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1.
Digit Health ; 10: 20552076241234744, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38559580

RESUMO

An ongoing and heated scientific debate pertains to the conceptualization and quantification of adolescents' problematic smartphone use (PSU). To address the limitations of existing surveys, the smartphone pervasiveness scale for adolescents (SPS-A) has been designed to measure the subjective frequency of smartphone usage during significant moments within daily routines. Given the weak correlations in prior literature between self-reported PSU metrics and objective use data, this study investigates the relationships between diverse self-reported objective metrics of smartphone engagement-that is duration, frequency, and count of notifications-and the SPS-A scale, employing a cohort of Swiss adolescents (N = 1396; Mage = 15.8, SDage = 0.81; 59% female). The findings reveal a substantial correlation between the total objectively measured duration of smartphone engagement and the SPS-A scale (r = .41 for iOS users and r = .42 for Android users). Moreover, a similar trend emerges as users are categorized by their level of objective use, with each category displaying a linear augmentation in smartphone pervasiveness levels. Instead, modest correlations emerge when considering the quantity of device unlocks and notifications. Noteworthy, no gender disparities emerged. These results add to our knowledge about the usefulness of the concept and measurement of smartphone pervasiveness: not only the SPS-A is a valid alternative to scales on "smartphone addiction" to capture non-pathological PSU, but it is also a better predictor of smartphone objective duration of use than self-reported measures. The correlation found between self-reported pervasiveness and actual use is discussed in light of the debate about the relevance of screen time in the study of PSU.

2.
Trends Cogn Sci ; 27(12): 1102-1104, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37838613

RESUMO

Neuroscientific buzzwords, such as 'brain hacks', have become commonplace when discussing social media (SM)-platform engineering. Despite societal debates, few studies have used neuroscientific approaches to validate the claims empirically. We call here for a transformative shift engaging scientists and other stakeholders to address this critical knowledge gap.


Assuntos
Neurociências , Mídias Sociais , Humanos , Encéfalo
3.
J Med Internet Res ; 25: e45540, 2023 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-37725422

RESUMO

BACKGROUND: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals' data. OBJECTIVE: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. METHODS: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. RESULTS: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. CONCLUSIONS: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. TRIAL REGISTRATION: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Adolescente , Criança , Humanos , Adulto Jovem , Lista de Checagem , Saúde Mental , Reprodutibilidade dos Testes , Ensaios Clínicos como Assunto
4.
Front Psychol ; 14: 1092109, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37089739

RESUMO

Background: Several large-scale studies and reviews have reported both negative and positive associations of social media use with well-being, suggesting that the findings are more complex and need more nuanced study. Moreover, there is little or no exploration of how social media use in adolescence influences flourishing, a more all-encompassing construct beyond well-being, including six sub-domains (i.e., happiness, meaning and purpose, physical and mental health, character, close social relationships, and financial stability). This paper aims to fill this gap by understanding how adolescents might flourish through social media activities by fulfilling the basic needs pointed out by the Self-Determination Theory, i.e., relatedness, autonomy, and competence. Methods: The study is drawn on cross-sectional data collected from 1,429 Swiss adolescents (58.8% females, Mage = 15.84, SDage = 0.83) as part of the HappyB project in Spring 2022. Self-reported measures included the Harvard Adolescent Flourishing scale, positive and negative online social experiences, self-disclosure on social media, and social media inspiration. Control variables included, among others, self-esteem, ill-being, and personality. Results: After applying Bonferroni's correction, results of the hierarchical regression analyses showed that positive social media experiences (ß = 0.112, p < 0.001) and social media inspirations from others (ß = 0.072, p < 0.001) and for others (ß = 0.060, p = 0.003) were positively associated with flourishing. Flourishing was inversely associated with negative social media experiences (ß = -0.076, p < 0.001). Among covariates, self-esteem (ß = 0.350, p < 0.001), ill-being (ß = -0.252, p < 0.001), perceived school environment (ß = 0.138, p < 0.001), self-reported level of physical activity (ß =0.109, p < 0.001), and perceived socio-economic status (ß = -0.059, p = 0.001) were all related to flourishing. In contrast, gender, high school year, age, perceived stress, and personality (extraversion and neuroticism) were not. Conclusion: Using a well-being framework to investigate social media use in adolescents is needed to go beyond the ill-being perspective. Our results align with the needs pointed out by the Self-Determination Theory. Carrying out social media activities in a way that promotes-rather than diminishes-flourishing should be included as an additional good habit influencing adolescents' development. We suggest that interventions aiming to foster adolescents' flourishing should include curricula aiming to promote a good use of social media through positive online social relationships and inspirational contents.

