The Relationship between E-Health Literacy and Educational Participation Motivation among Elderly Individuals: The Chained Mediating Effects of Self-Identity and Social Capital.

Aims/Background In light of the increased utilization of digital technology among the elderly population, understanding the relationship between e-health literacy, self-identity, social capital, and educational participation motivation has become crucial. This study aims to investigate these relationships and explore the mediating effects of self-identity and social capital on the elderly population. By shedding light on these aspects, the study seeks to contribute to the existing knowledge base and inform intervention strategies to enhance the elderly individuals' overall well-being and engagement with digital health resources. Methods A questionnaire survey was conducted in a sample consisting of 578 elderly participants. Data of the surveyed variables were analyzed. Mediating effect analysis methods were employed to explore the mediating roles of self-identity and social capital in the relationship between e-health literacy and educational participation motivation among the elderly individuals. Results The results revealed a significant positive correlation between e-health literacy, self-identity, social capital, and educational participation motivation among elderly individuals. Furthermore, self-identity and social capital were found to play significant mediating roles between e-health literacy and educational participation motivation. Specifically, self-identity and social capital acted as complete mediators, with a mediating effect value of 0.61, between e-health literacy and educational participation motivation. Additionally, the chained mediating effect of self-identity and social capital was also significant. Conclusion This study demonstrated that e-health literacy and educational participation motivation are closely intertwined, with self-identity and social capital acting as the mediators in this association, in the elderly population, providing valuable guidance for enhancing the health and quality of life and offering insightful references for the development and implementation of relevant policies.

Anxiety and e-health literacy levels of patients scheduled for thoracic surgery.

OBJECTIVE: This study was conducted to examine the relationship between the pre-operative anxiety levels of patients scheduled for thoracic surgery and their e-health literacy levels pertaining to skills such as finding and evaluating electronic health information about health problems. METHODS: This study was a descriptive and correlational study. One hundred and two patients scheduled for thoracic surgery were interviewed in Izmir. The Amsterdam pre-operative anxiety and information scale (APAIS), the Visual Analog Scale for anxiety (VAS-A), the eHealth literacy scale (eHEALS), and a patient information form were used to collect data. RESULTS: The mean VAS-A score of the patients was 6.02 ± 2.51, their mean APAIS score was 18.73 ± 5.85, and their mean eHEALS score was 24.84 ± 9.21. There was no significant relationship between the anxiety and e-health literacy levels of the patients. Significant differences were found in the e-health literacy levels of the patients according to their ages and reasons for surgery. CONCLUSION: Patients scheduled for thoracic surgery were determined to experience moderate anxiety and need moderate levels of information. The patients were also found to have moderate e-health literacy levels. There was no significant relationship between the anxiety and e-health literacy levels of the patients.

OBJETIVO: Examinar la relación entre los niveles de ansiedad pre-operatoria de los pacientes que se someterán a una cirugía torácica y la alfabetización en salud electrónica, como encontrar y evaluar información de salud electrónica sobre problemas de salud. MÉTODOS: Estudio descriptivo y relacional. Para recopilar datos se utilizaron la Escala de Ansiedad e Información Pre-operatoria de Amsterdam (APAIS), la Escala de Ansiedad Analógica Visual (EVA-A) y la Escala de Alfabetización en E-salud, y un formulario de información descriptiva del paciente. RESULTADOS: Según la EVA-A, los niveles de ansiedad de los pacientes fueron de 6.02 ± 2.51. La puntuación APAIS fue de 18.73 ± 5.85. La puntuación de la escala de alfabetización en salud electrónica de los pacientes fue de 24.84 ± 9.21. No hubo una relación significativa entre los niveles de ansiedad de los pacientes y su alfabetización en salud electrónica. Se encontró una diferencia significativa entre los niveles de alfabetización en salud electrónica de los pacientes según su edad y el motive de la cirugía. CONCLUSIONES: Los pacientes que serán sometidos a cirugía torácica experimentan ansiedad moderada y se determinó que necesitan información moderada. También se descubrió que los pacientes tenían niveles moderados de conocimientos sobre cibersalud. No hubo una relación significativa entre la ansiedad y los niveles de alfabetización en salud electrónica de los pacientes.

Validation of the extended e-health literacy scale: structural validity, construct validity and measurement invariance.

