Copenhagen Diabetes Consensus (CODIAC) 2021: User involvement in diabetes care, prevention and research.

AIMS: User involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices. METHODS: A literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings. RESULTS: The literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes. CONCLUSIONS: User involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs.

Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review.

BACKGROUND: Though still a young field of research, gamified digital interventions have demonstrated potential in exerting a favourable impact on health and overall well-being. With the increasing use of the internet and digital devices, the integration of game elements presents novel opportunities for preventing mental disorders and enhancing mental health. Hence, this review aims to assess the effectiveness of gamified interventions focusing on preventing mental disorders or promoting mental health among adults. METHODS: Based on a scoping review across four databases (MEDLINE, Embase, PsycInfo and Web of Science), 7,953 studies were initially identified. After removing duplicates and screening titles, abstracts and full texts, 16 studies were identified as suitable for inclusion in a narrative synthesis of findings. We included interventional studies encompassing an intervention and a control group aiming to investigate the effectiveness of the use of gamified digital mental health interventions and the use of gamified digital elements. RESULTS: Overall, positive effects of gamified interventions on mental health-related outcomes were identified. In particular, beneficial consequences for psychological well-being and depressive symptoms were observed in all studies. However, further outcomes, such as resilience, anxiety, stress or satisfaction with life, showed heterogenous findings. Most game elements used were reward, sensation and progress, whilst the quantity of elements was not consistent and, therefore, no substantiated conclusion regarding the (optimal) quantity or composition of game elements can be drawn. Further, the outcomes, measurements and analyses differed greatly between the 16 included studies making comparisons difficult. CONCLUSION: In summary, this review demonstrates the potential of integrating digital game elements on mental health and well-being with still a great gap of research. A taxonomy is needed to adequately address relevant game elements in the field of mental health promotion and prevention of mental disorders. Therefore, future studies should explicitly focus on the mechanisms of effect and apply rigorous study designs.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Coronavirus-related health literacy levels among school administrators and influencing factors.

Our study aimed to determine the level of coronavirus-related health literacy among school administrators and the factors that influence this. The sample of this cross-sectional study consisted of 402 school administrators serving in primary, secondary and high schools in Ankara. The data were collected between September 2021 and February 2022 using the descriptive characteristics questionnaire and the Coronavirus-Related Health Literacy Questionnaire (HLS-COVID-Q22). It was seen that 64.4% of the participants were male, 34.6% were 40 years old or younger and 35.6% were working in primary schools; 77.6% of the participants had a sufficient, 16.2% had a problematic and 6.2% had an inadequate level of coronavirus-related health literacy. Age, gender, chronic disease status, type of school they work in, level of knowledge about coronavirus, level of confusion due to knowledge about coronavirus, willingness to be vaccinated, believing that vaccines are safe/effective/compatible with their religious beliefs were found to affect coronavirus-related health literacy (p < 0.05). Gender, age, information satisfaction on coronavirus, confusion due to information on coronavirus and 'Overall, I believe that vaccinations are effective' explained 24.9% of HLS-COVID-Q22 variance (Adjusted R2 = 0.249, F = 13.080, p < 0.001). This study found the coronavirus-related health literacy level among school administrators to be sufficient. It found that their level of health literacy was affected by gender, age, chronic disease status, type of school they worked at, level of knowledge about coronavirus, level of confusion due to information about coronavirus, desire to be vaccinated and their thoughts about vaccines.

Online health information-seeking behaviour and mental well-being among Finnish higher education students during COVID-19.

Online health information-seeking behaviour has increased since the World Health Organization declared COVID-19 a global pandemic in March 2020. This study examined whether health-related information on COVID-19 searched on the internet was associated with mental well-being among higher education students. A cross-sectional internet survey was conducted among 18- to 34-year-old students in Finland (N = 2976; mean age 24.61 years and median 24) in the spring of 2020. The data were analysed using descriptive statistics, Pearson's chi-square tests, Kruskal-Wallis nonparametric H tests, and a two-way ANOVA. The results indicated that most students (86% of females, 82% of males) used the internet to search for information on COVID-19. Students' self-perceived abilities to determine the relevance of online information on COVID-19 were associated with mental well-being.

Gender differences in sense of coherence among university students during the COVID-19 pandemic in Turkey.

