Perceived eHealth Literacy and Information Behavior of Older Adults Enrolled in a Health Information Outreach Program

In collaboration with a public library system, faculty from a health sciences center library offered a series of courses for older adults based on the NIHSeniorHealth Toolkit for Trainers. A mixed-methods survey was offered to all program attendees during the training sessions. The survey assessed participants’ perceived eHealth literacy, which websites they searched for eHealth information, participants’ most/least trusted sources of health information, and if/what barriers exist for older adults when searching for eHealth information. Results from this pilot program indicate that participants believe access to eHealth resources is important and useful, but are unsure what online resources are available, how to find them, or how to evaluate their quality.     

Health Literacy and Use and Trust in Health Information

There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people’s use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public’s ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.     

Social Cognitive Factors and Perceived Social Influences That Improve Adolescent eHealth Literacy

While adolescents are increasingly using the Internet for health information, little research has been done to assess and improve their “eHealth literacy”—the abilities to find, evaluate, and apply online health information. This study examines the extent to which adolescents' levels of eHealth literacy can be improved by known determinants such as social cognitive factors and perceived social influences, either independently or jointly. Among 182 middle-schoolers, an eHealth literacy intervention was carried out. It involved qualitative and quantitative baseline research, three online training sessions, and a postintervention survey. According to hierarchical regression model results, social cognitive factors of outcome expectations and involvement, but not health motivation, significantly improved eHealth literacy, and all the perceived social influence variables significantly improved eHealth literacy. However, no joint effect of social cognitive factors and perceived social influences was found. In light of these findings, educators need to make eHealth literacy programs personally relevant to adolescents and reinforce local social norms about the importance of seeking health information online.     

Understanding Health Literacy for Strategic Health Marketing: eHealth Literacy,Health Disparities,and the Digital Divide

Even despite policy efforts aimed at reducing health-related disparities, evidence mounts that population-level gaps in literacy and healthcare quality are increasing. This widening of disparities in American culture is likely to worsen over the coming years due, in part, to our increasing reliance on Internet-based technologies to disseminate health information and services. The purpose of the current article is to incorporate health literacy into an Integrative Model of eHealth Use. We argue for this theoretical understanding of eHealth literacy and propose that macro-level disparities in social structures are connected to health disparities through the micro-level conduits of eHealth literacy, motivation, and ability. In other words, structural inequities reinforce themselves and continue to contribute to healthcare disparities through the differential distribution of technologies that simultaneously enhance and impede literacy, motivation, and ability of different groups (and individuals) in the population. We conclude the article by suggesting pragmatic implications of our analysis.     

Relationship Among Patients' Perceived Capacity for Communication,Health Literacy,and Diabetes Self-Care

The mechanisms underlying the relations among health literacy, perceived capacity for communication, diabetes knowledge, and diabetes self-care are unclear. This study tested this relation using structural equation modeling with a sample of 137 Chinese patients 65 years of age or older with type 2 diabetes. The model showed that health literacy, knowledge, communication capacity, and diabetes self-care formed complex relations. After adjusting for age, education, and Chinese cultural influence, health literacy affected diabetes self-care indirectly through perceived capacity for communication (standardized estimate coefficient = .641, p < .001) but not diabetes knowledge. To enhance self-care, interventions should be tailored to increase patient health literacy and perceived capacity for communication with health care providers. Training should be provided to patients to enhance their communication abilities.     

The Status of Health Literacy Research in Health Communication and Opportunities for Future Scholarship

While national concern is growing, the scholarly body of knowledge in health literacy is still relatively small in health communication literature. The field began to distinguish itself as an outgrowth of adult literacy that focused on patient understanding of health information. It grew out of medicine and public health science mostly, and still today the majority of research can be found in health professional journals. However, the links with health communication, particularly with provider–patient communication and with printed health information, have been established and documented over the last decade. This article is a conceptual review that highlights state-of-the-science literature that has made connections between health literacy and health communication. Evidence reveals the contribution that health literacy can have on the health communication body of knowledge. The article illuminates the gaps in research and possibilities for theory development and future studies.     

The Influence of Offline and Online Intrinsic Motivations on Online Health Information Seeking

ABSTRACT

We examine how intrinsic motivations in two health interaction contexts – online and doctor’s office visit – influence online health information seeking (OHIS). Many studies have approached OHIS through short-term gratification of informational needs. Our study uses a conceptual framework of intrinsic human motivation to better understand OHIS as a form of sustained behavior. We applied Self Determination Theory’s three key constructs (Autonomy, Competence, and Relatedness) within a locus of patient-physician relations. Our findings, based on a survey of 993 online health information seekers in India, show that support for Autonomy in the online context explains all three categories of OHIS behaviors: Diagnosis and Treatment Information Seeking, General Health Information Seeking, and Office Visit Information Seeking. Support for Relatedness in the online context explains only Office Visit Information Seeking. However, support for Autonomy, Competence, and Relatedness in the office visit experience could not explain why people engage in OHIS overall. Motivations for the office visit are not associated with the online experience, suggesting that online and offline are not just two kinds of substitute health interaction contexts.     

Determinants of eHealth Literacy among Adults in China

eHealth can empower patients to make informed health decisions. However, inaccurate and misleading health information is not uncommon on the Internet, which requires users’ competencies to both utilize eHealth technologies and evaluate eHealth credibilities. Therefore, this study investigates the determinants of both self-efficacy in utilizing eHealth and frequency of eHealth information evaluation. An Internet-based survey of 923 Chinese adults who are residing in China aged from 21 to 55 years old was conducted. Path analysis was adopted to examine sociodemographic variables, Internet literacy, and health information evaluation as determinants of eHealth literacy variables. Findings demonstrated that Internet literacy positively predicted only self-efficacy in utilizing eHealth. In contrast, health information orientation positively predicted both self-efficacy in utilizing eHealth and frequency of eHealth information evaluation. In addition, Internet literacy and health information orientation mediated the predicted effects of sociodemographic factors on the two eHealth variables. The findings imply that Internet literacy is no longer the primary determinant of eHealth competencies for adults who are tech-savvy users. Instead, interests in health information play a crucial role in improving eHealth competencies.     

Perceived Barriers to Internet-Based Health Communication on Human Genetics

The Internet has emerged as potential vehicle for distributing health communication to millions of individuals because it is interactive, user controlled, and offers breadth and depth of information. However, its widespread use by the public may be limited due to three overarching concerns: privacy and confidentiality, information accuracy and perceptions of credibility, including limited credibility of some government-sponsored web sites. To explore the potential of using the Internet, especially for delivering information on human genetics communication, 15 focus groups and one interview were conducted with African American and European American adult males and females in a southeastern town. We found that the participants recognized great potential in the Internet for health communication on human     

青岛市居民接触各类大众传播渠道及健康传播可及情况调查

目的了解青岛市城市和农村居民接触各类大众传播渠道及健康传播可及情况。方法多阶段整群随机抽样、入户问卷调查≥15岁符合条件的居民，城市300人，农村304人。结果看电视：城市为97．2％，农村为96．7％；听广播：城市为加．2％．农村为6．7％；读报：城市为89．2％，农村为51．7％；留意宣传栏：城市为34．9％，农村为58．9％；留意广告或流动数字媒体：城市为43．0％，农村为33．9％；接受短信：城市为64．4％，农村为43．9％；上网：城市为38．6％，农村为6.0％；愿意参加宣传活动：城市为57．2％．农村为83．8％。定期收看电视健康节目：城市为11．8％，农村为5．2％；定期收听广播健康节目：城市为3．2％．农村为0．6％。居民主动获得健康信息来自卫生专业人员：城市为69．7％，农村为78．9％。“电视新闻＋报纸新闻＋宣传活动＋短信”组合可及性：城市为98．6％，农村为94．0％。农村55岁以上的居民接触各类传播渠道比例低于其他年龄的居民。结论电视是青岛城乡居民可及性最高的传播渠道；在健康传播中联合应用多种传播渠道会更好的实现传播目标。     

A Qualitative Study Examining Latino Functional Health Literacy Levels and Sources of Health Information

The purpose of this study was to determine the health information sources used by Latinos in southwest Ohio, identify individual Latino residents’ functional health literacy levels, and identify any access barriers to those sources of health information. Results show almost two-thirds had low acculturation levels to US culture. Overall, the major source of health information is a medical setting, followed by media technology (which included the Internet). However, when it comes to being ill, the primary source becomes a media choice, then medical. The barriers to accessing health information included language and lack of confidence/knowledge. Participants reported moderate satisfaction with the sources of health information available, and had an ‘adequate’ health literacy level in Spanish. This study was important because it filled an existing information gap for the Latino community, a racial ethnic minority population in the southwest Ohio area. With the results of this study, health educators and other health care practitioners might be better able to understand the health care needs of the Latino community and could essentially create improved and culturally competent health communications.     