BACKGROUND: Given the rapid proliferation and use of online health resources, many of which may be of dubious quality, there is an increasing need to develop electronic health literacy (e-health literacy) skills among the population of internet users. E-health literacy encompasses the skills and abilities needed to access, understand, validate, evaluate, interpret, and apply online health-related information. Measuring e-health literacy has become crucial for developing targeted interventions, assessing their impact, and producing high-quality research findings that can inform health policy and clinical practice, which can lead to improved health outcomes and potentially reducing health inequalities. The scales need to be valid and reliable so that decisions are based on high-quality data. In this regard, the issue of the measurement invariance of scales across different demographic groups has been neglected. This is critical, as assessments should be valid across different sociodemographic groups to avoid bias when comparing them. The aim of this study was to validate the Extended e-health literacy scale (eHEALS-E) on general population and investigate its structural validity and internal consistency, construct validity in terms of convergent and discriminant validity, and examine its measurement invariance across gender, age, education and social status. METHODS: The data were collected as a part of a national health literacy survey conducted by the Slovenian National Institute of Public Health. For this survey the initial eHEALS-E scale was revised in order to address its limitations and applicability to general population. Based on a nationally representative sample, the final sample for the analysis comprised 1,944 individuals who at least occasionally used one of the various internet services to obtain health-related information. Multiple group confirmatory factor analysis was used to examine the measurement invariance of the scale. RESULTS: With some adjustments, the measurement model of the revised 6-dimensional eHEALS-E scale demonstrated a good fit to the data (χ2 = 2508, df = 282, RMSEA = 0.064, SRMR = 0.070, CFI = 0.90). The scale had good internal consistency (alpha = 0.89). Although evidence of the scale's convergent and discriminant validity was partially provided, the analysis revealed robust measurement invariance across sociodemographic groups. CONCLUSIONS: With a minor limitation, the scale ensures an unbiased e-health literacy assessment across different social groups, which is crucial for interventions that aim to reduce health-related social inequalities. This ensures that the interventions derived from the assessment of reality are equally valid and effective for everyone, regardless of their sociodemographic background.

Examining the mediating role of e-health literacy in the relationship between COVID-19 awareness and dispositional hope and the experiences of those who survived the disease.

The aim of this study was to examine the mediating effect of e-health literacy levels on the relationship between individuals' awareness of COVID-19 and dispositional hope during the COVID-19 pandemic. The research was conducted with a mixed-methods design. Quantitative data were collected for the study online using Google Forms and qualitative data were collected online with an interview technique. In this framework, the qualitative data were obtained from a total of 15 people who had been diagnosed with COVID-19. These participants were selected using the snowball sampling method. A personal information form, e-Health Literacy Scale, Coronavirus Awareness Scale, Dispositional Hope Scale, and semistructured interview form were utilized in the course of the research. As a result of, it was determined that there were significant relationships between coronavirus awareness and both e-health literacy and dispositional hope, as well as between e-health literacy and dispositional hope. The measurement model was found to have good fit values. Testing the structural equation model, it was determined that e-health literacy had a full mediating role between coronavirus awareness and dispositional hope. In addition, this study showed that people who had COVID-19 had increased awareness of COVID-19 after contracting the disease.

Association of 24-hour movement guideline adherence, mental health and quality of life in young adults: the role of e-Health literacy.

Background: The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions. Objective: This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations. Methods: 1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis. Results: Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH. Conclusion: This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

Evaluating E-Health Literacy, Knowledge, Attitude, and Health Online Information in Portuguese University Students: A Cross-Sectional Study.

BACKGROUND: The main objective of the present study was to assess e-health literacy in a sample of Portuguese university students and its association with the level of knowledge and seeking for COVID-19-related information. METHODS: This cross-sectional online study was conducted on Portuguese university students. All students completed a questionnaire consisting of demographic characteristics, e-health Literacy Scale (eHEALS), and a questionnaire about knowledge, attitude, and health online information seeking. RESULTS: A total of 534 students (76.8% women), with a mean age of 24.3 years old (SD = 7.8), participated in this cross-sectional study, 53.0% of students were from non-health sciences. The mean score of eHEALS literacy was 28.8 (SD = 5.6). Most students (71.1%) classified the Internet as a useful, or very useful, tool in helping them make health related decisions. The use of the Internet as a tool to research health information for a period of two or more hours (OR = 1.9; CI 95% = 1.2; 3.4), to search online for health information on professional websites (OR = 2.3; CI 95% = 1.4; 3.6), to search in official media (OR = 2.3; CI 95% = 1.4; 3.9), and to study in the field of health sciences (OR = 1.6; CI 95% = 1.1; 2.6) increased the likelihood of having sufficient e-health literacy. CONCLUSION: From a public health perspective, there is a need to develop programs that increase health literacy among university students.

