ABSTRACT
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.
ABSTRACT
BACKGROUND: Most of the existing studies demonstrating the relationships between health literacy and health service use have been conducted outside Europe and cannot be generalised to European healthcare systems. Moreover, the majority of studies measure healthcare use via self-reports. This study investigated whether health literacy is related to the use of health services measured objectively via patient records in a European country. METHODS: 9617 members of a Belgian health insurance fund (59% females, ages 18-88â years, mean age 55.8â years) completed an online questionnaire including the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q) and agreed to have their responses linked to the insurance fund's health service use records. A two-part model approach was used to assess the association between health literacy and the use of healthcare services and the costs related, adjusting for personal and behavioural characteristics. RESULTS: Low health literacy is associated with more admissions to 1-day clinics, general practitioner (GP) home consultations, psychiatrist consultations and ambulance transports, and with longer stays in general hospitals. Associations with psychiatric hospitalisations and specialist consultations are also found but are not significant when correction for multiple comparisons is applied. In contrast, health literacy is not significantly related to the number of GP consultations, admissions to 1-day surgical clinics or emergency consultations. The relationship between health literacy and medication use is inconsistent. CONCLUSION: The results partly confirm that low health literacy is associated with greater use of healthcare services, and especially of more specialised services. Improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and thus contribute to population health.