5.
Front Psychol ; 14: 1126015, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36968730

RESUMO

In this perspective, we aim to bring together research on mobile assessments and interventions in the context of mental health care in youth. After the COVID-19 pandemic, one out of five young people is experiencing mental health problems worldwide. New ways to face this burden are now needed. Young people search for low-burden services in terms of costs and time, paired with high flexibility and easy accessibility. Mobile applications meet these principles by providing new ways to inform, monitor, educate, and enable self-help, thus reinventing mental health care in youth. In this perspective, we explore the existing literature reviews on mobile assessments and interventions in youth through data collected passively (e.g., digital phenotyping) and actively (e.g., using Ecological Momentary Assessments-EMAs). The richness of such approaches relies on assessing mental health dynamically by extending beyond the confines of traditional methods and diagnostic criteria, and the integration of sensor data from multiple channels, thus allowing the cross-validation of symptoms through multiple information. However, we also acknowledge the promises and pitfalls of such approaches, including the problem of interpreting small effects combined with different data sources and the real benefits in terms of outcome prediction when compared to gold-standard methods. We also explore a new promising and complementary approach, using chatbots and conversational agents, that encourages interaction while tracing health and providing interventions. Finally, we suggest that it is important to continue to move beyond the ill-being framework by giving more importance to intervention fostering well-being, e.g., using positive psychology.

6.
J Med Internet Res ; 25: e36964, 2023 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-36729571

RESUMO

BACKGROUND: Most research on web-based help seeking for mental health problems has focused on the antecedents of this behavior. Therefore, little is known about the outcomes of web-based help seeking in general or in specific mental health issues. OBJECTIVE: This study was a systematic review and meta-analysis of the literature on the antecedents and consequences of web-based help-seeking behaviors for depressive symptoms. METHODS: A systematic literature search was carried out in 6 scientific databases, leading to 48 studies (for a total of 314,921 participants) included in the qualitative synthesis and 19 included in the meta-analysis. RESULTS: The results indicated a positive relationship between depressive symptoms and web-based help-seeking behaviors through online support groups (r=0.089; P=.009), and Generation Z (r=0.102; P=.008) tended to participate in support groups more than previous generations. In addition, web-based help seeking was positively related to empowerment (r=0.245; P=.004). Other forms of support reported included the internet and specific self-help tools, but no significant relationships were found with depressive symptoms. CONCLUSIONS: More studies examining the outcomes are needed, together with a more rigorous assessment of web-based help-seeking behaviors. Ultimately, we propose a summary framework for the literature on this topic, including the antecedents, patterns of use, and outcomes of web-based help seeking in the context of depressive symptoms.


Assuntos
Depressão , Comportamentos Relacionados com a Saúde , Humanos , Depressão/terapia , Internet , Poder Psicológico
7.
Front Psychiatry ; 13: 981881, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36465307

RESUMO

Background: During the COVID-19 lockdown in 2020, adolescents' mental health was largely undermined. A general increment in screen time was reported. However, the long-term effects of the latter on adolescents' mental health are still little explored. Methods: In the present natural experiment, we investigated these effects using longitudinal data collected before and after the first lockdown in Switzerland. Data come from 674 Swiss adolescents (56.7% females, Mage = 14.45, SDage = 0.50) during Spring 2019 (T1) and Autumn 2020 (T2) as part of the longitudinal MEDIATICINO study. Self-reported mental health measures included somatic symptoms, inattention, anxiety, irritability, anger, sleep problems, obsessive-compulsive symptoms, loneliness, and depression. Measures for screen-media activities included time spent on the Internet, smartphones, social media, video gaming, instant messaging, and television viewing. They were all assessed at T1 and T2. Results: Paired-sample t-tests with Bonferroni's correction showed that most mental health problems increased over time with an overall medium effect size (Hedge's g = 0.337). In particular, medium effect sizes were found for anxiety, depression, and inattention; small-to-medium effect sizes were reported for loneliness, sleep problems, and obsessive-compulsive symptoms; and a small effect size was found for somatic symptoms. Screen-media activities increased, with the exception of television viewing and video gaming. The results of the hierarchical regression analyses showed that, controlling for covariates, increased time spent on social media - calculated as the difference between T2 and T1 - was the only screen-media activity significantly associated with worse mental health at T2 (ß = 0.112, p = 0.016). More time spent in structured media activities like television viewing diminished levels of inattention (ß = -0.091, p = 0.021) and anxiety (ß = -0.093, p = 0.014). Among covariates, being female, experiencing two or more life events, having mental health problems at T1, and using screens for homeschooling negatively influenced mental health at T2. Conclusion: These results align with literature indicating a small but negative effect of social media time on mental health. Underlying mechanisms are manifold, including increased exposure to COVID-19 news, heightened fear of missing out, social comparison, and time-displaced for activities such as physical activity and green time. However, in line with the structured days hypothesis, getting involved in media-structured activities like television viewing might protect against mental health symptoms.

