The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change.

IMPORTANCE: The study highlights the potential and limitations of the Large Language Models (LLMs) in recognizing different states of motivation to provide appropriate information for behavior change. Following the Transtheoretical Model (TTM), we identified the major gap of LLMs in responding to certain states of motivation through validated scenario studies, suggesting future directions of LLMs research for health promotion. OBJECTIVES: The LLMs-based generative conversational agents (GAs) have shown success in identifying user intents semantically. Little is known about its capabilities to identify motivation states and provide appropriate information to facilitate behavior change progression. MATERIALS AND METHODS: We evaluated 3 GAs, ChatGPT, Google Bard, and Llama 2 in identifying motivation states following the TTM stages of change. GAs were evaluated using 25 validated scenarios with 5 health topics across 5 TTM stages. The relevance and completeness of the responses to cover the TTM processes to proceed to the next stage of change were assessed. RESULTS: 3 GAs identified the motivation states in the preparation stage providing sufficient information to proceed to the action stage. The responses to the motivation states in the action and maintenance stages were good enough covering partial processes for individuals to initiate and maintain their changes in behavior. However, the GAs were not able to identify users' motivation states in the precontemplation and contemplation stages providing irrelevant information, covering about 20%-30% of the processes. DISCUSSION: GAs are able to identify users' motivation states and provide relevant information when individuals have established goals and commitments to take and maintain an action. However, individuals who are hesitant or ambivalent about behavior change are unlikely to receive sufficient and relevant guidance to proceed to the next stage of change. CONCLUSION: The current GAs effectively identify motivation states of individuals with established goals but may lack support for those ambivalent towards behavior change.

Mental Health Pandemic During the COVID-19 Outbreak: Social Media As a Window to Public Mental Health.

Intensified preventive measures during the COVID-19 pandemic, such as lockdown and social distancing, heavily increased the perception of social isolation (i.e., a discrepancy between one's social needs and the provisions of the social environment) among young adults. Social isolation is closely associated with situational loneliness (i.e., loneliness emerging from environmental change), a risk factor for depressive symptoms. Prior research suggested vulnerable young adults are likely to seek support from an online social platform such as Reddit, a perceived comfortable environment for lonely individuals to seek mental health help through anonymous communication with a broad social network. Therefore, this study aims to identify and analyze depression-related dialogues on loneliness subreddits during the COVID-19 outbreak, with the implications on depression-related infoveillance during the pandemic. Our study utilized logistic regression and topic modeling to classify and examine depression-related discussions on loneliness subreddits before and during the pandemic. Our results showed significant increases in the volume of depression-related discussions (i.e., topics related to mental health, social interaction, family, and emotion) where challenges were reported during the pandemic. We also found a switch in dominant topics emerging from depression-related discussions on loneliness subreddits, from dating (prepandemic) to online interaction and community (pandemic), suggesting the increased expressions or need of online social support during the pandemic. The current findings suggest the potential of social media to serve as a window for monitoring public mental health. Our future study will clinically validate the current approach, which has implications for designing a surveillance system during the crisis.

Use of Health Belief Model-based Deep Learning to Understand Public Health Beliefs in Breast Cancer Screening from Social Media before and during the COVID-19 Pandemic.

Breast cancer is the second leading cause of cancer death for women in the United States. While breast cancer screening participation is the most effective method for early detection, screening rate has remained low. Given that understanding health perception is critical to understand health decisions, our study utilized the Health Belief Model-based deep learning method to predict and examine public health beliefs in breast cancer and its screening behavior. The results showed that the trends in public health perception are sensitive to political (i.e., changes in health policy), sociological (i.e., representation of disease and its preventive care by public figure or organization), psychological (i.e., social support), and environmental factors (i.e., COVID-19 pandemic). Our study explores the roles social media can play in public health surveillance and in public health promotion of preventive care.

Assessing COVID-19 Health Literacy (CoHL) and its relationships with sociodemographic features, locus of control and compliance with social distancing rules during the first lockdown in France.

