Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey.

BACKGROUND: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. OBJECTIVE: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. METHODS: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. RESULTS: Age (ß=-.17; P=.02), gender (ß=-.22; P=.01), and medical satisfaction (ß=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (ß=.13; P=.05) and satisfaction with medical encounters (ß=.34; P<.001) but negatively predicted by education (ß=-.18; P=.03) and eHealth literacy (ß=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (ß=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (ß=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (ß=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (ß=-.22; P=.01). CONCLUSIONS: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.

Digital Pathways to Positive Health Perceptions: Does Age Moderate the Relationship Between Medical Satisfaction and Positive Health Perceptions Among Middle-Aged and Older Internet Users?

OBJECTIVES: We explored the influence of e-trust, e-health literacy, e-health information seeking, and e-health information consumerism on medical satisfaction and positive health perceptions. METHODS: Our sample consisted of 499 randomly selected panel members aged 40-93. We employed hierarchical ordinary least squares (OLS) regression analyses and structural equation modeling (SEM). We examined the moderating role of age on the relationship between medical satisfaction and positive health perceptions. RESULTS: A significant interaction was found between age and medical satisfaction in predicting positive health perceptions in the OLS regression models. Medical satisfaction has a stronger association with self-care, health-related quality of life, and health status in the older adult sample as compared with the middle-aged sample. SEM analyses revealed that e-health information seeking has an indirect effect on both medical satisfaction and positive health perceptions through its significant direct effect on e-health information consumerism. Both e-trust and e-health consumerism were significant predictors. The e-health literacy and e-trust measures were significant predictors of the positive health perception index in the OLS regression models. DISCUSSION: The results contribute to our understanding of the potential benefits information technologies have for the health and well-being of computer-connected aging adults.

Expansion of Parson's sick role into cyberspace: Patient information consumerism and subjective health in a representative sample of U.S. internet users.

The self-help culture, in the context of the U.S. medical system, demands proactive patient behavior as more responsibility for good health falls on the patient. The presence of health/medical information online alters the dynamics of medical encounters and transforms patients into reflexive consumers or consumer-patients who are engaged in personal health management. This paper examined whether using health information obtained from the Internet to manage personal health care (referred as e-health information consumerism) is associated with subjectively reported negative health outcomes in a representative sample of Internet users in the U.S. These outcomes are conceptualized as experiencing (a) adverse affect (feeling worried and anxious) and (b) health problem due to using Internet information. An online survey (n = 710) was conducted with study participants who were recruited from the largest online probability U.S. research panel developed by a non-profit academic research firm, Knowledge Networks. Analyses included multivariate regressions that included the statistical interactions between e-health information consumerism and the communicational and interactional aspects of medical encounters. Parallel models were tested in the gender-stratified subsamples. Results indicate that robust associations exist between e-health information consumerism and patient-reported health outcomes. Respondents who indicated greater satisfaction with medical communication reported lower averages on experiencing worry and a health problem due to e-health information consumerism. While e-health information consumerism is significantly associated with experiencing a self-reported health problem in both men and women, the association with adverse affect is significant only among women. The moderating role of patient satisfaction with medical communication is stronger among women. Interestingly, the moderating role of patient satisfaction with a medical interaction is stronger among respondents who reported higher averages on experiencing a health problem due to e-health information consumerism. e-Health information consumerism can translate into health benefits if the Internet information is deployed to promote a satisfactory medical partnership.

Burnout among direct-care workers in nursing homes: Influences of organisational, workplace, interpersonal and personal characteristics.

AIMS AND OBJECTIVES: The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes. BACKGROUND: Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. METHODS: A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. CONCLUSIONS: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. RELEVANCE TO CLINICAL PRACTICE: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

Being an Informed Consumer of Health Information and Assessment of Electronic Health Literacy in a National Sample of Internet Users: Validity and Reliability of the e-HLS Instrument.

BACKGROUND: The Internet, with its capacity to provide information that transcends time and space barriers, continues to transform how people find and apply information to their own lives. With the current explosion in electronic sources of health information, including thousands of websites and hundreds of mobile phone health apps, electronic health literacy is gaining an increasing prominence in health and medical research. An important dimension of electronic health literacy is the ability to appraise the quality of information that will facilitate everyday health care decisions. Health information seekers explore their care options by gathering information from health websites, blogs, Web-based forums, social networking websites, and advertisements, despite the fact that information quality on the Internet varies greatly. Nonetheless, research has lagged behind in establishing multidimensional instruments, in part due to the evolving construct of health literacy itself. OBJECTIVE: The purpose of this study was to examine psychometric properties of a new electronic health literacy (ehealth literacy) measure in a national sample of Internet users with specific attention to older users. Our paper is motivated by the fact that ehealth literacy is an underinvestigated area of inquiry. METHODS: Our sample was drawn from a panel of more than 55,000 participants maintained by Knowledge Networks, the largest national probability-based research panel for Web-based surveys. We examined the factor structure of a 19-item electronic Health Literacy Scale (e-HLS) through exploratory factor analysis (EFA) and confirmatory factor analysis, internal consistency reliability, and construct validity on sample of adults (n=710) and a subsample of older adults (n=194). The AMOS graphics program 21.0 was used to construct a measurement model, linking latent factors obtained from EFA with 19 indicators to determine whether this factor structure achieved a good fit with our entire sample and the subsample (age ≥ 60 years). Linear regression analyses were performed in separate models to examine: (1) the construct validity of the e-HLS and (2) its association with respondents' demographic characteristics and health variables. RESULTS: The EFA produced a 3-factor solution: communication (2 items), trust (4 items), and action (13 items). The 3-factor structure of the e-HLS was found to be invariant for the subsample. Fit indices obtained were as follows: full sample: χ(2) (710)=698.547, df=131, P<.001, comparative fit index (CFI)=0.94, normed fit index (NFI)=0.92, root mean squared error of approximation (RMSEA)=0.08; and for the older subsample (age ≥ 60 years): χ(2) (194)=275.744, df=131, P<.001, CFI=0.95, NFI=0.90, RMSEA=0.08. CONCLUSIONS: The analyses supported the e-HLS validity and internal reliability for the full sample and subsample. The overwhelming majority of our respondents reported a great deal of confidence in their ability to appraise the quality of information obtained from the Internet, yet less than half reported performing quality checks contained on the e-HLS.

