Perceived and performed electronic health literacy of medical sciences students.

BACKGROUND: Evidence indicates that perceived skills for searching the Internet for health information may differ from actual skills in searching, finding, and appraising health information. OBJECTIVES: This study investigated the perceived and performed eHealth literacy of medical sciences students, as well as the relationships between those literacies. METHODS: This study enrolled 228 medical sciences students (convenience sample) in Iran. The study tools include the eHEALS literacy scale for the perceived eHealth literacy and a questionnaire designed by the authors to assess performed eHealth literacy (skills around access, understanding, appraising, applying, and generating information). Data were analysed using descriptive statistics and the Pearson correlation coefficient. RESULTS: In general, over 70% of students perceived their skills of access and appraisal as good/very good, correlating with their estimated performance. Students perceived they were less confident in some appraisal skills (e.g., using information from the Internet to make health decisions) than others. Performed skills in information generation were mostly poor or very good; performed application skills generally good/very good. CONCLUSIONS: The eHEALS score scales with actual skills (access and appraisal). Support is necessary for students in particular types of appraisal skills.

Evaluation of the Psychometric Properties of the Arab Compulsive Internet Use Scale (CIUS) by Item Response Theory Modeling (IRT).

INTRODUCTION: The psychometric properties of the Arab translation of the Compulsive Internet Use Scale (CIUS) have been previously studied by confirmatory factor analysis (CFA) with AMOS software using the asymptotically distribution-free (ADF) estimator. Unidimensionality has been achieved at the cost of correlating several item variance errors. However, several reviews of SEM software packages and estimation methods indicate that the option of robust standard errors is not present in the AMOS package and that ADF estimation may yield biased parameter estimates. We therefore explored a second analysis through item response theory (IRT) using the parametric graded response model (GRM) and the marginal maximum likelihood (MML) estimation method embedded in the LTM package of R software. Differential item functioning (DIF) or item bias across subpopulations was also explored within IRT framework as different samples were investigated. The objective of the current study is to (1) analyze the Arab CIUS scale with IRT, (2) investigate DIF in three samples, and (3) contribute to the ongoing debate on Internet-use-related addictive behaviors using the CIUS items as a proxy. METHODS: We assessed three samples of people, one in Algeria and two in Lebanon, with a total of 1520 participants. RESULTS: Almost three out of every five items were highly related to the latent construct. However, the unidimensionality hypothesis was not supported. Furthermore, besides being locally dependent, the scale may be weakened by DIF across geographic regions. Some of the CIUS items related to increasing priority, impaired control, continued use despite harm, and functional impairment as well as withdrawal and coping showed good discriminative capabilities. Those items were endorsed more frequently than other CIUS items in people with higher levels of addictive Internet use. CONCLUSIONS: Contrary to earlier ADF estimation findings, unidimensionality of the CIUS scale was not supported by IRT parametric GRM in a large sample of Arab speaking participants. The results may be helpful for scale revision. By proxy, the study contributes to testing the validity of addiction criteria applied to Internet use related-addictive behaviors.

Health websites on COVID-19: are they readable and credible enough to help public self-care?

OBJECTIVE: There are concerns about nonscientific and/or unclear information on the coronavirus disease 2019 (COVID-19) that is available on the Internet. Furthermore, people's ability to understand health information varies and depends on their skills in reading and interpreting information. This study aims to evaluate the readability and creditability of websites with COVID-19-related information. METHODS: The search terms "coronavirus," "COVID," and "COVID-19" were input into Google. The websites of the first thirty results for each search term were evaluated in terms of their credibility and readability using the Health On the Net Foundation code of conduct (HONcode) and Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Gunning Fog, and Flesch Reading Ease Score (FRE) scales, respectively. RESULTS: The readability of COVID-19-related health information on websites was suitable for high school graduates or college students and, thus, was far above the recommended readability level. Most websites that were examined (87.2%) had not been officially certified by HONcode. There was no significant difference in the readability scores of websites with and without HONcode certification. CONCLUSION: These results suggest that organizations should improve the readability of their websites and provide information that more people can understand. This could lead to greater health literacy, less health anxiety, and the provision of better preventive information about the disease.

Are health websites credible enough for elderly self-education in the most prevalent elderly diseases?