8.
Int J Public Health ; 67: 1604978, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36158782

RESUMO

Objectives: To describe changes in adherence to recommendations for physical activity (PA), screen time (ST), and sleep duration over the first two waves of the pandemic in Switzerland, and to assess the associations of these lifestyle behaviours with life satisfaction and overall health as well-being indicators. Methods: In this observational study, we included 2,534 participants (5-16 years) from four Swiss cantons. Participants, or their parents, completed repeated questionnaires and reported on their (child's) lifestyle and well-being, between June 2020 and April 2021. We used linear and logistic regression models to assess the associations between lifestyle and well-being. Results: The percentage of children meeting the recommendations for PA and ST decreased from the pre-pandemic period to the first wave, with a slight recovery during the second wave. Participants meeting all three recommendations during the second wave were more likely to report excellent health (OR: 1.65 [95% CI: 1.00-2.76]) and higher life satisfaction (ß: 0.46 [0.16-0.77]) in early 2021 than participants not meeting any recommendation. Conclusion: We showed a substantial impact of the COVID-19 pandemic on children's and adolescents' lifestyle, and a positive association between meeting lifestyle recommendations and well-being.


Assuntos
COVID-19 , Pandemias , Adolescente , COVID-19/epidemiologia , Criança , Humanos , Estilo de Vida , Sono , Suíça/epidemiologia
9.
Comput Hum Behav Rep ; 7: 100204, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35611352

RESUMO

The COVID-19 pandemic has affected the life of children and adolescents in an unprecedented way. In the present study, we focused on two activities that have been likely affected by mitigation measures: screen time and green time. We investigated how both influenced each other during the pandemic, how they affected children's and adolescents' mental health, and which role socio-demographic characteristics have in predicting screen time, green time, and mental health. We used data collected between autumn 2020 and spring 2021 from 844 participants aged 5 to 19 of a population-based, prospective cohort study in Canton Ticino, Italian-speaking Switzerland. We analyzed the data using an extended version of the Random Intercept Cross-Lagged Panel Model with time-invariant socio-demographic covariates and mental health as outcome. Results showed that, at the between-person level, screen time was a risk factor and green time a protective factor of mental health. However, within-person deviations of screen time and green time during the pandemic did not consistently predict mental health. Furthermore, they did not influence each other over time. Gender, age, perceived economic situation of the family, Body Mass Index and the availability of green space nearby all influenced stable measures of green time and screen time (i.e., random intercepts). Our results highlight the need for targeted actions to promote green time and raise awareness about the detrimental effect of screen time on children's and adolescents' mental health.

10.
Front Psychol ; 13: 840845, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444584

RESUMO

Instant messaging (IM) is a highly diffused form of communication among younger populations, yet little is known about the emotional experience during IM. The present study aimed to investigate the emotional experience during IM by drawing on the Circumplex Model of Affect and measuring heart rate and electrodermal activity as indicators of arousal in addition to self-reported perceived emotional valence. Using an experimental design, we manipulated message latency (i.e., response after 1 min versus 7 min) and message valence (positive versus negative response). Based on data collected from 65 young adults (50% male; M age = 23.28, SD = 3.75), we observed arousal as participants' electrodermal activity levels increased from the time a fictitious peer started typing a response to the receipt of that response, especially in the delayed condition. Electrodermal activity levels also increased in both the positive and the negative message conditions. No changes were observed for heart rate. Participants' self-report perceived emotional valence revealed that positive messages were evaluated as more pleasant and the peer as more available, while no difference in the self-report was found for message latency. These findings shed light on the emotional experience during IM by adding valuable insights on the physiological processes underlying the anticipation of social reward, but only during delayed IM exchange that can be observed in Human-Computer-Interaction.

