3 and 4—in formulating a search query, evaluating the source of the information, and in scanning a website for relevant information. Conclusions: Many patients have insufficient skills to properly use Health 1.0 and Health 2.0. Formulating proper search strategies and evaluating the found information caused problems among the majority of patients. Concerning Health 2.0, use and awareness of these applications is low and patients should be guided in the use of them. Our findings may contribute to the awareness of patients’ eHealth literacy problems among health professionals, and stress the importance of usability guidelines in Web design. %M 23399720 %R 10.2196/jmir.2428 %U http://www.jmir.org/2013/2/e27/ %U https://doi.org/10.2196/jmir.2428 %U http://www.ncbi.nlm.nih.gov/pubmed/23399720 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 6 %P e153 %T Association of eHealth Literacy With Colorectal Cancer Knowledge and Screening Practice Among Internet Users in Japan %A Mitsutake,Seigo %A Shibata,Ai %A Ishii,Kaori %A Oka,Koichiro %+ Laboratory of Health and Behavioral Sciences, Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan, 81 4 2947 7189, mitsu@tmig.or.jp %K eHealth Literacy %K Internet %K Colorectal Neoplasms %K Consumer Health Information %K Health Promotion %D 2012 %7 13.11.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: In rapidly developing Internet-user societies, eHealth literacy has become important in promoting wellness. Although previous studies have observed that poor health literacy is associated with less knowledge and screening practice of colorectal cancer (CRC), little is known about whether eHealth literacy is associated with these variables. Objective: The present study examined associations between eHealth literacy, knowledge of CRC, and CRC screening practices. Methods: Data were analyzed for 2970 Japanese adults (men, 49.9%; mean age ± SD, 39.7 ± 10.9 years) who responded to an Internet-based cross-sectional survey. Knowledge of the definition of CRC, its risk factors and screening practice, previous experience of CRC screening, score on the Japanese version of the eHEALS (J-eHEALS), sociodemographic attributes (sex, age, marital status, educational attainment, and household income level), and frequency of Internet usage were obtained. Sociodemographic attributes and frequency of Internet usage were used as control variables in the multiple regression and logistic regression models. Results: eHealth literacy was positively associated with CRC knowledge (β = .116, < .001), when the covariables of both eHealth literacy and CRC knowledge were used in the multiple regression model. Moreover, after controlling for sociodemographic factors, which were significantly associated with eHealth literacy and CRC screening practice, an increase of 1 point in the eHEALS score signified that participants were 1.03 times (95% CI = 1.01–1.05) more likely to undergo CRC screening. Conclusions: Internet users with high eHealth literacy are more likely to have knowledge and previous screening practice related to CRC compared to those with low eHealth literacy. %M 23149453 %R 10.2196/jmir.1927 %U http://www.jmir.org/2012/6/e153/ %U https://doi.org/10.2196/jmir.1927 %U http://www.ncbi.nlm.nih.gov/pubmed/23149453 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e87 %T What do Web-Use Skill Differences Imply for Online Health Information Searches? %A Feufel,Markus A %A Stahl,S Frederica %+ Harding Center for Risk Literacy, Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Lentzeallee 94, Berlin, 14195, Germany, 49 3082406 ext 292, feufel@mpib-berlin.mpg.de %K Public access to information %K computer literacy %K information-seeking behavior %K patient education handout %K human factors %K digital divide %K information retrieval %D 2012 %7 13.06.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health information is of variable and often low scientific quality. In particular, elderly less-educated populations are said to struggle in accessing quality online information (digital divide). Little is known about (1) how their online behavior differs from that of younger, more-educated, and more-frequent Web users, and (2) how the older population may be supported in accessing good-quality online health information. Objective: To specify the digital divide between skilled and less-skilled Web users, we assessed qualitative differences in technical skills, cognitive strategies, and attitudes toward online health information. Based on these findings, we identified educational and technological interventions to help Web users find and access good-quality online health information. Methods: We asked 22 native German-speaking adults to search for health information online. The skilled cohort consisted of 10 participants who were younger than 30 years of age, had a higher level of education, and were more experienced using the Web than 12 participants in the less-skilled cohort, who were at least 50 years of age. We observed online health information searches to specify differences in technical skills and analyzed concurrent verbal protocols to identify health information seekers’ cognitive strategies and attitudes. Results: Our main findings relate to (1) attitudes: health information seekers in both cohorts doubted the quality of information retrieved online; among poorly skilled seekers, this was mainly because they doubted their skills to navigate vast amounts of information; once a website was accessed, quality