Non-pharmaceutical interventions (NPIs) implemented to mitigate the COVID-19 pandemic halted everyday life in higher education along with social and psychological impacts. The objective of our study was to explore the factors related to sense of coherence (SoC) from a gender perspective among university students in Turkey. This is a cross-sectional survey conducted online with a convenience sampling method as part of the international COVID-Health Literacy (COVID-HL) Consortium. SoC was measured by a nine-item questionnaire that was adapted to the Turkish language, including socio-demographic information and health status, including psychological well-being, psychosomatic complaints, and future anxiety (FA). 1595 students from four universities, of whom 72% were female, participated in the study. Cronbach's alpha for the SoC scale was 0.75. Based on the median split of the individual scores, levels of SoC showed no statistically significant difference according to gender. Logistic regression analysis indicated that higher SoC was associated with medium and high subjective social status, studying in private universities, high psychological well-being, low FA, and none/one psychosomatic complaint. While results were similar among female students, type of university and psychological well-being showed no statistically significant association with SoC among males. Our results indicate that structural (subjective social status) and contextual (type of university) factors, along with gender-based variations, are associated with SoC among university students in Turkey.

[Prevention perspective: mental health of schoolchildren in Germany]. / Perspektive Prävention: Psychische Gesundheit von Schülerinnen und Schülern in Deutschland.

BACKGROUND: The COVID-19 pandemic has impacted the learning and health of children and adolescents. The aim of this paper is to examine school students' mental health problems, family burden, and support needs during the pandemic depending on the type of school. Approaches to school-based prevention and health promotion are discussed. METHODS: Findings are based on data from the population-based COPSY study (T1: 05/2020 - T4: 02/2022) and the BELLA study (T0, pre-pandemic comparison). Approximately 1600 families with children aged 7 to 19 years were surveyed at each measurement point (T). Mental health problems were assessed using the SDQ, while family burden and support needs were captured with individual items in the parent report. RESULTS: Mental health problems increased among students in all school types at the beginning of the pandemic and have stabilized at a high level. Elementary school students are particularly affected (increase from 16.9% pre-pandemic to 40.0% at T2), especially in behavioral problems (11.7% to 24.6%) and hyperactivity (13.9% to 34.0%). Secondary school students also show higher levels of mental health problems (21.4% to 30.4%). Pandemic-related burden is consistently high, as is the need for family support received from schools/teachers and experts. DISCUSSION: There is a high need for mental health promotion and prevention measures in the school setting. These should start at primary school age in the sense of a "whole school approach" at different levels and include external stakeholders. In addition, binding legal requirements are needed in all federal states to create framework conditions and structures for school-based health promotion and prevention, including access to necessary resources.

University students' experience of the Beirut port explosion: associations with subjective well-being and subjective symptoms of mental strain.

BACKGROUND: On 4 August 2020, an explosion shook Beirut, killing more than 200 people and leaving thousands injured or homeless. AIMS: This study examined mental health of university students through a cross-sectional online survey between December 2020 and January 2021. METHODS: The questionnaire consisted of the WHO-5, sense of coherence (SoC), future anxiety, self-developed subjective symptoms of mental strain (SSMS), and items assessing proximity to explosion, extent of injury and house damage. Gender, study level and social status were used as sociodemographic characteristics. RESULTS: Of 1042 participants, 30.8% were at 0-7 km from explosion; 38.1% reported physical injuries; and 12.4% saw their home damaged. Two third (60.3%) reported ≥3 SSMS, and 73.4% reported low well-being. Students with low well-being were more often female and master students (p < 0.001). Females were more often affected by ≥3 SSMS (p < 0.001). Regression analysis with low well-being as dependent variable revealed significant associations with study level (OR: 2.30-2.94), future anxiety (OR: 2.72-4.34) and SoC (OR: 1.81-5.61). For ≥3 SSMS, females (OR: 3.09), moderate/very close distance (OR: 2.13-4.98), injury/death of family member or friend (OR: 2.07-2.06), house damage (OR: 1.72) future anxiety (OR: 1.97-3.11) and SoC (1.79-2.88) were significant predictors. DISCUSSION: Preventive mental health strategies that strengthen SoC and outlook on future could protect against SSMS and low well-being following major trauma.

Health promoting schools and COVID-19: preparing for the future.