Predictors of the Use of Physician's Televisits During the COVID-19 Pandemic in Poland.

Telemedicine-based contacts between patients and physicians were allowed in Poland only in 2016. However, using such services was not common due to the lack of a relevant reimbursement scheme. During the COVID-19 pandemic, the use of telemedicine and e-health systems increased radically. The aim of this study was the assessment of factors predicting the use of physician's televisit in the Polish general adult population. The analysis was based on data from an online survey of 2410 Internet users performed in October 2020. The logistic regression modeling revealed that both health (HL) and e-health literacy (eHL), the use of e-health services before the pandemic, the use of social media, and from sociodemographic variables, age, gender, vocational status, and marital status were significant predictors of obtaining televisit from a physician during the pandemic. Pre-pandemic experience with ehealth applications strongly predicted utilizing televisits during the pandemic. Respondents with higher levels of HL and eHL were more likely to use such telemedicine services than those with lower levels.

Factors Associated with the e-Health Literacy Among Older Adults with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

Background: The telemanagement model in chronic diseases needs older patients to have a certain level of e-Health literacy. According to Electronic Health Literacy model, factors associated with the e-Health literacy among older patients could be comprehensively investigated from individual, situational, and environmental aspects. Objectives: To investigate the e-Health literacy levels among older patients with chronic obstructive pulmonary disease (COPD) and explore associated factors. Methods: A cross-sectional study was conducted among older patients with COPD. The e-Health Literacy Scale was used to measure individuals' e-Health literacy. The multiple linear regression was applied to identify factors associated with e-Health literacy. Results: A total of 230 responses were included in the final analysis. The average score of e-Health literacy for older COPD patients was 24.66 (6.86). After adjusting the model, the results of multiple linear regression demonstrated that aging attitudes (B = 0.067, p < 0.001), technophobia (B = -0.285, p < 0.001), and self-efficacy (B = 0.431, p < 0.001) accounted for 68.3% (p < 0.001) of the total variation in e-Health literacy. Conclusion: This study identifies significant correlations of technophobia, aging attitudes, and self-efficacy, respectively, with e-Health literacy, and self-efficacy and technophobia may be constant predictive factors of e-Health literacy. In the future, intervention research on e-Health literacy should be conducted from a social psychology perspective, with particular emphasis on addressing negative aging attitudes and technophobia. That will promote the tele-management model of chronic diseases. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

Relationship between potential profile analysis of e-health literacy and physical activity level in elderly diabetic patients in community / 中国实用护理杂志

Objective:To understand the potential categories of e-health literacy of elderly diabetic patients in community, and analyze the relationship between each category and physical activity level, in order to provide theoretical basis for formulating intervention measures to improve e-health literacy of elderly diabetic patients.Methods:This study was across-sectional survey. Elderly diabetic patients from 3 community health service centers in Fenyang City, Shanxi Province were selected by convenient sampling method from January to June 2023. General data questionnaire, e-Health Literacy Scale and International Physical Activity Questionnaire were used to investigate the elderly diabetic patients. Mplus8.0 was used for potential profile analysis, and SPSS 26.0 software was used to compare the differences in physical activity levels among different categories of e-health literacy.Results:Totally 248 elderly diabetes patients in the community aged 60-88 (63.8 ± 6.4) years, 135 males (54.4%) and 113 females (45.6%). The e-health literacy scores of 248 elderly diabetic patients in community were (17.70 ± 5.30), which could be divided into three potential categories: general low literacy group (56.0%, 139/248), high evaluation ability-medium literacy group (18.2%, 45/248) and high access ability-high literacy group (25.8%, 64/248). Three potential categories of physical activity levels were (1 464.74 ± 190.37), (2 094.40 ± 139.70), (2 368.44 ± 157.27) metabolic equivalent-min per week, and the difference was statistically significant ( F=118.83, P<0.001). Conclusions:The e-health literacy of elderly diabetic patients in community can be divided into three potential categories, and the physical activity level of patients with different e-health literacy categories is different. It is suggested that targeted intervention should be conducted based on the homogenous group of elderly diabetic patients with e-health literacy to improve their physical activity level.