Health literacy (HL) is critical to find, understand and use health information for adopting appropriate health behavior, especially during a pandemic crisis in which people can be exposed to an overwhelming amount of information from different media. To this end, we conducted an online study to first validate the measure of COronaVIrus Disease appeared in 2019 (COVID-19) health literacy (CoHL) and then investigated its relationships with locus of control (LoC), news information search and the adoption of protective behaviors (PBs) during the first lockdown in France. We first showed the good structural and psychometric qualities of the CoHL scale on a 3-dimensional structure: the Critical dimension, the Extraction/Communicative and the Application/Communicative dimension. We then found that CoHL was associated with the adoption of PBs suggesting that people with higher CoHL tended to adopt more PBs during the first lockdown, regardless of their LoC. However, people with low CoHL would be more likely to adopt PBs if they believe that they may get COVID-19 due to the behavior and health conditions of others (high external LoC). The study has implications for the design of public health campaigns for people with inadequate HL and with a different LoC.

Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models.

BACKGROUND: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. OBJECTIVE: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. METHODS: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine-related information on Twitter. RESULTS: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine-related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. CONCLUSIONS: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media.

Health Literacy, Processing Capacity, Illness Knowledge, and Actionable Memory for Medication Taking in Type 2 Diabetes: Cross-Sectional Analysis.

BACKGROUND: Patient knowledge about the purpose of medications is crucial to ensure safe and correct use, so it is an important index of adherence in patients with chronic illness. OBJECTIVE: We examined how health literacy and its components (processing capacity and knowledge about illness) influence memory for medication purposes. DESIGN: We conducted a cross-sectional study to examine memory for medication purposes in relation to health literacy, processing capacity, and illness knowledge among patients with diabetes in outpatient clinics. PARTICIPANTS: Six hundred seventy-four adults who were diagnosed with type II diabetes mellitus, age 40 years or older, taking 5 or more current medications, native speakers of English, and with glycosylated hemoglobin (HbA1c) of 6.0 or more, were recruited to the study. MAIN MEASURES: We included measures of processing capacity, illness knowledge, health literacy, and actionable memory for medication taking (memory for medication purpose). KEY RESULTS: Results suggested an association between health literacy and both processing capacity and health knowledge, with some evidence that knowledge can compensate for limited processing capacity in order to maintain health literacy. Furthermore, health literacy was associated with memory for medication purposes, with processing capacity and health knowledge partly mediating this association. This pattern of results supports the process-knowledge model of health literacy. CONCLUSIONS: Our findings establish the role of health literacy in medication taking, in relation to broader cognitive abilities and knowledge. Implications for improving the learning of medication purpose among diverse older adults with chronic illness are discussed. TRIAL REGISTRATION: NIH trial registry number: NCT01296633.

A User Study on the Feasibility and Acceptance of Delivering Physical Activity Programs to Older Adults through Conversational Agents.

The implementation of evidence-based physical activity (PA) programs for older adults is limited in part due to the administration-related personnel costs. The rapid growth of the off-the-shelf smart speakers, conversational agents (CAs), demonstrates the potential of scalable delivery of PA programs to older adults at home. We implemented a PA virtual coach based on an evidence-based PA program on a Google Home device, and conducted a user study to examine how older adults interact with the virtual coach. Results suggested that all older adults were able to complete the PA program with guidance from the virtual coach, and showed high acceptance and intentions to use CAs in the future. Analyses on conversation turn-taking further suggested that all older adults (including 80% novice CAs users) experienced minimum difficulty talking with the PA virtual coach. Relationships among age, technology acceptance, conversation patterns and the perceived sociability of CAs are also discussed.

Exploring the role of teams and technology in patients' medication decision making.

