Association between social capital, mental health, and digital health literacy among the university students in China: a multigroup analysis based on major difference.

BACKGROUND: This study aimed to clarify medical-nonmedical difference on the relationship between social capital, mental health and digital health literacy of university students in China, and furtherly provide evidence-based suggestions on the improvement of the digital health literacy for the university students. METHODS: The snowball sampling method was used to collect data from the university students (including medical students and nonmedical students) through online questionnaires, and finally 1472 university students were included for the data analysis, of whom, 665 (45.18%) were medical students, 807 (54.82%) were nonmedical students; 462 (31.39%) were male, 1010 (68.61%) were female. Mean value of the age was 21.34 ± 2.33 for medical students vs. 20.96 ± 2.16 for nonmedical students. Descriptive analysis, chi-square test analysis, one-way Analysis of Variance (conducted by SPSS) and structural equation modeling (conducted by AMOS) were employed to explore the difference on the relationship between social capital, mental health and digital health literacy between the medical students and nonmedical students. RESULTS: The mean value of the digital health literacy was 36.27 (37.33 for medical students vs. 35.39 for nonmedical students). The SEM analysis showed that there was a statistically positive correlation between social capital and digital health literacy (stronger among the nonmedical students (0.317) than medical students (0.184)). Mental health had a statistically positive impact on the digital health literacy among medical students (0.242), but statistically significant correlation was not observed in nonmedical students (0.017). Social capital was negatively correlated with the mental health for both medical students and NMS (stronger among the nonmedical students (0.366) than medical students (0.255)). And the fitness indices of SEM were same between medical students and nonmedical students (GFI = 0.911, AGFI = 0.859, CFI = 0.922, RMSEA = 0.074). CONCLUSION: The digital health literacy of the university student was relatively high. Both social capital and mental health could exert a positive effect on digital health literacy, while social capital was found to be positively associated with mental health. Statistical difference was found between medical students and nonmedical students on the above correlations. Implications were given on the improvement of the digital health literacy among university students in China.

Digital health literacy and associated factors among internet users from China: a cross-sectional study.

BACKGROUND: As the internet develops and 5G technology becomes increasingly prominent, the internet has become a major source of health-related information. Increasingly, people use the internet to find health-related information, and digital health literacy is now a set of essential capabilities to improve their health in the digital era. However, little is known about the factors that influencing digital health literacy. This study aimed to assess digital health literacy scores and identify its influencing factors among internet users in China. Additionally, this study explored the participant's actual skills using an additional set of performance-based items from the Digital Health Literacy Instrument (DHLI). METHODS: An online cross-sectional study was conducted in August 2022. Participants aged ≥18 years were recruited to complete the survey. Data were collected using the Chinese revised version of the DHLI, the self-reported internet use questionnaire, and the sociodemographic questionnaire. We conducted multivariate linear regression analyses to explore the relationships among the sociodemographic variables, behavior of internet use, and the digital health literacy scores. RESULTS: In total, 702 participants completed the survey. The mean DHLI score was 2.69 ± 0.61. Multivariate linear regression analyses showed that the age groups 35-49 (ß = - 0.08, P = 0.033), 50-64 (ß = - 0.161, P < 0.001), and ≥ 65 (ß = - 0.138, P < 0.001) were negatively associated with DHL scores. However, education level, including bachelor's or associate degree (ß = 0.255, P = 0.002) and master's degree and above (ß = 0.256, P < 0.001), frequency of health-related Internet usage (ß = 0.192, P < 0.001), the number of digital devices used (ß = 0.129, P = 0.001), and OHISB (ß = 0.103, P = 0.006) showed a positive relationship with DHL scores. CONCLUSIONS: The study findings demonstrate that age, educational levels, number of technological devices used, and greater use of the web for health information were independently associated with DHL scores. Healthcare providers should consider providing training programs tailored to specific sociodemographic factors to improve the ability that find and use accurate information online to meet digital health services, which contributes to enhance their self-management and reduce health disparities.

Associations between digital health literacy and health system navigating abilities among Norwegian adolescents: validating the HLS19-DIGI scale using Rasch modeling.