We face an unprecedented period of history during which COVID-19 is clustered with other global conditions, such as obesity, undernutrition, an infodemic, and climate change. This syndemic (synergy of epidemics) calls for the development of children's and youth's health literacy and socioemotional skills, support for behavioural hygiene (e.g. washing hands, wearing masks), and adults' responsibility and caring. Moreover, it calls for creating conditions for healthy living and learning for all and paying extra attention to inequalities that have increased during the pandemic. Today, more than ever, there is an essential demand for schools to create environments that maintain and promote health for all. Within this commentary, we argue that whole-school approaches, such as the health promoting school, are essential to fight against the pandemic and to prepare schools for future challenges.

Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic.

BACKGROUND: This study investigates university students' digital health literacy and web-based information-seeking behaviours during the early stages of the COVID-19 pandemic in England. It compares undergraduate and postgraduate students in non-health related subjects with health care students, many of whom were preparing for, or working in, frontline roles. The survey was conducted as part of a wider study by the COVID-HL research consortium. METHODS: A cross-sectional study was conducted among n = 691 university students aged ≥18 years from 25 universities across England using an adapted digital survey developed by COVID-HL. Data were collected regarding sociodemographic characteristics and specific measures drawn from the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI). These had been adapted for use in an English setting and to the specific context of the COVID-19 pandemic. Other data collected included students' anxiety or worries about the future using the Dark Future Scale as well as behaviours in online information-seeking. Data were analysed using correlations to test for relationships between constructs and also between group comparisons to test for differences between students studying health and non-health related subjects. RESULTS: Across digital health literacy dimensions, there was no significant difference between students studying health-related subjects and other students. Health care students did report greater difficulties in relation to how to behave online. They also relied less on public body sources for information about the pandemic. A significant difference was found between the two student populations in relation to their anxiety about the future with health care students reporting fewer fears about the future. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with evaluating online information which may frustrate public health efforts. This could be addressed by ensuring health students' curriculum in particular encompasses digital health literacy.

Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis.

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (ß=-0.13, p < 0.05) and SOC (ß=-0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (ß = 0.34, p < 0.01) and DHL (ß = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (ß= -0.11, p = 0.004) and financial satisfaction (ß= -0.12, p = 0.004) on anxiety of older adults.Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

University students' sense of coherence, future worries and mental health: findings from the German COVID-HL-survey.

Early-on in the COVID-19 pandemic when universities were closed as part of the nation-wide public health response to the COVID-19 outbreak, studying and student life significantly changed. Based on limited evidence the aim of this study was to explore the relationship between sense of coherence (SoC), future worries and mental health outcomes among German university students during the early phase of the pandemic. A cross-sectional online survey with n = 14 916 participants was carried out by inviting all private and public universities in Germany. All data were analysed using univariate, bivariate and multivariate statistics. Findings indicate a low and very low wellbeing for 38% of university students. Moreover, 29% reported being affected by at least two health complaints more than once week. Both health outcomes follow a social gradient and could be more frequently observed for respondents with lower subjective social status and female students. Regression analysis revealed significant association between the SoC dimensions and wellbeing (OR: 1.2-2.03) as well as health complaints (OR: 1.58-1.71). A high level of future worries was associated with low/very low wellbeing (OR: 2.83) and multiple health complaints (OR: 2.84). Based on the results, the public health response to the pandemic and university health promotion should therefore consider student mental health as an important target within their policy and action frameworks.

Adaptation and validation of the Digital Health Literacy Instrument for Portuguese university students.

BACKGROUND: Health literacy is an important skill to deal with information and positively influences individual and community health. Information concerning health is available from a plethora of online resources. The concept of digital health literacy has gained prominence with the pandemic. The absence of valid tools to analyse digital literacy levels are scant. This study aims to translate, adapt and validate the Portuguese version of the Digital Health Literacy Instrument (DHLI) as used in the global COVID-HL Network. METHODS: Participants were mostly students from social sciences, psychology, education and health sciences. The Portuguese version of the DHLI contained five dimensions each consisting of three items. An online survey with university students (n = 1815, 75.1% female, average age: 24.15 years) was administered to test the validity of the Portuguese version of the DHLI. Data were analysed using exploratory and confirmatory factor analysis. Pearson correlations were also studied. RESULTS: Two items revealed symmetry and kurtosis problems. We chose to eliminate them from the analysis. Different exploratory factor analysis attempts were made, obtaining two possible models to be tested in the confirmatory factor analysis: a three-factor model and a four-factor model. A four-factor structure of the instrument (information searching, adding self-generated content, evaluating reliability, determining relevance) was supported by confirmatory factor analysis and had good internal consistency. CONCLUSIONS: The Portuguese version of the Digital Health Literacy Instrument met adequate psychometric criteria. Therefore, it can be confidently used in Portuguese students' assessment of digital health literacy. Representative studies are needed to shed light on different target groups and their COVID-19-related DHLI.