OBJECTIVES: We know little about how electronic health records (EHRs) should be designed to help patients, pharmacists, and physicians participate in interprofessional shared decision making. We used a qualitative approach to understand better how patients make decisions with their health care team, how this information influences decision making about their medications, and finally, how this process can be improved through the use of EHRs. DESIGN: Participants from 4 regions across Canada took part in a semistructured interview and completed a brief demographic survey. The interview transcripts were thematically analyzed by means of the multidisciplinary framework method. SETTINGS AND PARTICIPANTS: Thirty participants, 18 years of age and older with at least one chronic illness, were recruited from across Canada. We interviewed participants in their homes, at the school of pharmacy, or another location of their choosing. RESULTS: We identified 4 main themes: (1) complexity of patient decision making: who, where, what, when, why; (2) relationships with physicians and pharmacists: who do I trust for what?; (3) accessing health information for decision making: how much and from where?; and (4) patients' methods of managing information for health decision making. Across the themes, participants appreciated expert advice from professionals and wanted to be informed about all options, despite concerns about limited knowledge. EHRs were perceived as a potential solution to many of the barriers identified. CONCLUSION: Patients make decisions with their health care providers as well as with family and friends. The pharmacist and physicians play different roles in helping patients in making decisions. We found that making EHRs accessible not only to health care providers but also to patients can provide a cohesive and clear context for making medication-related decisions. EHRs may facilitate clear communication, foster interprofessional understanding, and improve patient access to their health information. Future research should examine how to develop EHRs that are adaptive to user needs and desires.

Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study.

BACKGROUND: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. OBJECTIVE: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. METHODS: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. RESULTS: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. CONCLUSIONS: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.

Pharmacy-Based Approach to Improving Heart Failure Medication Use by Older Adults with Limited Health Literacy: Learning from Interdisciplinary Experience.

Heart failure is a chronic disease requiring careful attention to self-care. Patients must follow instructions for diet and medication use to prevent or delay a decline in functional status, quality of life, and expensive care. However, there is considerable heterogeneity in heart failure patients' knowledge of important care routines, their cognition, and their health literacy, which predict the ability to implement self-care. Our interdisciplinary team of cognitive scientists with health literacy expertise, pharmacists, and physicians spent 18 years designing and testing protocols and materials to assist ambulatory heart failure patients with their care. Our approach is theory- as well as problem-driven, guided by our process-knowledge model of health literacy as it relates to self-care among older adult outpatients with either heart failure or hypertension. We used what we had learned from this model to develop a pharmacy-based protocol and tailored patient instruction materials that were the central component of a randomized clinical trial. Our results showed improved adherence to cardiovascular medications, improved health outcomes and patient satisfaction, and direct cost reductions. These results demonstrate the value of our interdisciplinary efforts for developing strategies to improve instruction and communication with attention to health literacy, which are core components of pharmacy and other ambulatory healthcare services. We believe attention to health literacy with medication use will result in improved health outcomes for older adult patients with heart failure and other complex chronic diseases.

A Multi-faceted Approach to Promote Comprehension of Online Health Information Among Older Adults.

Purpose of the Study: Older adults' self-care often depends on understanding and utilizing health information. Inadequate health literacy among older adults poses a barrier to self-care because it hampers comprehension of this information, particularly when the information is not well-designed. Our goal was to improve comprehension of online health information among older adults with hypertension who varied in health literacy abilities. Design and Methods: We identified passages about hypertension self-care from credible websites (typical passages). We used a multi-faceted approach to redesign these passages, revising their content, language, organization and format (revised passages). Older participants read both versions of the passages at their own pace. After each passage, they summarized the passage and then answered questions about the passage. Results: Participants better remembered the revised than the typical passages, summarizing the passages more accurately and uptaking information more efficiently (less reading time needed per unit of information remembered). The benefits for reading efficiency were greater for older adults with more health knowledge, suggesting knowledge facilitated comprehension of information in the revised passages. Implications: A systematic, multi-faceted approach to designing health documents can promote online learning among older adults with diverse health literacy abilities.

Cognition and Health Literacy in Older Adults' Recall of Self-Care Information.

Purpose of the Study: Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods: We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results: Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. Implications: These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.

Adult age differences in information foraging in an interactive reading environment.

When learning about a single topic in natural reading environments, readers are confronted with multiple sources varying in the type and amount of information. In this situation, readers are free to adaptively respond to the constraints of the environment (e.g., through selection of resources and time allocation for study), but there may be costs of exploring and switching between sources (e.g., disruption of attention, opportunity costs for study). From an ecological perspective, such properties of the environment are expected to influence learning strategies. In the current study, we used a novel reading paradigm to investigate age differences in the effects of information richness (i.e., sentence elaboration) and costs of switching between texts (i.e., time delay) on selection of sources and study time allocation. Consistent with the ecological view, participants progressed from less informative to more informative texts. Furthermore, increased switch cost led to a tendency to allocate more effort to easier materials and to greater persistence in reading, which in turn, led to better memory in both immediate and delayed recall. Older adults showed larger effects of switch cost, such that the age difference in delayed recall was eliminated in the high switch cost condition. Based on an ecological paradigm of reading that affords choice and self-regulation, our study provided evidence for preservation with age in the ability to adapt to changing learning environments so as to improve performance. (PsycINFO Database Record

Information Foraging Across the Life Span: Search and Switch in Unknown Patches.

