Analysis of Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and eHealth literacy: an online survey for digital experience design.

Introduction: Since the enactment of the revised Pharmaceutical Affairs Act in Japan in 2009, self-medication practices have increased in the country. However, studies report that consumers pay little attention to the medication facts and risks indicated on the packages of over-the-counter (OTC) medicines, which could be a potential risk. Since the COVID-19 pandemic, the digital transformation of purchasing OTC medicines has progressed. As an appropriate design for the digital transformation is likely to improve consumers' literacy and them obtaining medical information, this study systematically examines Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and its correlation to eHealth literacy, exploring an appropriate digital experience design in purchasing OTC medicine. Methods: Participants from the Greater Tokyo Area of Japan participated in an online survey. Consumers' current behavior and preferences in accessing OTC medicine, receiving medication guidance, and obtaining medical information were examined. eHealth literacy was assessed using the J-eHEALS. Descriptive statistics, text mining, and thematic analysis were conducted to answer research questions. Results: Over 89% of the respondents who had experience in purchasing OTC medicines preferred local pharmacies or stores rather than online purchasing, p < 0.001. Obtaining medicine guidance in pharmacies or stores was the main preference over other approaches, p < 0.001. Furthermore, most of the participants accepted selecting medicine on shelves and digital screens in-store. However, they were accustomed to using smartphones to obtain additional information at the pharmacy or drug store, p < 0.001; this behavior was positively correlated with eHealth literacy, p < 0.001. Conclusions: Japanese consumers are seeking a combination of conventional and digital behaviors for purchasing OTC medicine rather than opting for a particular method. Most consumers prefer purchasing and receiving instructions in-store while searching for additional decision-making information online. eHealth literacy is positively associated with digital behaviors of OTC medicine information acquisition but less associated with medicine purchases and selections. The hybrid digital experience design may enhance the OTC medicine purchase experience and reduce potential risks by providing appropriate information.

Medical Students' and Radiology Technician Trainees' eHealth Literacy and Hygiene Awareness-Asynchronous and Synchronous Digital Hand Hygiene Training in a Single-Center Trial.

Next to the known nosocomial infections, the COVID-19 pandemic was an example for the need for the immediate implementation of functioning hygiene concepts and knowledge transfer. The aim of this study was to evaluate the self-assessment of ehealth literacy in terms of finding, using and critically evaluating health information and theoretical and practical hygiene awareness on a voluntary participation basis at the Jena University Hospital in 2022. The well-established and validated eHEALS and WHO questionnaire on hand hygiene (HH) knowledge for healthcare workers was completely filled by 204 participants (191 medical students; 13 healthcare trainees). In a second step, after the questionnaire, 77 participants completed additional asynchronous, digitally guided self-training using DesiCoach 2Go. In the end, a synchronous hand disinfection was carried out in the hospital using Visirub, by separating it into a group without (n = 191; with and without HH questionnaire) and a group with (n = 31; with HH questionnaire) previously completed self-training. For the eHL, the respondents tended to have a positive self-assessment of finding, using and critically evaluating health information. The voluntary participants of the practical hand disinfection who had received self-training were able to achieve significantly better results (p = 0.0047), resulting in fewer wetting gaps in a subsequent performance with Visirub than those who had not received digital self-training. The survey showed that healthcare-related participants belonging to the "digital native" generation have above-average knowledge on HH and profit by digitally guided self-training.

The relationship between eHealth literacy and palliative care knowledge, attitudes, and practice among nurses: a cross-sectional study.