BACKGROUND: The Elderly and their caregivers need credible health information to manage elderly chronic diseases and help them to be involved in health decision making. In this regard, health websites are considered as a potential source of information for elderlies as well as their caregivers. Nevertheless, the credibility of these websites has not been identified yet. Thus, this study aimed to evaluate the credibility of the health websites on the most prevalent chronic diseases of the elderly. METHODS: The terms "Chronic obstructive pulmonary disease", "Alzheimer's", "Ischemic heart disease", and "Stroke" were searched using the three popular search engines. A total of 216 unique websites were eligible for evaluation. The study was carried out using the HONcode of conduct. The chi-square test was carried out to determine the difference between conforming and nonconforming websites with HONcode principles and website categories. RESULTS: The findings showed that half of the evaluated websites had fully considered the HONcode principles. Furthermore, there was a significant difference between websites category and compliance with HONcode principles (p value < .05). CONCLUSION: Regarding the poor credibility of most prevalent elderly diseases' websites, the potential online health information users should be aware of the low credibility of such websites, which may seriously threaten their health. Furthermore, educating the elderly and their caregivers to evaluate the credibility of websites by the use of popular tools such as HONcode of conducts before utilizing their information seems to be necessary.

Persian language health websites on Ebola disease: less credible than you think?

BACKGROUND: Ebola virus disease is an emergency situation in the area of international public health for which currently, there is no standard treatment. Thus, there is an essential need for awareness of individuals about the Ebola disease and consequently its prevention. Internet and health websites are considered a source of health information about certain diseases. Therefore, in this study, the credibility of Persian-language websites on Ebola is assessed. MATERIALS AND METHODS: The term "Ebola" was searched using the Yahoo, Google, and Bing search engines. The first 30 websites resulting from each search engine were studied. Persian language was a prerequisite for inclusion. Duplicate and inaccessible websites were excluded and 62 websites were retained for evaluation. These websites were manually assessed by the researchers. The research tool was HONcode official toolbar as well as the checklist set by the researchers based on the HONcode of Conduct tool. The data were analyzed using SPSS 18.0 software. RESULTS: None of the retrieved websites was officially approved by the HONcode of Conduct. Moreover, the manual evaluation showed that none of them had fully considered the eight criteria of HONcode. The results showed that most of the retrieved websites (62%) were commercial. The justifiability criterion had been considered in 89% of the studied websites, but the authority criterion had been considered by only 16% of the websites. CONCLUSION AND RECOMMENDATIONS: Regarding the poor reliability of Persian websites on the Ebola disease, and considering that Persian language people prefer to read the information in their native language, it is recommended that the authorized health organizations introduce reliable health websites in the Persian language. This will help them to take part in active healthcare decision-making and disease prevention. Moreover, it is necessary to educate people especially Persian language ones about the website evaluation tools, which can be used to assess the credibility of health websites before consuming the information on those websites.

Assessing the eHealth literacy skills of family caregivers of medically ill elderly.

OBJECTIVES: The purpose of current research is to assess the eHealth literacy level in the family caregivers of the elderly with hypertension and type-II diabetes. METHODS: A total of 160 caregivers completed the eHEALS questionnaire. The effect of participants' gender, education, and age on eHealth literacy was evaluated. For evaluation of the correlation between the accession of health information importance and the internet usefulness for decision-making, Spearman's correlation coefficient was applied. RESULTS: The participants eHealth literacy mean score was 26.163(SD=8.83). The age of participants had a meaningful impact on the level of eHealth literacy (t=6.074; P<0.001). Furthermore, among variant education levels in terms of eHealth literacy score significant differences existed (F=5.222; P=0.001). DISCUSSION: The family caregivers have a poor level of eHealth literacy. eHealth information is more important for family caregivers with a higher eHealth literacy, which may be due to their higher skills in obtaining health and medical information from the internet. Caregivers' age should be considered once recommending them for the internet using to obtain health information, as the age was an affecting factor. CONCLUSION: Health centers and authorities in charge of the elderly health are recommended to train caregivers with proper skills to use online health information, such that the elderly enjoy the benefits, including improved care conditions and savings in terms of treatment costs and time.

Evaluation of the Quality and Accessibility of Available Websites on Kidney Transplantation.