BACKGROUND: Despite increasing global attention to health literacy and adolescents' digital health information seeking, no unidimensional instruments measuring digital health literacy (DHL) in adolescents have reportedly been validated using Rasch modeling. Moreover, the evidence of adolescents' abilities to navigate the health system (NAV-HL) in light of their DHL proficiency is still scarce. Therefore, our study aims to evaluate the psychometric properties of a DHL instrument (HLS19-DIGI scale) in order to investigate DHL in adolescents and young adults aged 16-25 and associations with abilities to navigate the health system. METHODS: A population-based cross-sectional survey among 890 Norwegian adolescents was conducted during April-October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and binary regression models were used to analyze the data. RESULTS: The HLS19-DIGI scale was sufficiently unidimensional, whereas no differential item functioning or disordered response categories were observed. However, relatively poor targeting was revealed indicating too many easy items for the target population. Yet, a high proportion (54%) of low DHL proficiency in adolescents was observed, as well as DHL was positively associated with the abilities to navigate the health system. CONCLUSIONS: The HLS19-DIGI scale is considered a sufficiently unidimensional and valid instrument for measuring DHL in adolescents, which may be a useful tool for health authorities, public health workers, and health service providers. While DHL affects adolescents' abilities to navigate the health system, future research should measure and examine their ability to utilize digital health services, separately.

Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users.

BACKGROUND: As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. OBJECTIVE: This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. METHODS: The validation study was conducted in 8 PHC centers in the territory of the Macva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. RESULTS: A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P<.05) for all 7 eHLQ scores were observed for age, education, perceived material status, perceived health status, searching for health information on the internet, and occupation (except domain 4). In multivariable regression models, searching for health information on the internet and being aged younger than 65 years were associated with higher values of all domain scores except the domain feel safe and in control for variable age. CONCLUSIONS: This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of EHL and in the planning of digital health interventions at the population and individual level due to its strong psychometric properties in the Serbian context.

Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology.

BACKGROUND: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. OBJECTIVE: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. METHODS: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. RESULTS: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. CONCLUSIONS: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.

Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study.

BACKGROUND: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. OBJECTIVE: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? METHODS: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. RESULTS: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. CONCLUSIONS: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged.

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.

Digital proficiency: assessing knowledge, attitudes, and skills in digital transformation, health literacy, and artificial intelligence among university nursing students.

BACKGROUND: Implementing digital transformation and artificial intelligence (AI) in education and practice necessitates understanding nursing students' attitudes and behaviors as end-users toward current and future digital and AI applications. PURPOSE: This study aimed to assess the perceived knowledge, attitudes, and skills of nursing students regarding digital transformation, as well as their digital health literacy (DHL) and attitudes toward AI. Furthermore, we investigated the potential correlations among these variables. METHODS: A descriptive correlational design was employed in a Saudi nursing college utilizing a convenience sample of 266 nursing students. A structured questionnaire consisting of six sections was used, covering personal information, knowledge, skills and attitudes toward digital transformation, digital skills, DHL, and attitudes toward AI. Descriptive statistics and Pearson correlation were employed for data analysis. RESULTS: Nursing students exhibited good knowledge of and positive attitudes toward digital transformation services. They possessed strong digital skills, and their DHL and positive attitude toward AI were commendable. Overall, the findings indicated significant positive correlations between knowledge of digital transformation services and all the digital variables measured (p = < 0.05). Senior students reported greater digital knowledge and a positive attitude toward AI. CONCLUSION: The study recommends an innovative undergraduate curriculum that integrates opportunities for hands-on experience with digital healthcare technologies to enhance their digital literacy and skills.

[Social inequality in the context of digital health applications: digital divides in access, use, effectiveness, and privacy]. / Soziale Ungleichheit im Zusammenhang mit digitalen Gesundheitsanwendungen: Digitale Spaltungen in den Bereichen Zugang, Nutzung, Wirksamkeit und Privatsphäre.