College Students' E-health Literacy, Social Media Use, and Perceptions of E-cigarettes in Taiwan.

This study aimed to examine the relationship between social media use, e-health literacy, and the risk and benefit perceptions of e-cigarettes among college students in Taiwan. A cross-sectional online survey was conducted with 1,571 Taiwanese college students, which included four questionnaires to assess participants' perceptions, social media use behavior, e-health literacy, and sociodemographic factors. The data were presented in terms of means, standard deviations, and percentages. Stepwise regression was used to identify factors associated with the participants' perceptions. The study found that 75.01% of the participants were exposed to e-cigarette information on social media, with 31.26% actively searching for it and 15.95% sharing it. Participants had a high e-cigarette risk perception, indicating low benefit perception, but acceptable e-health literacy. Factors such as current e-cigarette and tobacco use, e-health literacy, academic achievement, and sex significantly predicted e-cigarette risk perception, while sharing e-cigarette related information, sex, age, academic achievement, and current e-cigarette use significantly predicted its benefit perception. Thus, implementing effective e-health literacy programs to enhance college students' e-cigarette risk perception is recommended along with a proactive approach to tackle e-cigarette advertising messages on social media, minimizing their sharing behavior to decrease their perception of associated benefits.

The Awareness of the Role of Commercial Determinants of Health and the Readiness to Accept Restrictions on Unhealthy Food Advertising in Polish Society.

The negative consequences of commercial determinants of health (CDoH) have become a major challenge for public health systems, especially in terms of non-communicable diseases (NCDs). CDoH are defined as profit-driven factors that influence health. In this study, we assessed the awareness of CDoH and the attitudes toward potential restrictions on advertising, as well as fiscal interventions targeting food products with harmful effects on health in Polish society. Our analysis is based on data from a computer-based web interviewing (CAWI) survey performed in May 2022 among 2008 adult internet users from Poland. Multivariable logistic regression models were developed for variables derived from three items exploring the respondents' understanding of the relationship between CDoH and NCDs, as well as three items asking about their acceptance of a prohibition of advertising unhealthy products during sports events, a general ban on unhealthy food advertising, and their attitudes toward sugar-sweetened beverages (SSBs). Food (FL) and e-health literacy (eHL) levels were consistently positive predictors of both awareness of CDoH and acceptance of the proposed actions. Both higher FL and eHL were significantly associated with the opinion that advertising unhealthy food is associated with the prevalence of NCDs (OR, 95% CI: 1.03, 1.02-1.05, and 1.04, 1.02-1.06, respectively). Health literacy was less frequently a significant predictor of the dependent variables. Among sociodemographic factors, a respondent's level of education and age showed a significant relationship with their awareness and acceptance of countermeasures against CDoH. Respondents with a university master's level of education were more likely to agree with the statement on the relationship between big industry profits and harm to society's health (OR, 95% CI: 1.96, 1.42-2.69) and to support a ban on advertising unhealthy food similar to that for tobacco products (OR, 95% CI: 1.66, 1.21-2.27). Respondents suffering from chronic diseases were also consistently more likely to show a greater understanding of the harmful impact of CDoH and support proposed restrictions. For example, they were more likely to agree with restrictions on advertising harmful products during sports events (OR, 95% CI: 1.23, 1.02-1.50) and the introduction of a sugar tax (OR, 95% CI: 1.26, 1.03-1.54). Our study revealed that more than 50% of the Polish population is conscious of the problem of the harmful effects of big industries producing and selling processed food, sugar-sweetened beverages, and alcoholic beverages. Interestingly, slightly more than half of the respondents supported the introduction of restrictions on advertising such products. Still, only approximately 30% of them accepted a sugar tax to counter the obesity epidemic. The results of our study indicate that Polish society is open to the introduction of regulations aimed at limiting the impact of commercial determinants of health. To our knowledge, this is one of the first studies to assess the awareness of CDoH and the acceptance of restrictions to limit their impact.