PURPOSE: (i) to assess the quality of health websites on kidney transplant and (ii) to evaluate the accessibility of these websites and their concordance with the existing guidelines. MATERIALS AND METHODS: The terms "kidney transplantation" and "renal transplantation" were searched in the three most popular search engines Google, Yahoo, and Bing. 58 unique websites were eligible for the analysis . The Websites accessibility was evaluated using the AChecker tool. Kruskal-Wallis test was performed to examine any significant difference between accessibility issues across different domains. The eligible websites were screenedfor quality based on the HONcode of conducts. Moreover, the daily traffic data of each website was determined by Alexa. The correlation of known accessibility problems with website popularity was examined too. RESULT: The main reported known problems belonged to "scripts must have functional text," "text equivalents," "accessible forms," and "text links for server-side image map". Although the mean accessibility errors in governmental (10.25 ± 7.274) and organizational (12.31 ± 9.469) websites were less than those in the other domains, the differences were not significant (P = 0.60). Findings showed no significant correlation (P > 0.05) betweenthe extent of known problems (16.50 ± 12.18) and Alexa ranking (253675.07 ± 534690.947). Furthermore, most websites on kidney transplant were not certified by the HONcode. CONCLUSION: The health websites designers should be aware of accessibility problems, because there is a growing population of potential users with disabilities. This study indicated the need to ensure the compliance of kidney transplant websites with accessibility guidelines such as Section 508. Furthermore, most surveyed websites were of poor quality and unreliable. Therefore, physicians should warn their patients about unqualified online health information and guide them to websites which are more reliable.

eHealth Literacy and General Interest in Using Online Health Information: A Survey Among Patients with Dental Diseases.

OBJECTIVES: The aim of the study is to explore the eHealth literacy and general interest in using eHealth information among patients with dental diseases. METHODS: A total of 171 patients with dental diseases completed the survey including the eHEALS. The effect of participants' age, gender and education on eHealth literacy was assessed. Spearman's correlation coefficient was also used to assess the correlation between the importance of access to health information and the usefulness of the internet for decision-making. RESULTS: The mean score of eHealth literacy in the participants was 30.55 (SD=4.069). The participants' age has significant effect on eHealth literacy level (t=3.573, P-value=0.002). Moreover, there was a significant correlation between the total score of eHealth literacy and the importance of access to eHealth information (r=0.33, n=171, P<0.s001). The difference in eHealth literacy in terms of educational background showed no statistically significant differences (F=1.179, P-value=0.322). DISCUSSION: The participants had a high level of eHealth literacy. Determining eHealth literacy among dental patients leads to a better understanding of their problems in health decision-making. CONCLUSION: Dental institutions efforts should aim to raise awareness on online health information quality and to encourage patients to use evaluation tools, especially among low electronic health literate patients.

Websites as a tool for public health education: determining the trustworthiness of health websites on Ebola disease.

OBJECTIVES: Health service providers use internet as a tool for the spreading of health information and people often go on the web to acquire information about a disease. A wide range of information with varying qualities and by authors with varying degrees of credibility has thus become accessible by the public. Most people believe that the health information available on the internet is reliable. This issue reveals the need for having a critical view of the health information available online that is directly related to people's life. The Ebola epidemic is an emergency situation in the international public health domain and the internet is regarded as an important source for obtaining information on this disease. Given the absence of studies on the trustworthiness of health websites on Ebola, the present study was conducted to assess the trustworthiness of websites which are focused on this disease. METHODS: The term "Ebola" was searched in Google, Yahoo and Bing search engines. Google Chrome browser was used for this purpose with the settings fixed on yielding 10 results per page. The first 30 English language websites in each of the three search engines were evaluated manually by using the HONcode of conduct tool. Moreover, the official HONcode toolbar was used to identify websites that had been officially certified by HON foundation. Results: Almost the half of the retrieved websites were commercial (49%). Complementarity was the least-observed criterion (37%) in all the websites retrieved from all three-search engines. Justifiability, Transparency and Financial Disclosure had been completely observed (100%). DISCUSSION: The present study showed that only three criteria (Justifiability, Transparency and Financial Disclosure) out of the eight HON criteria were observed in the examined websites. Like other health websites, the websites concerned with Ebola are not reliable and should be used with caution. CONCLUSION: Considering the lack of a specific policy about the publication of health information on the web, it is necessary for healthcare providers to advise their patients to use only credible websites. Furthermore, teaching them the criteria for assessing the trustworthiness of health websites would be helpful.