In this study, we used a word search puzzle paradigm to investigate age differences in the rate of information gain (RG; i.e., word gain as a function of time) and the cues used to make patch-departure decisions in information foraging. The likelihood of patch departure increased as the profitability of the patch decreased generally. Both younger and older adults persisted past the point of optimality as defined by the marginal value theorem (Charnov, 1976), which assumes perfect knowledge of the foraging ecology. Nevertheless, there was evidence that adults were rational in terms of being sensitive to the change in RG for making the patch-departure decisions. However, given the limitations in cognitive resources and knowledge about the ecology, the estimation of RG may not be accurate. Younger adults were more likely to leave the puzzle as the long-term RG incrementally decreased, whereas older adults were more likely to leave the puzzle as the local RG decreased. However, older adults with better executive control were more likely to adjust their likelihood of patch-departure decisions to the long-term change in RG. Thus, age-dependent reliance on the long-term or local change in RG to make patch-departure decisions might be due to individual differences in executive control.

Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge.

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60-88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.

Nonreciprocal plasmonics enables giant enhancement of thin-film Faraday rotation.

Light propagation is usually reciprocal. However, a static magnetic field along the propagation direction can break the time-reversal symmetry in the presence of magneto-optical materials. The Faraday effect in magneto-optical materials rotates the polarization plane of light, and when light travels backward the polarization is further rotated. This is applied in optical isolators, which are of crucial importance in optical systems. Faraday isolators are typically bulky due to the weak Faraday effect of available magneto-optical materials. The growing research endeavour in integrated optics demands thin-film Faraday rotators and enhancement of the Faraday effect. Here, we report significant enhancement of Faraday rotation by hybridizing plasmonics with magneto-optics. By fabricating plasmonic nanostructures on laser-deposited magneto-optical thin films, Faraday rotation is enhanced by one order of magnitude in our experiment, while high transparency is maintained. We elucidate the enhanced Faraday effect by the interplay between plasmons and different photonic waveguide modes in our system.

The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures.

We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (S-TOFHLA and REALM). One hundred forty six community-dwelling older adults participated; 103 had been diagnosed with hypertension. The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both of the health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. S-TOFHLA performance reflected processing capacity as well as general knowledge, whereas performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in various health care contexts.

Theoretical and experimental research on designer surface plasmons in a metamaterial with double sets of circular holes.

The designer surface plasmons (DSPs) are studied by the use of a kind of metamaterial with a structure of double sets of circular holes: subwavelength apertures, and indentations. The diameter and spacing of the indentations are smaller at least one order of magnitude than those of the apertures. A theoretical model is built to analyze the DSPs sustained by the indentations by using effective dipoles method. The influence of the DSPs on the transmission property is revealed for electromagnetic waves passing through the apertures. In order to verify the theoretical predication, a set of the metamaterial samples is made and the transmission spectra are measured in microwave regime. Our results provide a new proof for the existence of DSPs and are promising for proposing some techniques for optoelectronic devices in terahertz and microwave regime.

Broadband gradient index microwave quasi-optical elements based on non-resonant metamaterials.

Utilizing non-resonant metamaterial elements, we demonstrate that complex gradient index optics can be constructed exhibiting low material losses and large frequency bandwidth. Although the range of structures is limited to those having only electric response, with an electric permittivity always equal to or greater than unity, there are still numerous metamaterial design possibilities enabled by leveraging the non-resonant elements. For example, a gradient, impedance matching layer can be added that drastically reduces the return loss of the optical elements due to reflection. In microwave experiments, we demonstrate the broadband design concepts with a gradient index lens and a beam-steering element, both of which are confirmed to operate over the entire X-band (roughly 8-12 GHz) frequency spectrum.