Given the massive increase in digital health tools, the question about the impact of these tools on health equity has gained importance. The aim of this narrative review is to discuss the extent and central aspects of the digital divide. To illustrate the extent of the digital divide, we draw on data from the Liter@te study, which interviewed low-literacy individuals regarding their use of digital health tools and their digital health literacy. The results of the Liter@te study are compared with population surveys conducted in parallel. Four areas can be distinguished in relation to digital divides: access, use, effectiveness, and privacy. Inequalities can be observed in all four areas. While differences in access or material infrastructure, as well as in usage patterns and the required literacies, have already been investigated in some studies, the data basis for a comprehensive assessment of the unequal effects of digital health tools in different population groups is still lacking. Digital divides in the area of privacy protection is an emerging field. However, transparent and understandable privacy measures will undoubtedly be an important prerequisite for the widespread use of digital health tools. Overall, in addition to a better data base, involvement of disadvantaged population groups in the development of digital health interventions is necessary.

[Digital health literacy in Germany: current status, concepts, and challenges]. / Digitale Gesundheitskompetenz der Bevölkerung in Deutschland: Aktueller Stand, Konzepte und Herausforderungen.

A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger­2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL.

Preparing for the future of healthcare: Digital health literacy among medical students in Lahore, Pakistan.

Objective: Digital Health Literacy (DHL) is becoming a cardinal competence for all healthcare professionals (HCPs) including medical students for meaningful digital transformation of healthcare. As medical students need to navigate an increasingly digitalized healthcare environment, thus the study's objective was to assess digital health literacy among medical students. Methods: This cross-sectional analytical study was conducted at King Edward Medical University, Lahore from October 2022 to August 2023. Medical students were asked to complete a pen and paper questionnaire of the Digital Health Literacy Instrument (DHLI) after informed consent. DHLI covers seven categories: operational skills, information searching strategy, analyzing the usefulness of online information, navigational abilities, contributing user-generated material to internet-based platforms, and privacy protection. SPSS was used for data analysis. Results: Eight hundred ninety one medical students, from first year to final year, participated in the study. The overall mean score for DHL was 63.5 (SD=8.82). Medical students achieved a score of 83.2% of total score in their operational abilities, and 82.3% proficiency in privacy protection, which were deemed highly desirable. Furthermore, they achieved a satisfactory level in navigation skill (76.0%), information searching (73.1%), adding content (71.0%), determining the significance of data (70.1%), and assessing data reliability (68.7%), based on the overall score. A significant relationship was observed between the performance level of DHL domains and gender with higher scores in males in all domains except protecting privacy, which was higher in females and clinical years students (p-value < 0.05). Conclusion: The assessment of the DHL of medical students was deemed desirable. But certain obstacles were encountered in few domains of DHL i.e., data reliability, relevance determination, and content augmentation. It is imperative to elevate the level of DHL of medical students to harness the potential of digital technologies in enhancing healthcare.

Development of a patient-reported outcome measure of digital health literacy for chronic patients: results of a French international online Delphi study.

BACKGROUND: A psychometrically robust patient-reported outcome measure (PROM) to assess digital health literacy for chronic patients is needed in the context of digital health. We defined measurement constructs for a new PROM in previous studies using a systematic review, a qualitative description of constructs from patients, health professionals and an item pool identification process. This study aimed to evaluate the content validity of a digital health literacy PROM for chronic patients using an e-Delphi technique. METHODS: An international three-round online Delphi (e-Delphi) study was conducted among a francophone expert panel gathering academics, clinicians and patient partners. These experts rated the relevance, improvability, and self-ratability of each construct (n = 5) and items (n = 14) of the preliminary version of the PROM on a 5-point Likert scale. Consensus attainment was defined as strong if ≥ 70% panelists agree or strongly agree. A qualitative analysis of comments was carried out to describe personal coping strategies in healthcare expressed by the panel. Qualitative results were presented using a conceptually clustered matrix. RESULTS: Thirty-four experts completed the study (with 10% attrition at the second round and 5% at the third round). The panel included mostly nurses working in clinical practice and academics from nursing science, medicine, public health background and patient partners. Five items were excluded, and one question was added during the consensus attainment process. Qualitative comments describing the panel view of coping strategies in healthcare were analysed. Results showed two important themes that underpin most of personal coping strategies related to using information and communications technologies: 1) questionable patient capacity to assess digital health literacy, 2) digital devices as a factor influencing patient and care. CONCLUSION: Consensus was reached on the relevance, improvability, and self-ratability of 5 constructs and 11 items for a digital health literacy PROM. Evaluation of e-health programs requires validated measurement of digital health literacy including the empowerment construct. This new PROM appears as a relevant tool, but requires further validation.