concerns disappeared in both cohorts, (2) technical skills: skilled Web users effectively filtered information according to search intentions and data sources; less-skilled users were easily distracted by unrelated information, and (3) cognitive strategies: skilled Web users searched to inform themselves; less-skilled users searched to confirm their health-related opinions such as “vaccinations are harmful.” Independent of Web-use skills, most participants stopped a search once they had found the first piece of evidence satisfying search intentions, rather than according to quality criteria. Conclusions: Findings related to Web-use skills differences suggest two classes of interventions to facilitate access to good-quality online health information. Challenges related to findings (1) and (2) should be remedied by improving people’s basic Web-use skills. In particular, Web users should be taught how to avoid information overload by generating specific search terms and to avoid low-quality information by requesting results from trusted websites only. Problems related to finding (3) may be remedied by visually labeling search engine results according to quality criteria. %M 22695686 %R 10.2196/jmir.2051 %U http://www.jmir.org/2012/3/e87/ %U https://doi.org/10.2196/jmir.2051 %U http://www.ncbi.nlm.nih.gov/pubmed/22695686 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e60 %T Analysis of eHealth Search Perspectives Among Female College Students in the Health Professions Using Q Methodology %A Stellefson,Michael %A Hanik,Bruce %A Chaney,J. Don %A Tennant,Bethany %+ Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, United States, 1 352 294 1805, mstellefson@ufl.edu %K eHealth literacy %K college students %K Q methodology %K Internet search %K health professionals %K medical education %D 2012 %7 27.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. Objective: To systematically identify health professional college student perspectives of personal eHealth search practices. Methods: Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Results: Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Conclusions: Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet. %M 22543437 %R 10.2196/jmir.1969 %U http://www.jmir.org/2012/2/e60/ %U https://doi.org/10.2196/jmir.1969 %U http://www.ncbi.nlm.nih.gov/pubmed/22543437 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e19 %T eHealth Literacy: Extending the Digital Divide to the Realm of Health Information %A Neter,Efrat %A Brainin,Esther %+ Behavioral Sciences Department, Ruppin Academic Center, Bait 3, Ruppin Academic Center, Emeq Hefer, 40250, Israel, 972 98981352, neter@ruppin.ac.il %K eHealth literacy %K digital literacy %K health literacy %K digital divide %K health information search %D 2012 %7 27.01.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care. Objective: The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes. Methods: We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers. Results: Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains. Conclusions: The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers. %M 22357448 %R 10.2196/jmir.1619 %U http://www.jmir.org/2012/1/e19/ %U https://doi.org/10.2196/jmir.1619 %U http://www.ncbi.nlm.nih.gov/pubmed/22357448 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e125 %T eHealth Literacy 2.0: Problems and Opportunities With an Evolving Concept %A Norman,Cameron %+ CENSE Research + Design, 757-155 Dalhousie Street, Toronto, ON, M5B2P7, Canada, 1 4168543805, cameron.norman@utoronto.ca %K eHealth literacy, measurement, consumer eHealth, social media %D 2011 %7 23.12.2011 %9 Guest Editorial %J J Med Internet Res %G English %X As the use of eHealth grows and diversifies globally, the concept of eHealth literacy – a foundational skill set that underpins the use of information and communication technologies (ICT) for health – becomes more important than ever to understand and advance. EHealth literacy draws our collective attention to the knowledge and complex skill set that is often taken for granted when people interact with technology to address information, focusing our attention on learning and usability issues from the clinical through to population health level. Just as the field of eHealth is dynamic and evolving, so too is the context where eHealth literacy is applied and understood. The original Lily Model of eHealth literacy and scale used to assess it were developed at a time when the first generation of web tools gained prominence before the rise of social media. The rapid shifts in the informational landscape created by Web 2.0 tools and environments suggests it might be time to revisit the concept of eHealth Literacy and consider what a second release might look like. %M 22193243 %R 10.2196/jmir.2035 %U http://www.jmir.org/2011/4/e125/ %U https://doi.org/10.2196/jmir.2035 %U http://www.ncbi.nlm.nih.gov/pubmed/22193243 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e102 %T eHealth Literacy Among College Students: A Systematic Review With Implications for eHealth Education %A Stellefson,Michael %A Hanik,Bruce %A Chaney,Beth %A Chaney,Don %A Tennant,Bethany %A Chavarria,Enmanuel Antonio %+ Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, United States, 1 352 294 1805, mstellefson@ufl.edu %K eHealth literacy %K college students %K health occupations %K professional preparation %D 2011 %7 01.12.2011 %9 Review %J J Med Internet Res %G English %X Background: eHealth literacy