BACKGROUND: The crucial role that nurses play in offering palliative care to patients with life-threatening diseases is widely acknowledged, but the correlation between their eHealth literacy and their knowledge, attitudes, and practice in this domain has yet to be investigated. This study is conducted to investigate the status of eHealth literacy and knowledge, attitudes, and practice regarding palliative care among nurses, and to examine their relationship. METHODS: A cross-sectional study design was conducted among 546 nurses selected from the first-class tertiary hospitals located both inside and outside of Zhejiang Province between May 12 and May 20, 2022. The online survey of eHealth literacy scale (eHEALS) and scale of knowledge, attitudes, and practice (KAP) regarding palliative care was performed using snowball sampling through the WeChat mini program "Questionnaire Star". The Spearman rank correlation and binary logistic regression model were used to analyze the independent association between eHealth literacy and KAP toward palliative care. RESULTS: The median scores of eHEALS and KAP regarding palliative care were 32 (interquartile range[IQR] 29 to 38) and 82 (IQR 54 to 106) points. The results of correlation analysis showed that the KAP regarding palliative care was significantly correlated with eHEALS (rho = 0.189, P < 0.001). In addition, the results of binary logistic regression analysis demonstrated that the eHEALS score was independently associated with the KAP score regarding palliative care when controlling for sociodemographic factors (OR = 2.109; P < 0.001). CONCLUSION: Nurses who worked in first-class tertiary hospitals have good levels of eHealth literacy, while the overall level of KAP regarding palliative care is moderate. Our findings highlight that the eHEALS score is independently associated with the KAP score regarding palliative care. Therefore, nursing managers should adopt multiple measures to comprehensively improve eHealth literacy among nurses, further enrich their knowledge of palliative care, promote a positive transformation of attitudes towards palliative care, and efficiently implement palliative care practice, in order to promote high-quality development of palliative care.

Japanese Consumers' Attitudes towards Obtaining and Sharing Health Information Regarding Over-the-Counter Medication: Designing an Over-the-Counter Electronic Health Record.

Designing an over-the-counter medication electronic health record (OTC-EHR) may help improve OTC usage. An online survey for the conceptual OTC-EHR design examined participant characteristics, attitudes towards obtaining user-shared OTC medication information, health-related application usage, and the inclination to share anonymized health information. Descriptive statistics, tests to assess statistical significance, and text mining were used to analyze the results. The findings revealed that Japanese consumers, particularly those with high eHealth literacy and women, possess relatively positive attitudes towards obtaining user-shared OTC medication information than those with low eHealth literacy (t (280.71) = -4.11, p < 0.001) and men (t (262.26) = -2.78, p = 0.006), respectively. Most consumers own smartphones but do not use health-related applications. A minority held positive attitudes about sharing anonymized health information. The perceived helpfulness of OTC-EHR was positively associated with the usage of health-related applications (χ2 (4) = 18.35, p = 0.001) and attitude towards sharing anonymized health information (χ2 (3) = 19.78, p < 0.001). The study findings contribute towards OTC-EHR's design to enhance consumers' self-medication and reduce risks, while the psychological barriers to sharing anonymized health information should be improved by increasing the OTC-EHR's penetration rate and engaging in appropriate information design.

Could virtual dermatology services widen healthcare inequity for patients with chronic skin conditions: are we READHY?