高校学生电子媒介健康素养量表的编制及评价

目的编制适合高校学生的电子媒介健康素养量表,并评价该量表的信度和效度。方法通过将eHealth Literacy Scale（eHEALS）翻译为中文,结合文献、定性访谈、预测试进行修订。使用修订后的量表对1163名高校学生的电子媒介健康素养进行评估。结果高校学生电子媒介健康素养量表由20个条目组成,分为3个纬度：健康信息获取能力和健康信息评价能力和健康信息实践能力。量表各个维度的Cronbach＇s α系数在0.836-0.895之间,量表的所有条目的Cronbach＇s α 系数为0.915,说明量表具有较好的内部一致性。量表的因子分析载荷系数在0.451～0.829之间,3个维度与其对应的条目的相关系数有统计学意义（P〈0.05）。1163名学生所得的总分为（68.03-4-13.04）分,各条目平均（3.40±0.08）分。结论高校学生电子媒介健康素养量表有较好的的结构效度、内容效度和内部一致性,可作为评估高校学生电子媒介健康素养的工具。     

The Influence of Perceived Health on Labour Participation Among Long Term Unemployed

Backgrounds Few studies have addressed the specific contribution of health in relation to socio-demographic and motivational aspects to re-entering paid employment. The purpose of this study among beneficiaries of unemployment benefits is to evaluate the detrimental effects of poor health and a lack of motivation on the likelihood of getting a job and to develop a decision support model that predicts remaining unemployment after 12 months. Methods A longitudinal cohort study was conducted among people on unemployment benefit (UB) or social insurance benefit (SIB). The time-window of the study was 18 months. Written questionnaires were filled out 3 months post-benefit assessment, 6, 12 and 18 months. Multivariate logistic regression analysis was used to identify the barriers of re-entering paid employment. Subsequently, a predictive model was constructed to estimate the probability for every combination of determinants for a person to remain unemployed in the next 12 months. Results Older age (≥55 years), a poor perceived health, and a lack of willingness to accept a job were the most prominent predictive factors for remaining unemployed after 12 months in both UB and SIB groups. Lower education in the UB group and being married or living together and poor self-reliance in the SIB group were additional risk factors for long-term unemployment. Conclusion Vocational rehabilitation of people on long-term social benefit should address perceived health, socio-demographic, and motivational aspects as key factors that determine prolonged unemployment. A predictive flow chart can be used to detect most vulnerable persons at risk for remaining long-term unemployment.     

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites is a practical and well-written resource for public health and health communication professionals and web designers. This guide builds on the principles of web usability and adds to existing best practices by providing research-based strategies for writing and designing health websites especially for users with limited literacy and health literacy skills. This guide synthesizes years of lessons learned from Office of Disease Prevention and Health Promotion's original research with hundreds of web users, experience with revising the healthfinder.gov, as well as strategies supported by the Research-Based Web Design and Usability Guidelines (Usability.gov). In the United States, roughly one third of adults have limited literacy skills, yet far more (as many as 90%) have limited health literacy skills, meaning they have trouble understanding complex health information. This how-to guide is timely and developed with the aim of creating easy-to-use health websites to reach as many web users as possible, especially those with limited literacy and health literacy skills.     

Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study

BackgroundEffective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic.ObjectiveThis study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources.MethodsWe conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee.ResultsA total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19–related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization.ConclusionsThe internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic.     

Health Literacy,Numeracy, and Graphical Literacy Among Veterans in Primary Care and Their Effect on Shared Decision Making and Trust in Physicians

Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22–82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.     

基于互联网思维主导的健康教育对社区2型糖尿病患者健康素养及自我管理能力的影响

目的探讨基于互联网思维主导的健康教育在社区2型糖尿病患者中的应用效果。方法选取成都市3个社区2型糖尿病患者102例为研究对象,按照随机数字表法分为试验组54例、对照组48例。对照组给予常规健康教育,试验组联合应用基于互联网思维的健康教育。随访6个月,比较两组健康素养、自我管理能力、糖脂代谢、生活质量等指标。结果试验组社区2型糖尿病患者信息获取能力、交流互动能力、改善健康意愿、健康素养总分高于对照组(P<0.05);药物管理、饮食管理、运动管理、血糖监测、自我管理能力总分高于对照组(P<0.05);空腹血糖(FBG)、餐后2h血糖(2hFBG)、糖化血红蛋白(HbAlc)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)低于对照组(P<0.05);生理功能、心理功能、社会关系、治疗、生活质量总分低于对照组(P<0.05)。结论基于互联网思维主导的健康教育有助于促进社区2型糖尿病患者健康素养水平及自我管理能力的养成,对于控制糖脂代谢水平、改善患者生活质量,有积极的应用价值。     

Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD)

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients’ eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation’s National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = ?0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients benefit from web-based self-management support resources.     

The ABCs of Health Literacy

A significant portion of the US population has serious problems with both literacy and understanding how to effectively use and understand health-related information. An understanding of the breadth and significance of this problem and its impact on health outcomes is now clear. Interventions and strategies for effectively working with patients with limited literacy must be developed and evaluated. An agenda for medical and public health workers, health educators, and researchers is suggested.