Comparing Sports IoT Healthcare Devices and e-Health Literacy and Awareness among College Students: Pre-and Post-COVID-19 Perspectives / Comparación de dispositivos sanitarios de IoT para deportes y alfabetización y concienciación sobre salud electrónica entre estudiantes universitarios: perspectivas anteriores y posteriores a COVID-19

This study investigated the difference between sports major college students' perception of using IoT healthcare devices and e-health literacy before and after COVID-19. A quantitative research questionnaire was distributed randomly among 600 sports college students majoring in sports in metropolitan and non-metropolitan universities in Korea. The study's findings show a significant difference in perception of using IoT healthcare devices and e-health literacy before and after COVID-19. Secondly, before COVID-19, the perception of the use of IoT healthcare devices showed significant differences by grade. On the other hand, functional e-health literacy, communication e-health literacy, and critical e-health literacy showed significant differences by grade. Third, there was no significant difference in perception of the use of IoT healthcare devices by grade after COVID-19. Conversely, functional e-health literacy, communication e-health literacy, and critical e-health literacy showed significant differences by grade. Fourth, before COVID-19, there were statistically significant differences in perceptions of using IoT healthcare devices in local cars. However, there was no statistically significant difference in terms of e-health literacy. Fifth, there was no statistically significant difference in regional differences between the metropolitan and non-metropolitan areas after COVID-19. This study showed the differences between COVID-19 and after COVID-19 by comparing the high level of awareness of using IoT healthcare devices and e-health literacy of sports college students, which will foster talented people who can demonstrate professionalism in the sports field.(AU)

E-health literacy and associated factors among Korean adults during the COVID-19 pandemic: age-group differences.

The purpose of this study was to compare the mean scores of e-health literacy, health information, social relationships, and psychological status between younger, middle-aged, and older Korean adults during the COVID-19 pandemic and to identify the factors associated with e-health literacy as well as the moderating effect of age on the association between health information factors and e-health literacy. We used a cross-sectional survey of 2400 Korean adults aged 20 years or older residing in Seoul. Descriptive statistics, ANOVA, chi-square test, and hierarchical multiple regression analyses were used to analyze the data. Findings demonstrated an age-group difference in the mean score of e-health literacy with the older group having lower e-health literacy than the other groups. Health information, social support, and COVID-19-related anxiety were associated with e-health literacy and a moderating effect of age on the association between sources of health information and e-health literacy was also identified among the three age subgroups. This study emphasizes the importance of identifying e-health-related risk factors leading to health disparities between age groups.

The relationship between e-health literacy and information technology acceptance, and the willingness to share personal and health information among pregnant women.

BACKGROUND: Many factors may affect pregnant women's willingness to accept information (IT) technology and share their personal and health information. One of these factors is their e-health literacy level. OBJECTIVE: To investigate the relationship between e-health literacy and IT acceptance, as well as the willingness of pregnant women to share their information. METHODS: This survey was conducted among pregnant women visiting hospitals and private physicians' offices in Zahedan, Iran in 2019. Data were collected using a 4-part questionnaire with 66 questions. The data were analyzed using descriptive (frequency, percentage, mean and standard deviation) and inferential (Pearson correlation coefficient and linear regression) statistics. RESULTS: The mean scores of electronic health literacy, information technology acceptance, and willingness of pregnant women to share personal and health information were 27.43 ± 5.82, 145.49 ± 25.72, and 19.16 ± 5.47, respectively. There was a significant relationship between IT acceptance and information sharing, which means that with increasing IT acceptance, people were more willing to share their information. Also, the results showed that with the decrease in economic well-being, the willingness to share personal and health information decreases. CONCLUSION: This study showed that with the increase in e-health literacy of pregnant women, their IT acceptance grows. Increasing IT acceptance improves their willingness to share their information. Setting and updating information-sharing rules and security mechanisms with the participation of people can help reduce concerns and increase public trust. Healthcare policymakers can encourage the use of health IT in the prevention and treatment of diseases by providing relevant education and informing people.

Effects of Physical Activity on Mobile Phone Addiction Among College Students: The Chain-Based Mediating Role of Negative Emotion and E-Health Literacy.