[School health promotion in pandemic times. Results of the COVID-HL school principal study]. / Schulische Gesundheitsförderung in pandemischen Zeiten. Ergebnisse der COVID-HL-Schulleitungsstudie.

BACKGROUND: This study examines the extent to which schools implement activities on health promotion and prevention during the COVID-19 pandemic. Moreover, potential differences with regard to demographic variables, school type, state, and participation in state health promotion initiatives are determined. METHODS: As part of the international COVID Health Literacy Network, an online-based study was conducted from March to April 2021 with 2186 school principals from the German federal states of Baden-Württemberg, Hesse, Lower Saxony, and North Rhine-Westphalia. The implementation status of COVID-19-related school health promotion was assessed using a self-developed instrument. After examining the factorial structure of the instrument, univariate and bivariate data analyses were performed. RESULTS: Three dimensions of implementing school health promotion can be identified: (1) COVID-19-related support for pupils, (2) health promoting design of teaching, learning, and working conditions, and (3) the principles of Health Promoting Schools. A low level of implementation is observed for aspects of teaching, learning, and working conditions as well as for participation and cooperation with community stakeholders. Significant differences are observed, with female, older, and primary school principals reporting a higher implementation status, while for federal states non-homogenous differences are found. Stratified by participation in state health promotion initiatives, only schools with a certificate in health promotion show a higher level of implementation. DISCUSSION: The results indicate that the COVID-19 pandemic is a disruptive event for schools, impeding the implementation of holistic activities on health promotion and prevention. In particular, more attention should be given to the creation of health promoting working conditions, participation, and community cooperation.

[The relevance of networking in school health promotion]. / Die Relevanz von Netzwerkarbeit in der schulischen Gesundheitsförderung.

School is one of the most important places to start promoting the health of children and young people, partly because pupils spend a large part of their time here. However, school can only be partially dedicated to health promotion, and school itself is only part of the everyday environment by which health behaviour is shaped. In order to increase the effectiveness of health promotion, the formation of networks between school and municipal actors such as sports clubs, youth welfare services, counselling centres and health authorities seems to make sense.This article addresses the question of the relevance of networks in the context of school health promotion. The derivation is on the one hand based on the legal framework of the educational mandate of schools and the so-called Prevention Act of 2015 and on the other hand on the Ottawa Charter of the World Health Organization (WHO) as well as on the discourse developed from it around the terms "health promotion" and "setting approach". Perspectives are shown on how networks can be designed in a scientifically sound way and how suitable network partners can be won. Possible risks and opportunities of networking are analysed, and factors of success and failure are pointed out.Networking should be obligatory for schools in terms of health promotion. It can help identify needs within the school and at the same time be a key in dealing with resulting challenges. Networking requires above all the motivation of the actors. A common vision, fixed structures, continuity and appropriate personnel considerations contribute to the success of the cooperation.

[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior]. / Digitale Gesundheitskompetenz von Schülerinnen und Schülern. Ausprägung und Assoziationen mit dem Bewegungs- und Ernährungsverhalten.

BACKGROUND: While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior. METHODS: A cross-sectional study of 490 students from grade eight and nine from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, and soft drinks as well as weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS. RESULTS: Across all items, 15.3 to 37.5% of adolescents reported difficulties in acquiring and dealing with digital health information. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showed a limited digital HL. Adolescents with moderate and low digital HL reported higher levels of low physical activity and non-daily fruit and daily soft drink consumption. DISCUSSION: The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions. The school as a place of teaching and learning is a suitable setting because, among other things, of its fit with the mandatory strategy of media literacy education in schools.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. OBJECTIVE: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. METHODS: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. RESULTS: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

Are People With Chronic Diseases Satisfied With the Online Health Information Related to COVID-19 During the Pandemic?

