Electronic health (e-Health) interventions are emerging as an effective alternative model for improving secondary prevention of coronary artery disease (CAD). The aim of this study was to describe the effectiveness of different modes of delivery and components in e-Health secondary prevention programmes on adherence to treatment, modifiable CAD risk factors and psychosocial outcomes for patients with CAD. A systematic review was carried out based on articles found in MEDLINE, CINAHL, and Embase. Studies evaluating secondary prevention e-Health programmes provided through mobile-Health (m-Health), web-based technology or a combination of m-Health and web-based technology were eligible. The main outcomes measured were adherence to treatment, modifiable CAD risk factors and psychosocial outcomes. The quality appraisal of the studies included was conducted using the Joanna Briggs Institute critical appraisal tool for RCT. The results were synthesised narratively. A total of 4834 titles were identified and 1350 were screened for eligibility. After reviewing 123 articles in full, 24 RCTs including 3654 participants with CAD were included. Eight studies delivered secondary prevention programmes through m-Health, nine through web-based technology, and seven studies used a combination of m-Health and web-based technology. The majority of studies employed two or three secondary prevention components, of which health education was employed in 21 studies. The m-Health programmes reported positive effects on adherence to medication. Most studies evaluating web-based technology programmes alone or in combination with m-Health also utilised traditional CR, and reported improved modifiable CAD risk factors. The quality appraisal showed a moderate methodological quality of the studies. Evidence exists that supports the use of e-Health interventions for improving secondary prevention of CAD. However, a comparison across studies highlighted a wide variability of components and outcomes within the different modes of delivery. High quality trials are needed to define the most efficient mode of delivery and components capable of addressing a favourable outcome for patients. Not applicable.

Background: eHealth literacy is a key concept in the implementation of eHealth resources. However, most eHealth literacy definitions and frameworks are designed from the perceptive of the individual receiving eHealth care, which do not include health care providers’ eHealth literacy or acceptance of delivering eHealth resources. Aims: To identify existing research on eHealth literacy domains and measurements and identify eHealth literacy scores and associated factors among hospital health care providers. Methods: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. A systematic literature search was conducted in MEDLINE, Cinahl, Embase, Scopus, PEDro, AMED and Web of Science. Quantitative studies assessing eHealth literacy with original research, targeting hospital health care providers were included. Three eHealth literacy domains based on the eHealth literacy framework were defined a priori; (1) Individual eHealth literacy, (2) Interaction with the eHealth system, and (3) Access to the system. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Results: Fourteen publications, of which twelve publications were conducted in non-Western countries, were included. In total, 3,666 health care providers within eleven different professions were included, with nurses being the largest group. Nine of the included studies used the eHealth literacy scale (eHEALS) to measure eHealth literacy, representing the domain of individual eHealth literacy. A minority of the studies covered domains such as interaction with the eHealth system and access to the system. The mean eHEALS score in the studies ranged from 27.8 to 31.7 (8–40), indicating a higher eHealth literacy. One study reported desirable eHealth literacy based on the Digital Health Literacy Instrument. Another study reported a relatively high score on the Staff eHealth literacy questionnaire. eHealth literacy was associated with socio-demographic factors, experience of technology, health behaviour and work-related factors. Conclusions: Health care providers have good individual eHealth literacy. However, more research is needed on the eHealth literacy domains dependent on interaction with the eHealth system and access to the system. Furthermore, most studies were conducted in Eastern and Central-Africa, and more research is thus needed in a Western context. Trial registration: PROSPERO International Prospective Register of Systematic Reviews (CRD42022363039).

Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information. Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention. Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores. Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=–0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI –21.40 to –17.21, P<.001), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified. Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies. Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612

In the setting of established coronary artery disease (CAD), lower health literacy is associated with poor outcomes. The aim of this study was to determine whether health literacy at the index admission was associated with established CAD risk factors and with changes in CAD risk factors from baseline until 6 months after percutaneous coronary intervention (PCI). A multicenter cohort study recruited 3,417 patients aged ≥18 years who were treated with PCI. Assessments were made at the index admission for PCI and at 6-month follow-up, including 4 of the 9 scales from the Health Literacy Questionnaire, an assessment of behavioral risk factors and psychologic risk factors for CAD. In this large study, key aspects of health literacy were associated with behavioral and psychologic risk factors for CAD. For each 1-unit higher score on the health literacy scales, weekly physical activity was 12 to 20 intensity-adjusted minutes higher, and the odds of being a nonsmoker were 24% to 72% higher. The risk factors for CAD improved from baseline to 6-month follow-up, although most were not significantly associated with health literacy. Still, patients with lower health literacy scores were more likely to report a greater reduction in depression symptoms from baseline to 6-month follow-up. In conclusion, the study provides evidence that several aspects of health literacy are associated with risk factors for CAD. These results serve as a reminder to healthcare teams to consider health literacy challenges in connection with secondary prevention care.

Aims: Electronic health (eHealth) sources have great potential to improve patients’ access to health information for self-management of secondary prevention after percutaneous coronary intervention (PCI). It remains unclear, however, whether patients are health-related digitally active and whether they have sufficient eHealth literacy. This study aimed to determine the extent to which patients after PCI are health-related digitally active at baseline, 2 and 6 months after PCI, and to determine the association between patients’ eHealth literacy and their health-related digital activity. Methods and results: This multicentre cohort study included patients at three large referral PCI centres in Norway (n = 1970). Data were collected from medical records, national registries, and patients’ self-reports. The eHealth Literacy Scale (eHEALS) assessed patients’ eHealth literacy. At baseline, 67% had used the internet to find health information. The mean eHEALS score was 25.71 (standard deviation 6.22), illustrating a lower level of eHealth literacy. There were substantial associations between eHealth literacy and use of the internet to find health information [coefficient 10.90, 95% confidence interval (CI) 8.05–14.57]. At the 2-month follow-up, there were substantial associations between baseline eHealth literacy and use of the internet to find information about health, prevention, illness, or treatment [odds ratio (OR) 1.19, 95% CI 1.14–1.24] and use of health applications (OR 1.15, 95% CI 1.08–1.22). Conclusion: This study provides evidence that patients’ level of eHealth literacy after PCI is associated to how patients use, and can make use of, eHealth technology for health information. Registration: ClinicalTrials.gov (NCT03810612).

Fundamental roadblocks, such as non-use and low eHealth literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population. This prospective longitudinal study recruited 2,924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health, the eHealth literacy scale, and assessment of clinical, behavioural and psychological CAD risk factors. Regression analyses were used. Patients’ use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline, and lower physical activity and being a smoker at baseline and at 12-month follow-up. Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind. ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612