Advances in technology have resulted in increasing adoption of virtual dermatology services across the National Health Service. This has accelerated dramatically during the COVID-19 pandemic. Providing remote consultation alternatives empowers many patients to manage their health away from traditional in-person services. However, there is concern that universal implementation of such services may potentially widen healthcare inequalities for some patient groups. Reliably identifying at-risk groups is challenging. Co-design of health services has been proposed as a method to ensure equality and appropriateness of provision for all patients accessing a service by including them in the design process. In this study we profile the digital health literacy of patients with chronic skin conditions with the aim of using this information to redesign virtual services to support their long-term skin health. The Multidimensional Readiness and Enablement Index for Health Technology (READHY), comprising the eHealth Literacy Questionnaire (eHLQ), Health Literacy Questionnaire (HLQ) and Health Education Impact Questionnaire (heiQ), was used to assess patient skills, confidence and experience in using technology to manage their health. Consecutive patients under long-term follow-up in two specialist clinics supporting chronic skin conditions (organ transplant surveillance and biologics monitoring) completed questionnaires either in person or over the telephone. Between July and November 2021, 99 of 128 (77.3%) of patients invited to participate took part. Overall, these patients showed high levels of self-management skills, determination not to let health problems control their life and good support from family and healthcare professionals. In the domains related to digital skills, the responses were diverse. A cluster analysis identified multiple groups of patients with varying combinations of higher or lower level of digital health literacy, social and healthcare support, as well as capabilities in handling health condition and emotional responses. These preliminary data have provided important information for optimizing a co-design process aimed at tailoring services to support patients with chronic skin diseases. In particular, it has identified patient groups with distinct differences in terms of digital health literacy. Recognition of these groups and their differing profiles in terms of barriers to accessing virtual healthcare will be a key consideration in ensuring equitable representation in the service co-design process. It provides opportunities to target support to those patients with lower digital health literacy skills so that they may benefit from virtual services or adaptation of these services to address their specific needs. Alternatively, it allows recognition of patient groups who have higher digital health literacy and may safely benefit from alternative approaches to service provision such as patient-initiated follow-up.

eHealth literacy and capability in the context of the pandemic crisis

The rapidly increasing size of the ageing population, and in particular older adults living alone, requires the incorporation of eHealth into social and healthcare services, in order to choose the best way to manage their needs and demands for health and medical care. The purpose of this brief scoping study is to describe and identify an important dimension in this context, namely eHealth literacy (eHL) and its relation to health-promoting behaviours among older adults within the capability theoretical framework. The chapter examines some aspects of eHL and recent research highlighting the importance of eHL and the direct correlation between eHL and quality of life for older adults within the capability context. To make this more specific and explicit, this study takes into consideration outstanding circumstances, such as those caused by a pandemic crisis, namely the coronavirus disease 2019 (COVID-19). Since the COVID-19 pandemic has required urgent action and rapid containment, it offers a unique opportunity to test and evaluate the readiness of healthcare systems and to rapidly develop, scale up and enhance eHealth for the benefit of older people. However, this comes with a price, which is the necessity to quickly and effectively navigate complex information environments and manage behavioural changes and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Nutritional Supplement Use Influencing by Cyberchondria and E-Health Literacy During the COVID-19 Outbreak in Turkey

Aim: "We're not just fighting an epidemic;we're fighting an infodemic," said World Health Organization Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference. In this context, we examined vitamin-mineral use frequency as influenced by cyberchondria, or E-health literacy level, and related factors during the coronavirus disease-2019 outbreak. Method(s): In this cross-sectional study, participants who were admitted to the outpatient clinics in a tertiary hospital between March 2021 and April 2021 were asked questions on socio-demographic data, the presence of vitamin and mineral use, and knowledge. The cyberchondria scores by the cyberchondria severity scale and the E-health literacy scores by the electronic health literacy scale were assessed based on nutrition type choice. The use of vitamins and minerals was compared between regular and non-regular supplement users. Factors related to the presence of nutritional supplement use were assessed through logistic regression analysis. Result(s): A total of 417 participants, including those aged 39.3+/-12.09 years, were found to be regular nutritional supplement users at a rate of 52.99% during the outbreak. The most commonly used supplements were vitamin D (62.8%), vitamin C (54.4%), vitamin B12 (39.6%), zinc (37.9%), magnesium (35.7%), and iron (33.60%). The least used supplement was melatonin (5.30%). Iron, calcium, and vitamin A users had a higher cyberchondria score than non-users (p=0.002, p=0.044, and p=0.030, respectively). However, zinc, selenium, magnesium, calcium, vitamin B6, vitamin C, omega-3 fish oil, and probiotic users had a higher E-health literacy score than non-users (p<0.001, p=0.018, p<0.001, p=0.009, p=0.047, p=0.018, p=0.002, p=0.002, respectively). Logistic regression analyses identified higher E-health literacy [odds ratio (OR)=1.077;95% confidence interval (CI): 1.042-1.115;p<0.001], female sex (OR=1,659;95% CI: 1,005-2,737;p=0.048), graduated from university (OR=2,536;95% CI: 1,009-6,374;p=0.048), presence of health professional's advice (OR=3,716;95% CI: 2,260-6,119;p<0.001) and chronic disease presence (OR=2,755;95% CI: 1,420-5,347;p=0.003) were predictors of supplement usage during the outbreak. Conclusion(s): Higher E-health literate women with comorbidities were likely nutritional supplement users during the outbreak, regardless of cyberchondria severity or age generation differences.Copyright © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

