Development of a patient-reported outcome measure of digital health literacy for chronic patients: results of a French international online Delphi study.

BACKGROUND: A psychometrically robust patient-reported outcome measure (PROM) to assess digital health literacy for chronic patients is needed in the context of digital health. We defined measurement constructs for a new PROM in previous studies using a systematic review, a qualitative description of constructs from patients, health professionals and an item pool identification process. This study aimed to evaluate the content validity of a digital health literacy PROM for chronic patients using an e-Delphi technique. METHODS: An international three-round online Delphi (e-Delphi) study was conducted among a francophone expert panel gathering academics, clinicians and patient partners. These experts rated the relevance, improvability, and self-ratability of each construct (n = 5) and items (n = 14) of the preliminary version of the PROM on a 5-point Likert scale. Consensus attainment was defined as strong if ≥ 70% panelists agree or strongly agree. A qualitative analysis of comments was carried out to describe personal coping strategies in healthcare expressed by the panel. Qualitative results were presented using a conceptually clustered matrix. RESULTS: Thirty-four experts completed the study (with 10% attrition at the second round and 5% at the third round). The panel included mostly nurses working in clinical practice and academics from nursing science, medicine, public health background and patient partners. Five items were excluded, and one question was added during the consensus attainment process. Qualitative comments describing the panel view of coping strategies in healthcare were analysed. Results showed two important themes that underpin most of personal coping strategies related to using information and communications technologies: 1) questionable patient capacity to assess digital health literacy, 2) digital devices as a factor influencing patient and care. CONCLUSION: Consensus was reached on the relevance, improvability, and self-ratability of 5 constructs and 11 items for a digital health literacy PROM. Evaluation of e-health programs requires validated measurement of digital health literacy including the empowerment construct. This new PROM appears as a relevant tool, but requires further validation.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review.

BACKGROUND: Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. OBJECTIVE: This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. METHODS: A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. RESULTS: The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. CONCLUSIONS: This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50798.

eHealth literacy measurement tools: a systematic review protocol.

BACKGROUND: Improving eHealth literacy (eHL) is one of the biggest challenges currently facing the global healthcare community. Indeed the use of digital services has the potential to engage patients in care as well as improve the effectiveness of chronic disease self-management, it remains highly dependent on a patient's specific skills and experiences in the health care systems. Although eHealth literacy has gained momentum in the past decade, it remains an underresearched area, particularly eHealth literacy measurement. The aim of the review is to identify patient-reported outcome measures (PROMs) of eHealth literacy for adult populations and to summarize the evidence on their psychometric properties. METHODS: We will conduct a systematic literature review of the tools used to measure eHealth literacy for adult population. The search strategy aims to find published studies. A three-step search strategy will be used in this review. Published studies will be searched in CINAHL, PubMed, PsycINFO, and Web of Science from inception until end. Grey literature will be searched to find theses. Database search strategies will be formulated and tested with the assistance of an expert Health Sciences Librarian. The selection of studies will be done by two independent reviewers. Disagreements will be resolved through consensus, and a third reviewer will solve discrepancies. Furthermore, two reviewers will independently evaluate the methodological rigor of the instruments development and testing and assign a grade using the standardized Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be discussed with a third reviewer, expert in psychometrics. Extracted data will be aggregated and analyzed to produce a set of synthesized findings that will be used to develop evidence-informed recommendations in regard of eHL instruments. We will present a synthesis of all instruments, their psychometric properties, and make recommendations for eHL instrument selection in practice. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and a PRISMA flow diagram. DISCUSSION: This systematic review will summarize the evidence on the psychometric properties of PROMs instruments used to measure eHL and will help clinicians, managers, and policy-makers to select an appropriate instrument. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021232765.

L'impératif cosmique universel : l'apport du modèle de Roy au savoir infirmier.

The contemporary challenge in the field of health is undeniably that of devising a way to integrate humans and the environment that is beneficial to health. This article presents the universal cosmic imperative (UCI) philosophical perspective and the notion of the cosmic imperative that leads human beings to be creative in their relationship to nature. It begins by consolidating the exegesis of the internal evolution of Roy’s theory and identifying its influences. The epistemological and philosophical postulates upon which Roy’s theory was built are specified, and then the evolution of Roy’s thought is described in three main phases. The article then moves on to describe and explain the epistemological openings that Roy’s theory allows from the point of view of current health issues, especially environmental medicine, in a macro-meso-micro perspective of global health. Roy’s thinking is part of the question of the current turning point in the discipline of nursing (cure-care-healing) and the definition of its focus. Roy’s theory resists current theoretical developments, which it allows us to describe and question in a pattern that is fruitful for researchers.

e-Health interventions for healthy aging: a systematic review.

BACKGROUND: Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. OBJECTIVES: To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. METHODS: A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. RESULTS: Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. CONCLUSIONS: This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. SYSTEMATIC REVIEW REGISTRATION: The review protocol was registered in PROSPERO (registration number: CRD42016033163).

User-Centered Design for Promoting Patient Engagement in Chronic Diseases Management: The Development of CONCERTO.

Multimorbidity increases care needs among people with chronic diseases. In order to support communication between patients, their informal caregivers and their healthcare teams, we developed CONCERTO+, a patient portal for chronic disease management in primary care. A user-centered design comprising 3 iterations with patients and informal caregivers was performed. Clinicians were also invited to provide feedback on the feasibility of the solution. Several improvements were brought to CONCERTO+, and it is now ready to be implemented in real-life setting.

Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial.

INTRODUCTION: Multimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients' and their informal caregivers' needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making. METHODS AND ANALYSIS: This project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health. ETHICS AND DISSEMINATION: This study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03628963; Pre-results.