Background: Smartphones have become an important tool for college students' study and life, but mobile phone addiction caused by excessive dependence use of cell phones can have serious negative impacts on college students' mental health, life behaviors, and so on. It is urgent to explore the causes and influence mechanisms of college students' cell phone addiction. Purpose: The purpose of this study was to investigate the relationship between physical exercise and mobile phone addiction among Chinese college students and the mediating role of negative affect and e-health literacy between the two. Methods: The stratified sampling method was used to investigate the physical activity, mobile phone addiction, negative emotion and e-health literacy of 4621 university students in Jiangsu Province using the Physical Activity Rating scale, Mobile Phone Addiction scale, Depression-anxiety-stress scale and E-Health Literacy scale, Thus the data were statistically analysed using SPSS 26.0 and AMOS 23.0. Results: (1) Physical exercise was significantly negatively correlated with mobile phone addiction and negative emotion among college students (r=-.713, P<0.01; r=-.571, P<0.01), and physical exercise was significantly positively correlated with e-health literacy (r=0.616, P<0.01); (2) Negative emotion and e-health literacy played independent mediating roles between physical exercise and mobile phone addiction, respectively; (3) Negative emotion and e-health literacy played chain mediating roles between physical exercise and mobile phone addiction. Conclusion: This study explored the potential mechanisms of cell phone addiction in college students and found that physical activity can influence Internet addiction through the independent mediating effect including the chain mediating effect of negative emotions and e-health literacy. This study further reveals the mechanism of action of physical exercise affecting college students' cell phone addiction, and provides some reference value for the prevention and intervention of college students cell phone addiction.

Electronic health literacy and its association with lifestyle behavior among undergraduate students: A cross-sectional survey.

Background: This study aims to assess healthy lifestyle behaviors among undergraduate students and determine the association between electronic health literacy with lifestyle behavior among undergraduate Jordanian university students. Methods: A descriptive cross-sectional design was used. The study recruited 404 participants utilizing undergraduate students from public and private universities. The e-Health literacy scale was used to assess the level of health information literacy among university students. Results: Data were collected from 404 participants who reported very good health status, the majority of the participants were female 57.2% with an average age of 19.3 years. The results showed that participants had good health behavior in terms of exercise, taking breakfast, smoking status, and sleeping status. The results have shown an inadequate level of e-Health literacy 16.61 (SD = 4.10) out of 40. The vast majority of students, in terms of their attitudes toward the Internet, thought that Internet health information was very useful/useful (95.8%). Also, they thought that online health information was very important /important (97.3%). The results showed that students who were attending public universities had higher e-Health literacy scores rather than those who were attending private universities, t (402) = 1.81, p = .014. The mean e-Health literacy score for nonmedical students was higher than those for medical students (p = .022). Conclusion: The study's findings provide important insights into the health behaviors and electronic health literacy of undergraduate students in Jordanian universities, and offer valuable guidance for future health education programs and policies aimed at promoting healthy lifestyles in this population.

Behavior patterns and influencing factors: Health information acquisition behavior of Chinese senior adults on WeChat.

Due to the gradual adoption of WeChat by older adults in China and their interest in health information, Chinese older people started to acquire health information through WeChat. We explored the specific patterns and influencing factors of the elderly's health information acquisition behavior senior adults. The cross-sectional study collected self-reported data with survey (N = 336) in the southeast of China, Zhejiang province. The findings of this study extend the previous research by suggesting that elderly adults' health information acquisition behavior has three patterns (actively seeking, passively browsing, and long-term collecting). These findings contribute to a better understanding of digital literacy, three dimensions of health literacy and their relationship with three specific patterns of health acquisition behavior. This study also provides practical insights related to narrow the technological gap of the older adults, improve their e-Health literacy of the elderly, and purify the health information environment in the network.

Exploring E-Health Literacy and Technology-Use Anxiety among Older Adults in Korea.

The COVID-19 pandemic has increased the importance of health literacy in disseminating information on health in a non-contact society. This study focused on examining the acceptance capacity by older adults of smart devices in Korea and investigating the potential differences between men and women in terms of e-health literacy and technology-use anxiety. The study included 1369 respondents who were adults over 50 years of age and used welfare centers, public health centers, senior citizen centers, and exercise centers in Seoul and Incheon. An online survey was conducted from 1 June 2021 to 24 June 2021. The study found that the older adults' low levels of digital literacy could limit their access to health information and negatively impact their health. The difference between men and women in terms of technology-use anxiety was statistically significant, with the latent mean for men being higher than that for women. The effect sizes of the potential mean differences were found to be at a medium level for e-health literacy and a significant level for technology-use anxiety. With Korea's aging population and the need for the continuous management of chronic diseases among older adults, it is essential to discuss internet-based health information for disease maintenance and treatment.

Continuous usage intention of mobile health services: model construction and validation.