Associations between eHealth literacy, mental health-seeking attitude, and mental wellbeing among young electronic media users in China during the COVID-19 pandemic.

Objective: This study aimed to examine the associations among mental health related eHealth literacy (eHL), mental health-seeking attitude, and wellbeing among Chinese young electronic media users during the COVID-19 pandemic. Methods: A web-based cross-sectional survey was conducted in Guangzhou, China. The modified eHealth literacy Scale, Mental Help-Seeking Attitudes Scale, and Short Warwick-Edinburgh Mental Wellbeing Scale were used. Structural equation modeling (SEM) examined the associations between them and was adjusted by several controlled variables. Results: Totally, 1,008 participants completed the questionnaire and provided valid responses. The eHL showed a statistically significant and direct effect on mental wellbeing in this sample. The higher the level of eHL, the better wellbeing of the participants. The mental health-seeking attitude is also positively correlated with mental wellbeing, indicating that the more positive attitude toward seeking mental health services, the better the wellbeing participants reported. The higher level of eHL is significantly associated with a more positive attitude toward seeking mental health services. Conclusion: Training to improve eHL may optimize young electronic media users' mental health outcomes. Development and use of a mental health specific eHL instrument in future studies should be encouraged.

Can a validated website help improve university students' e-health literacy?

Background: The fight against fake news, mainly spread through Internet, is a major public health issue, even among undergraduate students. This study aims to evaluate the effectiveness of a website promoted by the Italian Federation of the Provincial Orders of the Medical Doctors as a first aid communication kit for health topics. Study design: Pre-post study using a web-based survey, conducted in April-May 2019 on Medical students and October-November 2020 on Communication Sciences students at the University of Florence (Italy). Methods: Undergraduate students of both schools were exposed to the use of the "dottoremaeveroche" website. Primary and secondary outcomes measures: the Italian-electronic Health Literacy Scale self-assessment tool was used to examine subjects' electronic Health literacy, and source quality. All responses were rated on a 5-point Likert scale. Changing in perception of abilities were examined using the Wilcoxon test. Results: The 362 participants felt moderately confident in electronic Health Literacy, with an initial Italian-electronic Health Literacy Scale overall mean score of 3.6±0.7 for medical and 3.2±0.8 for communication students. Medical students had a good idea of how to find helpful sources (3.9±0.8) and communication students felt confident in recognizing their quality (3.5±1.0). In contrast, their confidence in using Web information to make health decisions was low (medical: 2.9±1.1; communication: 2.8±1.1). All items improved significantly after "dottoremaeveroche" use (p<.001), with the overall mean score of Italian-electronic Health Literacy Scale increasing to 4.3±0.6 for medical and 4.1±0.8 for communication students. Conclusions: Low electronic health literacy levels can affect public health efforts, as seen during the COVID- 19 pandemic. The effectiveness of "dottoremaeveroche" among students showed the usefulness of online educational interventions that, if further implemented, could help combat the spread of infodemic.

Impact of Online-Delivered eHealth Literacy Intervention on eHealth Literacy and Health Behavior Outcomes among Female College Students during COVID-19.

