Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

The use of social media in public health education has been increasing due to its ability to remove physical barriers that traditionally impede access to healthcare support and resources. As health promotion becomes more deeply rooted in Internet-based programming, health education specialists are tasked with becoming more competent in computer-mediated contexts that optimize both online and offline consumer health experiences. Generating a better understanding of the benefits and drawbacks to using social media in the field is important, since health education specialists continue to weigh its advantages against potential concerns and barriers to use. Accordingly, this Special Issue aims to explore social media as a translational health promotion tool by bridging principles of health education and health communication that examine (1) the method with which social media users access, negotiate, and create health information that is both actionable and impactful for diverse audiences; (2) strategies for overcoming challenges to using social media in health promotion; and (3) best practices for designing, implementing, and evaluating social media forums in public health. In this commentary, we discuss the updated communication and advocacy roles and responsibilities of health education specialists in the context of social media research and practice.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of Internet users to locate, evaluate, and act upon online health information. eHealth advancements have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. The current manuscript describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is conceptualized as dynamic, cyclical, and shaped by contextual factors. Objective: This study systematically examined eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods: An adapted version of Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (N = 10), rating scales (N = 6), models (N = 4), and peer-reviewed model applications (N = 16). An inductive cluster analysis was conducted to identify salient themes across definitions. Dimensions, antecedents, and consequences within models and measures were extracted, deductively analyzed based on codes consistent with the TMC. Results: A disconnect remains between operational skills in definitions and the literacies within models and measures. Theoretical underpinnings of eHealth literacy remain dismal, although recent measures incorporate tenants of the social cognitive theory. Despite the transactional capabilities of eHealth, the role of “communication” remains underdeveloped and limited to the physical and cognitive processing of two-way interactions that occur in eHealth. Conclusions: The Transactional Model of eHealth Literacy (TMeHL) and a corresponding definition is proposed. eHealth literacy is a hierarchical and multidimensional intrapersonal skillset that mediates the cyclical effect of contextual factors (i.e., user-oriented, task-oriented) on factors related to patient activation. The intrapersonal skillset is comprised of four eHealth literacies, which correspond with operational behaviors central to defining eHealth literacy: functional (i.e., locate, understand), communicative (i.e., exchange), critical (i.e., evaluate), and translational (i.e., apply). As posited by the model and consistent with the TMC, this four-dimensional intrapersonal skillset counteracts the negative effect of noise produced by preceding contextual factors, to ultimately influence patient activation and expectations of future eHealth experiences.

Disparities in online health information accessibility are partially due to varying levels of eHealth literacy and perceived trust. This study examined the relationship between eHealth literacy and perceived trust in online health communication channels and sources among diverse sociodemographic groups. A stratified sample of Black/African Americans (n = 402) and Caucasians (n = 409) completed a Web-based survey that measured eHealth literacy and perceived trustworthiness of online health communication channels and information sources. eHealth literacy positively predicted perceived trust in online health communication channels and sources, but disparities existed by sociodemographic factors. Segmenting audiences according to eHealth literacy level provides a detailed understanding of how perceived trust in discrete online health communication channels and information sources varies among diverse audiences. Black/African Americans with low eHealth literacy had high perceived trust in YouTube and Twitter, whereas Black/African Americans with high eHealth literacy had high perceived trust in online government and religious organizations. Older adults with low eHealth literacy had high perceived trust in Facebook but low perceived trust in online support groups. Researchers and practitioners should consider the sociodemographics and eHealth literacy level of an intended audience when tailoring information through trustworthy online health communication channels and information sources.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Despite the relatively high prevalence of low health literacy among individuals living with Chronic Obstructive Pulmonary Disease (COPD), limited empirical attention has been paid to the cognitive and health-literacy-related skills that can uniquely influence patients’ health-related quality of life (HRQoL) outcomes. Objective: To examine how health literacy, eHealth literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD. Methods: Adults from the COPD Foundation’s National Research Registry (N = 174) completed a cross-sectional web-based survey that assessed socio-demographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (Model 1) and lung-specific (Model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables. Results: Health literacy, eHealth literacy and COPD knowledge accounted for 9% of variance in generic HRQoL (Adj. R2=21%), F(9, 164) = 6.09, P<.001. After adjusting for potentially confounding factors, health literacy (b = .08, SE = .02, 95% CI = [0.04, 0.12]) was the only predictor positively associated with generic HRQoL (P < .001). Higher health literacy scores were significantly (P < .05) associated with better scores on all five generic HRQoL dimensions. Adding health literacy, eHealth literacy and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (Adj. R2=26.40%), F(8, 161) = 8.59, P < .001). After adjusting for covariates, both health literacy (b = 2.63, SE = .84, 95% CI = [.96, 4.29], P < .001) and eHealth literacy (b = 1.41, SE = .67, 95% CI = [.09, 2.73], P < .001) were positively associated with lung-specific HRQoL. Health literacy was associated with better scores quantifying the impact of most lung-specific HRQoL indicators (i.e., cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level). eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. After adjusting for confounding variables, COPD knowledge (b = -.56, SE = .29, 95% CI = [-1.22, -.004], P < .05) was inversely associated with lung-specific HRQoL. Conclusions: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. Results confirm the importance of considering both health and eHealth literacy levels when designing patient education and self-management support programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among COPD patients, particularly when overarching intervention goals are to enhance HRQoL.