refers to the ability of individuals to seek, find, understand, and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem. While the current generation of college students has access to a multitude of health information on the Internet, access alone does not ensure that students are skilled at conducting Internet searches for health information. Ensuring that college students have the knowledge and skills necessary to conduct advanced eHealth searches is an important responsibility particularly for the medical education community. It is unclear if college students, especially those in the medical and health professions, need customized eHealth literacy training for finding, interpreting, and evaluating health- and medical-related information available on the Internet. Objective: The objective of our review was to summarize and critically evaluate the evidence from existing research on eHealth literacy levels among college students between the ages of 17 and 26 years attending various 4-year colleges and universities located around the world. Methods: We conducted a systematic literature review on numerous scholarly databases using various combinations of relevant search terms and Boolean operators. The records were screened and assessed for inclusion in the review based on preestablished criteria. Findings from each study that met inclusion criteria were synthesized and summarized into emergent themes. Results: In the final review we analyzed 6 peer-reviewed articles and 1 doctoral dissertation that satisfied the inclusion criteria. The number of participants in each reviewed study varied widely (from 34 to 5030). The representativeness of the results from smaller studies is questionable. All studies measured knowledge and/or behaviors related to college student ability to locate, use, and evaluate eHealth information. These studies indicated that many college students lack eHealth literacy skills, suggesting that there is significant room for improvement in college students’ ability to obtain and evaluate eHealth information. Conclusion: Although college students are highly connected to, and feel comfortable with, using the Internet to find health information, their eHealth literacy skills are generally sub par. College students, especially in the health and medical professions, would be well served to receive more customized college-level instruction that improves general eHealth literacy. %M 22155629 %R 10.2196/jmir.1703 %U http://www.jmir.org/2011/4/e102/ %U https://doi.org/10.2196/jmir.1703 %U http://www.ncbi.nlm.nih.gov/pubmed/22155629 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e94 %T A Framework for Characterizing eHealth Literacy Demands and Barriers %A Chan,Connie V %A Kaufman,David R %+ Biomedical Informatics, Columbia University, Vanderbilt Clinic 5, 622 West 168th St. , New York, NY, 10032, United States, 1 212 342 3461, davek@dbmi.columbia.edu %K eHealth %K health literacy %K cognition %K Bloom’s taxonomy %K cognitive task analysis %K consumer health %D 2011 %7 17.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Consumer eHealth interventions are of a growing importance in the individual management of health and health behaviors. However, a range of access, resources, and skills barriers prevent health care consumers from fully engaging in and benefiting from the spectrum of eHealth interventions. Consumers may engage in a range of eHealth tasks, such as participating in health discussion forums and entering information into a personal health record. eHealth literacy names a set of skills and knowledge that are essential for productive interactions with technology-based health tools, such as proficiency in information retrieval strategies, and communicating health concepts effectively. Objective: We propose a theoretical and methodological framework for characterizing complexity of eHealth tasks, which can be used to diagnose and describe literacy barriers and inform the development of solution strategies. Methods: We adapted and integrated two existing theoretical models relevant to the analysis of eHealth literacy into a single framework to systematically categorize and describe task demands and user performance on tasks needed by health care consumers in the information age. The method derived from the framework is applied to (1) code task demands using a cognitive task analysis, and (2) code user performance on tasks. The framework and method are applied to the analysis of a Web-based consumer eHealth task with information-seeking and decision-making demands. We present the results from the in-depth analysis of the task performance of a single user as well as of 20 users on the same task to illustrate both the detailed analysis and the aggregate measures obtained and potential analyses that can be performed using this method. Results: The analysis shows that the framework can be used to classify task demands as well as the barriers encountered in user performance of the tasks. Our approach can be used to (1) characterize the challenges confronted by participants in performing the tasks, (2) determine the extent to which application of the framework to the cognitive task analysis can predict and explain the problems encountered by participants, and (3) inform revisions to the framework to increase accuracy of predictions. Conclusions: The results of this illustrative application suggest that the framework is useful for characterizing task complexity and for diagnosing and explaining barriers