This study examined the effects of a novel online-delivered eHealth literacy intervention to improve eHealth literacy and positive health behaviors among female college students during COVID-19. Female college students taking a physical education class were allocated to either an online-based eHealth literacy intervention group (n = 62) or a physical education class (n = 58). Weekly two-hour sessions were implemented through Zoom videoconferencing over six weeks. We measured eHealth literacy, exercise self-schemata, and health behavior outcomes (eating, sleep, and exercise) before and after the intervention. A two-way repeated measures ANOVA was conducted to examine within- and between-group differences in all outcomes. The ANOVA (2 × 2) for the interaction effect of group and time showed a statistical significance in eHealth literacy and cognitive-emotional exercise self-schemata. There was a marginally significant interaction effect for exercise but none for eating and sleep. This was the first trial to examine the impact of the online eHealth literacy intervention on eHealth literacy and health behavior outcomes for college students during COVID-19. Preliminary findings indicated that the intervention showed promising effectiveness for improving eHealth literacy and promoting health behaviors among female college students.

The prevalence of eHealth literacy and its relationship with perceived health status and psychological distress during Covid-19: a cross-sectional study of older adults in Blekinge, Sweden.

BACKGROUND AND AIMS: eHealth literacy is important as it influences health-promoting behaviors and health. The ability to use eHealth resources is essential to maintaining health, especially during COVID-19 when both physical and psychological health were affected. This study aimed to assess the prevalence of eHealth literacy and its association with psychological distress and perceived health status among older adults in Blekinge, Sweden. Furthermore, this study aimed to assess if perceived health status influences the association between eHealth literacy and psychological distress. METHODS: This cross-sectional study (October 2021-December 2021) included 678 older adults' as participants of the Swedish National Study on Aging and Care, Blekinge (SNAC-B). These participants were sent questionnaires about their use of Information and Communications Technology (ICT) during the COVID-19 pandemic. In this study, we conducted the statistical analysis using the Kruskal-Wallis one-way analysis of variance, Kendall's tau-b rank correlation, and multiple linear regression. RESULTS: We found that 68.4% of the participants had moderate to high levels of eHealth literacy in the population. Being female, age [Formula: see text] years, and having a higher education are associated with high eHealth literacy ([Formula: see text]). eHealth literacy is significantly correlated ([Formula: see text]=0.12, p-value=0.002) and associated with perceived health status ([Formula: see text]=0.39, p-value=0.008). It is also significantly correlated ([Formula: see text]=-0.12, p-value=0.001) and associated with psychological distress ([Formula: see text]=-0.14, p-value=0.002). The interaction of eHealth literacy and good perceived health status reduced psychological distress ([Formula: see text]=-0.30, p-value=0.002). CONCLUSIONS: In our cross-sectional study, we found that the point prevalence of eHealth literacy among older adults living in Blekinge, Sweden is moderate to high, which is a positive finding. However, there are still differences among older adults based on factors such as being female, younger than 75 years, highly educated, in good health, and without psychological distress. The results indicated that psychological distress could be mitigated during the pandemic by increasing eHealth literacy and maintaining good health status.

eHealth literacy and capability in the context of the pandemic crisis

The rapidly increasing size of the ageing population, and in particular older adults living alone, requires the incorporation of eHealth into social and healthcare services, in order to choose the best way to manage their needs and demands for health and medical care. The purpose of this brief scoping study is to describe and identify an important dimension in this context, namely eHealth literacy (eHL) and its relation to health-promoting behaviours among older adults within the capability theoretical framework. The chapter examines some aspects of eHL and recent research highlighting the importance of eHL and the direct correlation between eHL and quality of life for older adults within the capability context. To make this more specific and explicit, this study takes into consideration outstanding circumstances, such as those caused by a pandemic crisis, namely the coronavirus disease 2019 (COVID-19). Since the COVID-19 pandemic has required urgent action and rapid containment, it offers a unique opportunity to test and evaluate the readiness of healthcare systems and to rapidly develop, scale up and enhance eHealth for the benefit of older people. However, this comes with a price, which is the necessity to quickly and effectively navigate complex information environments and manage behavioural changes and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Testing reliability and validity of the Vietnamese version of the eHealth literacy scale (eHEALS) among medical students in Vietnam.

