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      The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

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          Abstract

          The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals’ sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users’ characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources.

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          eHealth Literacy: Extending the Digital Divide to the Realm of Health Information

          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.
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            Measuring functional, communicative, and critical health literacy among diabetic patients.

            Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes. The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records. Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (alpha = 0.84, alpha = 0.77, and alpha = 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills. Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors.
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              eHealth Literacy 2.0: Problems and Opportunities With an Evolving Concept

              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.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                23 July 2018
                July 2018
                : 15
                : 7
                : 1553
                Affiliations
                [1 ]Department of Communication, University of Macau, E21, Avenida da Universidade, Taipa, Macau, China
                [2 ]Institute of Communication and Health, Lugano University, Switzerland, Ex Laboratorio, Via Buffi 13, 6904 Lugano, Switzerland; peter.schulz@ 123456usi.ch
                Author notes
                [* ]Correspondence: wychang@ 123456umac.mo ; Tel.: +853-8822-8991
                Author information
                https://orcid.org/0000-0003-4281-489X
                Article
                ijerph-15-01553
                10.3390/ijerph15071553
                6069069
                30041420
                ab6516aa-9ef0-4b9f-85ff-933f51463ff5
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 June 2018
                : 19 July 2018
                Categories
                Article

                Public health
                literacy knowledge,health promotion,health status,internet,mobile use
                Public health
                literacy knowledge, health promotion, health status, internet, mobile use

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