Shared Decision-Making in Nursing Homes: Factors Associated With the Empowerment of Direct Care Workers.

OBJECTIVE: The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. METHOD: The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. RESULTS: Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. DISCUSSION: SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.

Health information on the web and consumers' perspectives on health professionals' responses to information exchange.

BACKGROUND: Health information technology, which is sometimes referred to as informaticization of medicine, is changing the extent to which patients become competent producers of their own health by enabling them access to health information anytime and anywhere. OBJECTIVE: This research provides preliminary information on users' perceptions of the extent to which use of the Internet for health information impacts medical encounters. We specifically explored the following questions: (1) To what extent perceptions of positive or negative changes in medical encounters are associated with sociodemographic background of online health information seekers, and how often the Internet information is discussed with providers? (2) To what extent is there an association between perceived changes in medical encounters and frequency of referring to the Internet during medical encounters? (3) To what extent is there an association between sociodemographic background of online health information users and frequency of discussing of the Internet information with providers? METHODS: The data for this study was derived from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace-Survey of User Perceptions (N=710). This study used a nationally representative online research panel of the US adults maintained by the Knowledge Networks. Analysis of variance (ANOVA), chi-square, and t tests were performed to examine the data. RESULTS: Although Internet sources allow people the opportunity to gather health or medical information, discussion of this information was not a very common activity. It is noteworthy that half of the sample never or rarely discussed health/medical information obtained from Internet sources with health professionals. Chi-square analyses revealed that discussion of online health information with providers were associated with education, income, and marital status. We also found that discussion of the Internet information mostly promotes better physician-patient interactions. Analyses with post-hoc tests identified that perceived changes in medical encounters were associated with age, education, and income. However, 9.1% (64/703) of our respondents strongly agreed that the interactions with their providers have been strained. T test analyses showed that marital status, race, and gender were not significant. CONCLUSIONS: Embracing new technologies, and adapting to changing roles and relationships in delivery of medical care are critical to effective delivery of patient-centered care. Health professionals could also guide patients on how to evaluate information and where to access to reliable and accurate information.

I am proud and hopeful: age-based comparisons in positive coping affect among women who use online peer-support.

How do women who seek psychosocial support on the Internet by participating in cancer peer support groups respond to the process of coping with cancer? The current study examines whether older women with cancer have different perceptions about and are influenced to a different extent by online peer support than younger women. The study also explores age-based variations in outlook on coping with cancer as a result of using online support. Separate multivariate regression models estimated the effects of covariates on (1) positive coping affect (PCA) (2) positive coping affect-hopeful (PCA-H), and (3) positive coping affect-proud (PCA-P). A stratified analysis examined variations within age-based subsamples (≥51 and ≤50). Positive coping affect includes feeling proud about coping with cancer from a position of strength and empowerment rather than being a victim and being hopeful for a healthier future postdiagnosis. Online support was found to increase PCA significantly. This finding is consistent across age groups but was more pronounced for older patients. The only exception is that younger women perceive more benefit from using online support in terms of feeling proud. As severity of the symptoms increased, though the younger women increased the amount of time they were online, the older women increased the number of groups they participated in. The study concludes that the Internet might be particularly helpful for older adults who feel helpless to cope with cancer in old age. Online peer support services may help improve the patients' outlook on fighting with cancer and help them to feel more in control of their health.

Informational and decisional empowerment in online health support communities: initial psychometric validation of the Cyber Info-Decisional Empowerment Scale (CIDES) and preliminary data from administration of the scale.

PURPOSE: This article presents initial psychometric validation of an instrument developed to measure cyber informational and decisional empowerment. The article provides preliminary insights into the extent to which cyber patients view the digital environment of peer-based information and support as a resource for informed and empowered participation in self health care management. METHODS: Data come from cancer patients (N = 350) who participated in the Study of Virtual Health Networks for Cancer Patients of the 21st Century. Data were first analyzed using exploratory factor analysis with principle component extraction and Varimax rotation. Age-based split-sample analysis (≥ 51 and ≤ 50) was performed on a subsample, which consisted of only women (N = 255), in order to cross-validate psychometric data obtained from the full sample. A confirmatory factor analysis was conducted using AMOS 19.0. to further validate the scale. RESULTS: The composite scale is unidimensional with excellent internal consistency reliability. The highest average scores were obtained for informational empowerment items. The lowest average was for the item that measured empowerment to seek second opinion from additional health care professionals. CONCLUSIONS: The ability of this composite measure to provide information about the extent to which computer-connected patients view digital peer support as an empowerment tool makes it a valuable addition to the literature in health informatics, supportive cancer care, and health quality of life research.