encountered in task completion. The framework and analytic approach can be a potentially powerful generative research platform to inform development of rigorous eHealth examination and design instruments, such as to assess eHealth competence, to design and evaluate consumer eHealth tools, and to develop an eHealth curriculum. %M 22094891 %R 10.2196/jmir.1750 %U http://www.jmir.org/2011/4/e94/ %U https://doi.org/10.2196/jmir.1750 %U http://www.ncbi.nlm.nih.gov/pubmed/22094891 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e86 %T Does the eHealth Literacy Scale (eHEALS) Measure What it Intends to Measure? Validation of a Dutch Version of the eHEALS in Two Adult Populations %A van der Vaart,Rosalie %A van Deursen,Alexander JAM %A Drossaert,Constance HC %A Taal,Erik %A van Dijk,Jan AMG %A van de Laar,Mart AFJ %+ Department of Psychology, Health and Technology, University of Twente, Citadel H423, Drienerlolaan 5, PO Box 217, Enschede, 7500AE, Netherlands, 31 53 489 6099, r.vandervaart@utwente.nl %K e-health, literacy, internet, online, skills, health care, information %D 2011 %7 09.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet increases the availability of health information, which consequently expands the amount of skills that health care consumers must have to obtain and evaluate health information. Norman and Skinner in 2006 developed an 8-item self-report eHealth literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). This instrument has been available only in English and there are no data on its validity. Objectives: The objective of our study was to assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations. Methods: We examined the translated scale in a sample of patients with rheumatic diseases (n = 189; study 1) and in a stratified sample of the Dutch population (n = 88; study 2). We determined Cronbach alpha coefficients and analyzed the principal components. Convergent validity was determined by studying correlations with age, education, and current (health-related) Internet use. Furthermore, in study 2 we assessed the predictive validity of the instrument by comparing scores on the eHEALS with an actual performance test. Results: The internal consistency of the scale was sufficient: alpha = .93 in study 1 and alpha = .92 in study 2. In both studies the 8 items loaded on 1 single component (respectively 67% and 63% of variance). Correlations between eHEALS and age and education were not found. Significant, though weak, correlations were found between the eHEALS and quantity of Internet use (r = .24, P = .001 and r = .24, P = .02, respectively). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and nonsignificant: r = .18 (P = .09). The t tests showed no significant differences in scores on the eHEALS between participants who scored below and above median scores of the performance test. Conclusions: The eHEALS was assessed as unidimensional in a principal component analysis and the internal consistency of the scale was high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS instrument requires further study, since the relationship with Internet use was weak and expected relationships with age, education, and actual performance were not significant. Further research to develop a self-report instrument with high correlations with people’s actual eHealth literacy skills is warranted. %M 22071338 %R 10.2196/jmir.1840 %U http://www.jmir.org/2011/4/e86/ %U https://doi.org/10.2196/jmir.1840 %U http://www.ncbi.nlm.nih.gov/pubmed/22071338 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e90 %T Effects of an eHealth Literacy Intervention for Older Adults %A Xie,Bo %+ University of Maryland, College of Information Studies, 2117G Hornbake, South Wing, College Park, MD, 20740, United States, 1 301 405 8617, boxie@umd.edu %K Health literacy %K lifelong learning %K aged %K technology %D 2011 %7 03.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults generally have low health and computer literacies, making it challenging for them to function well in the eHealth era where technology is increasingly being used in health care. Little is known about effective interventions and strategies for improving the eHealth literacy of the older population. Objective: The objective of this study was to examine the effects of a theory-driven eHealth literacy intervention for older adults. Methods: The experimental design was a 2 × 2 mixed factorial design with learning method (collaborative; individualistic) as the between-participants variable and time of measurement (pre; post) as the within-participants variable. A total of 146 older adults aged 56–91 (mean 69.99, SD 8.12) participated in this study during February to May 2011. The intervention involved 2 weeks of learning about using the National Institutes of Health’s SeniorHealth.gov website to access reliable health information. The intervention took place at public libraries. Participants were randomly assigned to either experimental condition (collaborative: n = 72; individualistic: n = 74). Results: Overall, participants’ knowledge, skills, and eHealth literacy efficacy all improved significantly from pre to post intervention (P < .001 in all cases; effect sizes were >0.8 with statistical power of 1.00 even at the .01 level in all cases). When controlling for baseline differences, no significant main effect of the learning method was found on computer/Web knowledge, skills, or eHealth literacy efficacy. Thus, collaborative learning did not differ from individualistic learning in affecting the learning outcomes. No significant interaction effect of learning method and time of measurement was found. Group composition based on gender, familiarity with peers, or prior computer experience had no significant main or interaction effect on the learning outcomes. Regardless of the specific learning method used, participants had overwhelmingly positive attitudes toward the intervention and reported positive changes in participation in their own health care as a result of the intervention. Conclusions: The findings provide strong evidence that the eHealth literacy intervention tested in this study, regardless of the specific learning method used, significantly improved knowledge, skills, and eHealth literacy efficacy from pre to post intervention, was positively perceived by participants, and led to positive changes in their own health care. Collaborative learning did not differ from individualistic learning in affecting the learning outcomes, suggesting the previously widely reported advantages of collaborative over individualistic learning may not be easily applied to the older population in informal settings, though several confounding factors might have contributed to this finding (ie, the largely inexperienced computer user composition of the study sample, potential instructor effect, and ceiling effect). Further research is necessary before a more firm conclusion can be drawn. These findings contribute to the literatures on adult learning, social interdependence theory, and health literacy. %M 22052161 %R 10.2196/jmir.1880 %U http://www.jmir.org/2011/4/e90/ %U https://doi.org/10.2196/jmir.1880 %U http://www.ncbi.nlm.nih.gov/pubmed/22052161 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e75 %T Internet Use and eHealth Literacy of Low-Income Parents Whose Children Have Special Health Care Needs %A Knapp,Caprice %A Madden,Vanessa %A Wang,Hua %A Sloyer,Phyllis %A Shenkman,Elizabeth %+ University of Florida, Department of Health Outcomes and Policy, 1329 SW 16th Street, Room 5130, Gainesville, FL, 32610, United States, 1 352 265 7220, cak@ichp.ufl.edu %K Children %K Internet %K Medicaid %D 2011 %7 29.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet has revolutionized the way in which many Americans search for health care information. Unfortunately, being able to use the Internet for this purpose is predicated on having access to the Internet and being able to understand and comprehend online health information. This is especially important for parents of children with special health care needs who are forced to make many medical decisions throughout the lives of their children. Yet, no information is available about this vulnerable group. Objective: For parents of children with special health care needs we sought to (1) describe their Internet access and use, (2) determine which child and household factors were associated with Internet use, (3) describe eHealth literacy of Internet users, and (4) determine which child and household factors were associated with greater eHealth literacy. Methods: This was a cross-sectional telephone survey of 2371 parents whose children with special health care needs were enrolled in Florida’s Medicaid and State Children’s Health Insurance Plan (SCHIP) programs (4072 parents were approached). To be enrolled in the program, families must have incomes that are less than or equal to 200% of the federal poverty level. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy. Descriptive and multivariate analyses were conducted to address the study objectives. Results: The survey response rate was 58.2%. Participating parents were mainly female (2154/2371, 91%), white non-Hispanic (915/2371, 39%), English speaking (1827/2371, 77%), high school graduates (721/2371, 30%), married (1252/2371, 53%), and living in a two-parent household (1212/2371, 51%). Additionally, 82% of parents (1945/2371) in the sample reported that they used the Internet, and 49% of those parents used it daily (1158/2371). Almost three-quarters of Internet users had access to the Internet at home while about one-half had access at work. Parents who were African American, non-English speaking, older, and not college graduates were less likely to use the Internet than their referent groups (P < .001). About 74% of Internet users (1448/1945) reported that they knew how to find health information for their children. However, only about one-half (1030/1945) reported that they can tell high quality from low quality resources online or that they feel confident in using information accessed online to make health decisions. Multivariate regression results consistently showed that being a non-English speaker, having less than a high school education, and being older were all significantly associated with lower eHealth literacy (all P < .001). Conclusion: Low-income parents of children with special health care needs have access to and use the Internet as a source of information about their children's health. However, some parents are unable to distinguish between high and low quality information and are not confident in using the Internet. This information is timely because as the pressure to use the Internet to empower consumers and exchange information increases, issues related to access and disparities must be better understood. %M 21960017 %R 10.2196/jmir.1697 %U http://www.jmir.org/2011/3/e75/ %U https://doi.org/10.2196/jmir.1697 %U http://www.ncbi.nlm.nih.gov/pubmed/21960017