PURPOSE: A deluge of fake news and misinformation about the coronavirus disease 2019 (COVID-19) on the Internet poses challenges for the public in their search for reliable and relevant health information for taking protective measures, especially among people with chronic diseases (PWCD). This study aimed to (a) understand the satisfaction level of the online information related to COVID-19 in people with and without chronic diseases; (b) explore information-searching behavior and digital health literacy in PWCD; and (3) identify the possible predictors of information satisfaction among PWCD. METHODS: This was a multicity, cross-sectional study using an online survey with a convenience sample of people who (a) were 15 years of age or older and (b) had access to the Internet in mainland China, Hong Kong, and Macau. FINDINGS: Four thousand four hundred and seventy-two subjects completed the survey, of whom less than 50% felt satisfied with the online information. About 20% of respondents (n = 882) were diagnosed with at least one chronic disease and reported a lower level of information satisfaction (p = .003) than the people without chronic diseases. The majority of the PWCD obtained their online health information from social media. Higher digital health literacy (adjusted odds ratio [OR] = 5.07), higher frequency of searches regarding symptoms of COVID-19 (adjusted OR = 2.07), higher perceived importance of quickly learning from the information searched (adjusted OR = 1.63), and lower frequency of searches on the topic of dealing with psychological stress (adjusted OR = 0.54) were found to be predictors of information satisfaction among PWCD. CONCLUSIONS: The majority of PWCD sought online information related to COVID-19 from social media, and their level of information satisfaction was significantly lower than among people without chronic diseases. Digital health literacy is a strong and significant predictor of information satisfaction. CLINICAL RELEVANCE: To support PWCD, we not only have to provide them with clear and accurate information, but also promote their digital health literacy so that they may seek, understand, and appraise health information from the Internet to make appropriate health-related judgments and decisions.

[Mental Health of Children and Adolescents with and without Disabilities and Health-related Impairment: Results of the Representative German Child and Adolescent Health Survey (KiGGS Wave 2)]. / Psychische Gesundheit von Kindern und Jugendlichen mit und ohne Behinderung und krankheitsbedingter Einschränkung: Ergebnisse der repräsentativen Kinder- und Jugendgesundheitsstudie (KiGGS Welle 2).

BACKGROUND AND OBJECTIVE: Children and adolescents with disabilities and health-related impairment belong to a vulnerable population group. There are only few German findings on mental health that distinguish between children and adolescents with and without disabilities and health-related impairment. MATERIALS AND METHODS: Data were used from the German KiGGS Wave 2 of the Robert Koch-Institute from 2014-2017. A total of 11,830 children and adolescents aged 3-17 years were included using the parent perspective and 5,222 children and adolescents between 11-17 years using their self-assessments. Mental health outcomes were mental health problems (SDQ, parental assessment) and health-related quality of life (kidscreen, self-assessment). Univariate and bivariate analyses were conducted using cross-tables with Chi square tests and multivariate analyses using binary logistic regression models. RESULTS: In 16.5% of children aged 3-17 years, parents reported mental health problems; 48.4% of the interviewed children and adolescents aged 11-17 years reported a low health-related quality of life. Children with disabilities and health-related impairment had a significantly higher probability of mental health problems (OR: 5.11) and a low health-related quality of life (OR: 1.50). CONCLUSION: The findings suggest a need for action to strengthen mental health in children and adolescents with disabilities and/or health-related impairment. In this context, the educational settings of kindergarten and school are of great importance.

[Health Literacy: Germany in the Digital Race to Catch Up Introduction of Technological Innovations is not Sufficient]. / Gesundheitskompetenz: Deutschland in der digitalen Aufholjagd Einführung technologischer Innovationen greift zu kurz.

Recently, several acts have been passed by the German Ministry of Health to drive the digital transformation of the healthcare system. These aim at far-reaching innovations to improve care and increase the efficiency of the healthcare system. At the same time, the demands on users in dealing with digital applications and information are increasing. Digital health literacy is thus becoming particularly relevant. However, available studies show that the digital health literacy of the population in Germany is often limited. This paper explores challenges, gaps, and prospects regarding the implementation of these new digital health policies, particularly in terms of the implications for improving digital health literacy and increasing user involvement and participation by providing six major aspects that should be considered.