11.
PLoS One ; 17(2): e0263815, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35180248

RESUMO

Problematic smartphone use (PSU) during adolescence has been associated with negative short- and long-term consequences for personal well-being and development. Valid and reliable predictors and indicators of PSU are urgently needed, and digital trace data can add valuable information beyond self-report data. The present study aimed to investigate whether trace data (duration and frequency of smartphone use), recorded via an app installed on participants' smartphone, are correlated with self-report data on smartphone use. Additionally, the present study aimed to explore which usage indicators, i.e., duration, frequency, and time distortion of smartphone use, better predict PSU levels cross-sectionally and longitudinally, one year later. Results from a sample of 84 adolescents showed that adolescents tend to rely on the frequency of smartphone use when reporting on the time they spent with the smartphone. Traced duration of smartphone use as well as time distortion, i.e., over-estimation, are significant predictors of PSU. Methodological issues and theoretical implications related to predictors and indicators of PSU are discussed.


Assuntos
Comportamento do Adolescente , Transtorno de Adição à Internet/epidemiologia , Adolescente , Feminino , Humanos , Transtorno de Adição à Internet/psicologia , Masculino , Fatores de Risco
12.
Sci Rep ; 12(1): 1316, 2022 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-35079056

RESUMO

Well-being and smartphone use are thought to influence each other. However, previous studies mainly focused on one direction (looking at the effects of smartphone use on well-being) and considered between-person effects, with self-reported measures of smartphone use. By using 2548 assessments of well-being and trace data of smartphone use collected for 45 consecutive days in 82 adolescent participants (Mage = 13.47, SDage = 1.62, 54% females), the present study disentangled the reciprocal and individual dynamics of well-being and smartphone use. Hierarchical Bayesian Continuous Time Dynamic Models were used to estimate how a change in frequency and duration of smartphone use predicted a later change in well-being, and vice versa. Results revealed that (i) when participants used the smartphone frequently and for a longer period, they also reported higher levels of well-being; (ii) well-being positively predicted subsequent duration of smartphone use; (iii) usage patterns and system dynamics showed heterogeneity, with many subjects showing reciprocal effects close to zero; finally, (iv) changes in well-being tend to persist longer than changes in the frequency and duration of smartphone use.


Assuntos
Comportamento do Adolescente/psicologia , Saúde do Adolescente , Transtorno de Adição à Internet/psicologia , Modelos Estatísticos , Tempo de Tela , Smartphone , Adolescente , Teorema de Bayes , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pais/psicologia , Autorrelato
13.
Front Psychol ; 12: 671817, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34512437

RESUMO

The widespread diffusion of screen-based devices in adolescence has fueled a debate about the beneficial and detrimental effects on adolescents' well-being and development. With the aim of summarizing the existing literature on the associations between screen time (including Internet-related addictions) and adolescent brain development, the present scoping review summarized evidence from 16 task-unrelated and task-related neuroimaging studies, published between 2010 and 2020. Results highlight three important key messages: (i) a frequent and longer duration of screen-based media consumption (including Internet-related addictive behaviors) is related to a less efficient cognitive control system in adolescence, including areas of the Default Mode Network and the Central Executive Network; (ii) online activities act as strong rewards to the brain and repeated screen time augments the tendency to seek short-term gratifications; and (iii) neuroscientific research on the correlates between screen time and adolescent brain development is still at the beginning and in urgent need for further evidence, especially on the underlying causality mechanisms. Methodological, theoretical, and conceptual implications are discussed.

