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      eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature

      research-article
      , JD, MLIS 1 , , , MS, PhD 2
      (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications Inc.
      health literacy, aging, computers

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          Abstract

          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.

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          Most cited references63

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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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            Selective review of cognitive aging.

            Research concerned with relations between adult age and cognitive functioning is briefly reviewed. The coverage is necessarily selective, and is organized in terms of five major questions. These are what abilities are related to age, how many distinct influences are contributing to the relations between age and cognitive functioning, do the differences between people increase with advancing age, what is responsible for the discrepancies between cross-sectional and longitudinal age comparisons of cognitive functioning, and what methods can be used to identify causes of age-related influences on cognition. Although definitive answers are not yet possible, quite a bit of information relevant to the questions is now available. Moreover, the existing information has implications for the design, analysis, and interpretation of cognitive and neuropsychological research concerned with aging.
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              A Systematic Review of Randomized Controlled Trials on the Effectiveness of Computer-Tailored Physical Activity and Dietary Behavior Promotion Programs: an Update

              Background A review update is necessary to document evidence regarding the effectiveness of computer-tailored physical activity and nutrition education. Purpose The purpose of this study was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review. Methods Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education aimed at primary prevention in adults, published from September 2004 through June 2011. Results Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no information, including those for physical activity promotion. Effect sizes were small and generally at short- or medium-term follow-up. Conclusions The results of the 2006 review were confirmed and reinforced. Future interventions should focus on establishing larger effect sizes and sustained effects and include more generic health education control groups and objective measurements of dietary behavior. Electronic supplementary material The online version of this article (doi:10.1007/s12160-012-9384-3) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                November 2014
                10 November 2014
                : 16
                : 11
                : e225
                Affiliations
                [1] 1School of Information The University of Texas at Austin Austin, TXUnited States
                [2] 2School of Nursing & School of Information The University of Texas at Austin Austin, TXUnited States
                Author notes
                Corresponding Author: Ivan Watkins iwatkins@ 123456utexas.edu
                Author information
                http://orcid.org/0000-0002-4725-0504
                http://orcid.org/0000-0002-6016-6008
                Article
                v16i11e225
                10.2196/jmir.3318
                4260003
                25386719
                af22b7b8-628d-44f2-ae87-81ea00ad450a
                ©Ivan Watkins, Bo Xie. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.11.2014.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 12 February 2014
                : 13 March 2014
                : 16 July 2014
                : 31 July 2014
                Categories
                Original Paper
                Original Paper

                Medicine
                health literacy,aging,computers
                Medicine
                health literacy, aging, computers

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