BACKGROUND: In the context of COVID-19 pandemic, eHealth Literacy is important and essential for healthcare workers, especially medical students; eHealth Literacy Scale (eHEALS) was developed to measured eHealth literacy of individuals, with higher eHEALS scores indicated greater ehealth literacy. OBJECTIVES: The study evaluates the reliability and validity of Vietnamese version of eHEALS and analyzed some factors affecting on eHEALS score among Hanoi Medical University students in Vietnam. METHODS: A cross-sectional study design was adopted, and data were elicited from 494 medical students. Exploratory Factor Analysis (EFA); Cronbach's alpha and correlation coefficients; split-half assessment; Poisson regression analysis were applied. RESULTS: The total score of our subjects in the eHEALS was 30.34 ± 4.57. The results from Bartlett's test, Kaiser-Meyer-Olkin (KMO) test, calculated Cronbach's alpha coefficient and test-retest reliability were high. Poisson regression identified that eHEALS scores of participants was significantly associated with device, ongoing medical condition and trustworthiness of health information source (p < 0.05). DISCUSSION: Our study helps researchers who conduct studies in eHealth develop optimal applied and intervention researches in subjects with medical knowledge. Additional studies need to be required with numerous different groups of people in Vietnam. CONCLUSION: The Vietnamese version of eHEALS is a reliable and valid measure. Device, medical condition and trustworthiness of health information source are factors affecting on eHEALS score of students in Hanoi Medical University.

Electronic Health Literacy: A Key Determinant in Televisit Acceptance in Inner-City Patients With CKD

Background: Televisits have become a more widely used since the COVID pandemic in 2020. However, pts in underserved populations may not be as knowledgable about electronic health resources and may not be able to access this type of health care visit, worsening health care disparities. We examined the relationship between electronic health literacy and acceptance of televisits in an underserved inner-City population of pts with CKD. Method(s): 38 randomly selected CKD pts were surveyed in a face to face fashion including a demographics section, the eHEALS electronic health literacy assessment (scored from 8 to 40), and additional sections on televisit history. eHEALS is a validated 8 question survey that characterizes the subjective ability to find and use electronic health resources. Result(s): Mean age of the pts. was 67+/-15 yrs. 66% were female, 74% did not attend any college, 60% make less than $25,000 per year. 21% did not have any Internet access, 5.3% did not own a cell phone, and 5.3% of cell phone owners did not own a smart phone. 61% need help using the internet. The mean eHEALS of those who need help using the internet is 21.1+/-6.0 vs 27.5+/-8.6 (p=<0.05) for those who do not need help.76% of pts. had a televisit before the survey, of which 76% were telephone only and 24% had visits by both telephone and video. No participant had only used video. Those who had televisits did not differ based on age, education, gender and income from those who did not. Of the 24% of participants who did not have televisits, 100% need help using the internet vs 48% who had televisits (p=0.006). Mean eHEALS score of those who had a televisit was 25.1+/-7.9 vs 18.9+/-4.9 for those who did not (p=0.01). Conclusion(s): In our population of older inner-city CKD patients, 1. Almost one quarter had no home internet access, and over half needed help using it 2. Pts who needed help had lower eHealth literacy and were less likely to have televisits. 3. Televisit use related to eHealth literacy rather than age, education or income. 4. Administering eHEALS may identify people who would benefit most from in person visits, directed educational materials to help with televisits or for whom support should be provided 5. The rise in use of telehealth may further health resource inequities if eHealth literacy is not recognized as a potential negative social determinant in vulnerable populations.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China.

Objective: The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China. Methods: From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model. Result: Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions. Conclusion: The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Development and validation of digital health literacy competencies for citizens (DHLC), an instrument for measuring digital health literacy in the community.