Erratum: Addendum: Validation of the digital health literacy assessment among the university students in China.

[This corrects the article DOI: 10.3389/fpubh.2023.1294183.].

Exploring the Influence of YouTube on Digital Health Literacy and Health Exercise Intentions: The Role of Parasocial Relationships.

The purpose of this study was to analyze the mediating role of digital health literacy and the moderating effect of parasocial relationships on the relationship between the viewing experience of health exercise-related YouTube content and the intention for health exercise behavior. Based on the health action process approach, this study established a foundational theoretical model to analyze how digital health literacy mediates the impact of media viewing experience on health exercise behavior intention. Additionally, this study examined the moderating effect of parasocial relationships with YouTube creators. For empirical analysis, variables were measured using a self-administration method among 409 randomly sampled consumers of YouTube health exercise content. The collected data were analyzed using a structural equation model incorporating mediation parameters, and a multigroup model analysis was conducted to understand differences based on parasocial relationships. The results revealed that increased YouTube viewing experience enhanced cognitive, skill, and evaluative components of digital health literacy, which were significant factors in increasing health exercise behavior intention. Notably, the mediating effect of cognition played a crucial role, and the strengthening effect of parasocial relationships on this relationship was confirmed. These findings can be utilized as practical foundational data for designing digital health communication strategies, particularly in developing motivational mechanisms that encourage consumers to engage voluntarily and consistently in health behaviors based on online health information.

Empowering Patients Through Digital Health Literacy and Access to Electronic Medical Records (EMRs) in the Developing World.

This editorial discusses the transformative potential of digital health literacy and the critical role of electronic medical records (EMRs) in promoting patient empowerment in the healthcare landscape of developing countries. It examines the impact of digital media in healthcare, noting its ability to both democratize access to information and services and pose risks of misinformation among populations with limited health literacy. The discussion includes an overview of key literacy components critical for effectively navigating the digital healthcare ecosystem. Our article highlights the critical role of EMR in facilitating a patient-centered care (PCC) model, with a special emphasis on making EMR systems accessible and user-friendly for vulnerable groups in developing countries. The core aim of our study is twofold: First, it sheds light on the significant challenges - be they technical, financial, or infrastructural - that obstruct the adoption of sophisticated EMR systems in these areas. Second, it explores the essential aspect of digital health literacy, advocating for its improvement as a vital step toward enabling patients to effectively engage with their medical records. By addressing these key issues, our study seeks to illustrate how enhancing digital health literacy, alongside increasing the accessibility of EMR systems, can empower patients in the developing world to actively participate in their healthcare processes. This dual focus aims to contribute to the broader discourse on improving healthcare outcomes through more inclusive and patient-centered approaches, particularly in settings that are currently underserved by modern healthcare technologies. In conclusion, the editorial advocates for a concerted effort toward creating a more inclusive and empowered healthcare paradigm. It suggests integrating PCC principles, tailoring EMR systems to diverse needs, and enhancing digital health literacy as strategies to harness digital health innovations for better healthcare outcomes and equity. It emphasizes the importance of ongoing investment in education, technology, and policy to fully leverage digital health solutions in the developing world.

Validity and reliability of the Chinese version of digital health readiness questionnaire among hypertension patients in rural areas of China.