14.
Artigo em Inglês | MEDLINE | ID: mdl-33801510

RESUMO

BACKGROUND: The pervasiveness of smartphones has raised concerns about an increase in the prevalence of problematic smartphone use (PSU), which depends on a set of psychological and behavioral risk factors. Previous research has yielded mixed results on factors predicting PSU, including social anxiety and trust. In particular, the role of trust remained largely unexplored. In the present study, we aimed to investigate the relationship between social anxiety and PSU, via the mediating role of time spent on the phone, and to explore the moderating role of dispositional trust toward others, by using a moderated mediation model with PSU as the outcome. METHODS: A total of 240 young adults (Mage = 23.33, SD = 3.90, 50% male) answered an online questionnaire, which included the 12-item Social Anxiety Scale, a question on the daily duration of smartphone use, a single-item measure of dispositional trust, and the 10-item Smartphone Addiction Scale Short Version. Gender and occupational status were included as covariates. RESULTS: Social anxiety was significantly and positively related to PSU; however, smartphone use did not mediate this relationship. Although the relationship between smartphone use and PSU was significant and positive, the link between social anxiety and smartphone use was not. Dispositional trust moderated and strengthened the direct relationships between social anxiety and PSU as well as smartphone use and PSU. CONCLUSIONS: Heavy smartphone users as well as socially anxious individuals, with the tendency of trusting others, are more at risk of PSU, which can be explained by their preference and search for online connections.


Assuntos
Comportamento Aditivo , Smartphone , Adulto , Ansiedade/epidemiologia , Medo , Feminino , Humanos , Masculino , Confiança , Adulto Jovem
15.
Front Public Health ; 9: 793868, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35186872

RESUMO

The Covid-19 physical distancing measures had a detrimental effect on adolescents' mental health. Adolescents worldwide alleviated the negative experiences of social distancing by spending more time on digital devices. Through a systematic literature search in eight academic databases (including Eric, Proquest Sociology, Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, Pubmed, and Web of Science), the present systematic review and meta-analysis first summarized the existing evidence from 30 studies, published up to September 2021, on the link between mental health and digital media use in adolescents during Covid-19. Digital media use measures included social media, screen time, and digital media addiction. Mental health measures were grouped into conceptually similar dimensions, such as well-being, ill-being, social well-being, lifestyle habits, and Covid-19-related stress. Results showed that, although most studies reported a positive association between ill-being and social media use (r = 0.171, p = 0.011) and ill-being and media addiction (r = 0.434, p = 0.024), not all types of digital media use had adverse consequences on adolescents' mental health. In particular, one-to-one communication, self-disclosure in the context of mutual online friendship, as well as positive and funny online experiences mitigated feelings of loneliness and stress. Hence, these positive aspects of online activities should be promoted. At the same time, awareness of the detrimental effects of addictive digital media use should be raised: That would include making adolescents more aware of adverse mechanisms such as social comparison, fear of missing out, and exposure to negative contents, which were more likely to happen during social isolation and confinement due to the pandemic.


Assuntos
COVID-19 , Pandemias , Adolescente , Humanos , Internet , Saúde Mental , SARS-CoV-2
16.
PLoS One ; 15(9): e0237846, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941439

RESUMO

Nowadays, smartphone-Mediated Communication (SMC) has become a popular form of social interactions. The present experimental study manipulated three aspects of messaging in a WhatsApp chat as a form of SMC: synchronicity (immediate vs. time-lagged response), modality (with or without emojis), and valence (empathic accurate vs. empathic inaccurate response). The aim of this study was to investigate whether these three aspects had an impact on perceived social support, interpersonal trust, and personality attribution of the communication partner. The partial mediation of perceived social presence (the evaluation of the communication partner's accessibility) and subjective social presence (the perception of being concordant with him/her) was also examined. Participants were 160 young adults, balanced in gender. They were randomly assigned to different the experimental conditions where they engaged in a manipulated WhatsApp chat with a fictitious same-gender communication partner. Post-questionnaire data were analyzed using Structural Equation Modeling. Message valence (empathic accurate response) and modality (with emojis) significantly predicted higher levels of both forms of social presence. Synchronicity (immediate response) predicted higher levels of perceived but not subjective social presence. Social presence, in turn, was positively associated with social support, while subjective, but not perceived social presence, was positively associated with personality attribution. Neither perceived nor subjective social presence were related to interpersonal trust. Our results show that both what is said and how it is said impact the experience of interpersonal relations in SMC.


Assuntos
Comunicação , Smartphone , Envio de Mensagens de Texto , Adulto , Feminino , Humanos , Relações Interpessoais , Masculino , Modelos Teóricos , Personalidade , Apoio Social , Confiança
17.
J Gen Intern Med ; 34(6): 1007-1017, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30877457

RESUMO

BACKGROUND: Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES: Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. METHODS: Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS: The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION: Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Índice Glicêmico/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/métodos , Autocuidado/métodos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Letramento em Saúde/tendências , Humanos , Autocuidado/tendências
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