COVID-19 is a new disease in human life and has become pandemic. Pandemic Coronavirus Disease (COVID-19) has been speeding up digital transformation in every sector. Implementation of digital technology in health should be supported by the community's readiness, such as digital health literacy to achieve the goals, optimize health service performance, and blockage infodemics and miss information. Implementation of digital technology in health should be supported by the community's readiness, such as digital health literacy to achieve the goals, optimize health service performance, and blockage infodemics and miss information. This study aims to develop a tool to measure digital health literacy in the community through three stages such as expert review, pre-test and field test. DHLC adopted the five competencies areas into 18 questions and put eight questions related to health literacy; the total items question of DHLC are 26 items questions. This study reveals that all of the score digital competencies areas below 4. Score 4 in DHLC indicates that the community still need guidance to doing activity in the digital environment. Elevating digital health literacy in the citizens is urgent to control the spreading misinformation and disinformation that could worsen pandemics. Future studies need to conduct to test the validity and reliability of DHLC in various settings.

The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. OBJECTIVE: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. METHODS: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. RESULTS: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. CONCLUSIONS: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

A cross-sectional study of nursing students' eHealth literacy and COVID-19 preventive behaviours.

AIM: This study explored nursing students' eHealth literacy, lifestyle behaviours and COVID-19-related preventive behaviours and associated factors. DESIGN: A cross-sectional comparative correlational study. METHODS: Nursing students (n = 358) from a metropolitan area of South Korea were recruited for an online survey. The online questionnaire included: The eHealth Literacy Scale, the Health Promoting Lifestyle Profile-II and the COVID-19-related preventive behaviour scale. RESULTS: COVID-19-related preventive behaviours correlated positively with satisfaction with one's major, time spent seeking health information online, eHealth literacy and lifestyle behaviours. Significant factors affecting COVID-19-related preventive behaviours were the following: being female (ß = 0.194, p < .001), time spent seeking health information online (ß = 0.114, p = .002), eHealth literacy (ß = 0.167, p = .001) and lifestyle behaviours (ß = 0.266, p < .001). CONCLUSIONS: Findings highlight the need to strengthen searching behaviours to access accurate health information online and reinforce eHealth literacy and health-promoting lifestyle behaviours to improve COVID-19 preventive behaviours among nursing students.

The Longitudinal Relationship Between eHealth Literacy, Health-Promoting Lifestyles, and Health-Related Quality of Life Among College Students: A Cross-Lagged Analysis.

Objectives: This study aimed to explore the longitudinal associations between eHealth literacy, health-promoting lifestyles, and health-related quality of life (HRQoL) among college students. Methods: From December 2019 (T1) to December 2020 (T2), we administered the eHealth literacy scale, Short-Form Health Survey (SF-12), and Short-Form Health-Promoting Lifestyle Profile Scale to 1,181 college students in Jinan, China. Participants were recruited for 12 months for the two-stage survey. Results: Stable positive correlations were shown between eHealth literacy, health-promoting lifestyles, and HRQoL across time. The cross-lagged analysis showed that eHealth literacy at T1 predicted health-promoting lifestyles at T2 (ß = 0.080, P = 0.006); however, health-promoting lifestyles at T1 did not predict eHealth literacy at T2 (ß = -0.026, P = 0.499). HRQoL at T1 predicted health-promoting lifestyles at T2 (ß = 0.147, P < 0.001); however, similar to the eHealth literacy finding, health-promoting lifestyles at T1 did not predict HRQoL at T2 (ß = 0.045, P = 0.142). eHealth literacy was also bi-directionally associated with HRQoL, and the prediction effect of eHealth literacy at T1 to HRQoL at T2 (ß = 0.078, P = 0.008) was slightly higher than the prediction effect of HRQoL at T1 to eHealth literacy at T2 (ß = 0.074, P = 0.023). Conclusion: eHealth literacy and HRQoL may be antecedents for college students' health-promoting lifestyles. There may be significant bi-directional relationships between eHealth literacy and HRQoL.

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.

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.