BACKGROUND: Mobile health (mHealth) services can not give full play to their value if only it is used in the short term, and their continuous usage can achieve better effects in health management. This study aims to explore the factors that affect continuous usage intentions of mHealth services and their mechanism of action. METHODS: First, considering the uniqueness of health services and social environmental factors, this study constructed an extended Expectation Confirmation Model of Information System Continuance (ECM-ISC) to investigate factors that may influence the intention of continuous usage of mHealth services based on three dimensions, namely individual characteristics, technology and environment. Second, the survey method was used to validate the research model. The questionnaire items were derived from validated instruments and discussed by experts and data were collected both online and offline. The structural equation model was used for data analysis. RESULTS: There were 334 avidity questionnaires through cross-sectional data and these participants had used mHealth services ever. The reliability and validity of the test model were good, in which Cronbach's Alpha values of 9 variables exceeded 0.9, composite reliability 0.8, the average variance extracted value 0.5, and the factor loading 0.8. The modified model had a good fitting effect and strong explanatory power. It accounted for 89% of the variance in expectation confirmation, 74% of the variance in perceived usefulness, 92% of the variance in customer satisfaction, and 84% of the variance in continuous usage intention. Compared with the initial model hypotheses, perceived system quality was deleted according to the heterotrait-monotrait ratio, so paths related to it were deleted; perceived usefulness wasn't positively associated with customer satisfaction, and its path was also deleted. Other paths were consistent with the initial hypothesis. The two new added paths were that subjective norm was positively associated with perceived service quality (ß = 0.704, P < 0.001), and perceived information quality (ß = 0.606, P < 0.001). Electronic health literacy (E-health literacy) was positively associated with perceived usefulness (ß = 0.379, P < 0.001), perceived service quality (ß = 0.200, P < 0.001), and perceived information quality (ß = 0.320, P < 0.001). Continuous usage intention was influenced by perceived usefulness (ß = 0.191, P < 0.001), customer satisfaction (ß = 0.453, P < 0.001), and subjective norm (ß = 0.372, P < 0.001). CONCLUSIONS: The study constructed a new theoretical model including E-health literacy, subjective norm and technology qualities to clarify continuous usage intention of mHealth services, and empirically validated the model. Attention should be paid to E-health literacy, subjective norm, perceived information quality, and perceived service quality to improve continuous usage intention of users and self-management by mHealth Apps managers and governments. This research provides solid evidence for the validity of the expanded model of ECM-ISC in the mHealth field, which can be a theoretical and practical basis for mHealth operators' product research and development.

Evaluating the influence of health literacy and health-promoting COVID-19 protective behaviors on the spread of infection during the COVID-19 pandemic: A meta-analysis.

BACKGROUND: Health literacy and self-efficacy related to COVID-19 pandemic management are closely linked. Therefore, synthesis of relevant evidence regarding the positive aspects of health literacy and health-promoting protective measures among individuals during COVID-19 pandemic is necessary. OBJECTIVES: To determine the influence of e-health literacy and health-promoting coronavirus disease 2019 (COVID-19) protective behaviors on the spread of infection during the COVID-19 pandemic. MATERIAL AND METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane Library databases, as well as PROSPERO and ClinicalTrials.gov registry platforms were searched for eligible literature published from January 2020 to July 2022. Studies were included based on predefined Population, Intervention, Comparison, Outcomes and Study design (PICOS) criteria, and a summary of each study was prepared. To estimate the effect size, the standardized mean difference (SMD) of the evaluated parameters, e-health literacy and health-promoting COVID-19 protective behaviors was extracted. Using RevMan and MedCalc software, a meta-analysis was performed. RESULTS: Twelve eligible studies involving a total of 9854 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals were included in the meta-analysis. The pooled SMD for e-health literacy was 40.39 (95% confidence interval (95% CI): 28.14-52.63), with the following heterogeneity values: Tau2 of 396.80, ÷2 of 669.48, degrees of freedom (df) of 11, I2 of 98%, Z value of 6.47, and p < 0.001. Similarly, the pooled SM for COVID-19 protective behaviors was 15.90 (95% CI: 10.96-20.84) with Tau2 of 55.25, ÷2 of 252.92, df of 11, I2 of 98%, Z of 6.31, and p < 0.001. CONCLUSION: This study confirmed that e-health literacy and health-promoting COVID-19 protective behaviors have a strong positive impact on preventing the spread of COVID-19 infection and on its effective management. We recommend that interventions and applicable policies for promoting such e-literacy programs and preventative measures be given a high level of consideration.