Introduction: Digital health has the potential to support health care in rural areas by overcoming the problems of distance and poor infrastructure, however, rural areas have extremely low use of digital health because of the lack of interaction with technology. There is no existing tool to measure digital health literacy in rural China. This study aims to test and validate the digital health readiness questionnaire for assessing digital readiness among patients in rural China. Methods: Due to the different Internet environments in China compared to Belgium, a cultural adaptation is needed to optimize the use of Digital Health Readiness Questionnaire in China. Then, a prospective single-center survey study was conducted in rural China among patients with hypertension. Confirmatory factor analysis was computed to test the measurement models. Results: A total of 330 full questionnaires were selected and included in the analysis. The model-fit measures were used to assess the model's overall goodness of fit (Chi-square/degrees of freedom = 5.060, comparative fit index = 0.889, Tucker-Lewis index (TLI) = 0.869, root mean square error of approximation (RMSEA) = 0.111, standardized root mean square residual (SRMR) = 0.0880). TLI is a little bit lower than the borderline (more than 0.9) and RMSEA is higher than it (less than 0.08 means good model fit). We deleted two items 2 and 4 and the result shows a better goodness of fit (Chi-square/degrees of freedom = 4.897, comparative fit index = 0.914, TLI = 0.895, RMSEA = 0.109, SRMR = 0.0765). Conclusion: To increase applicability and generalizability in rural areas, it should be considered to use the calculation of only the parts Digital skills, Digital literacy and Digital health literacy which are equally applicable in a Belgian population as in a rural Chinese population.

Profiles of digital health literacy among university students and its association with mental health during the COVID-19 pandemic: A latent profile analysis.

Objective: Investigating the digital health literacy of university students can facilitate their effective acquisition of health information and adoption of appropriate protective behaviors. This study aims to explore the subtypes of digital health literacy among university students during the COVID-19 pandemic and their association with mental health outcomes. Methods: From 17 November to 14 December 2022, a stratified random sampling approach was used to conduct an online questionnaire survey on digital health literacy, fear of COVID-19, and depression status among students at Jilin University, China. A total of 1060 valid responses were obtained in the survey. Latent profile analysis identified subtypes of digital health literacy and linear regression analyses were used to examine the association of digital health literacy to the mental health outcome. Results: Three latent profiles were identified: Profile 1-low digital health literacy (n = 66, 6.23%), Profile 2-moderate digital health literacy (n = 706, 66.60%), and Profile 3-high digital health literacy (n = 288, 27.17%). Results from linear regression demonstrated a negative correlation between digital health literacy and fear of COVID-19 (B = -2.954, P < 0.001) as well as depression (B = -2.619, P < 0.001) among university students. Conclusions: This study indicated that the majority of university students exhibit a moderate level of digital health literacy during the COVID-19 pandemic. Additionally, the study validates a negative correlation between digital health literacy and mental health among university students.

Digital health literacy among primary and secondary school teachers-a quantitative study.

Introduction: Digital health literacy (DHL) is a key competency for individuals' daily decisions toward their health behavior and wellbeing. While there is much focus on health literacy (HL) among the general population, teachers have been rarely addressed. Given the shortages in the teaching workforce in Europe and the impact of demanding working conditions on their health, it is important to address DHL in teachers. This paper examines the DHL of primary and secondary teachers and its associations with sociodemographic and school-related factors. Methods: An online cross-sectional study was conducted with 1,600 German primary and secondary school teachers between October and December 2022. To assess DHL, the Digital Health Literacy Instrument (DHLI) including seven subscales was used. Statistical analyses were conducted on item and subscale level and an overall DHL score was calculated. Next to descriptive analyses, bivariate and regression analyses were conducted to explore potential associations with sociodemographic and school-related factors. Results: The frequency of difficulty in using digital health information varied across DHL dimensions and was greatest for protecting privacy (70.9%) and evaluating reliability (40.0%). In multivariate analysis, females more often reported a sufficient ability of adding content (OR = 1.61, CI = 1.05-2.48), while males more often reported a sufficient ability to protect their privacy (OR = 0.45, CI = 0.27-0.75). Teachers with leadership positions more often reported a sufficient ability in adding content (OR = 1.78, CI = 1.07-2.98). Regarding the ability to determine the relevance of online health-related information, no associations with a predictor variable were found. Discussion: The results suggest that it is important to examine the individual dimensions of DHL and their distinct associations with sociodemographic and school-level factors, rather than just to rely on the overall level of DHL. The differential patterns identified in this study suggest a greater intervention need for teachers from higher age groups, primary and secondary general schools, and those without leadership roles. However, based on the limited predictive power of the variables included, further individual and school-level factors and their potential association with DHL should be investigated in the future. The promotion of DHL should be integrated into both teacher education and in-service training.

A pioneering EMR-embedded digital health literacy tool reveals healthcare disparities for diverse older adults.

BACKGROUND: The COVID-19 pandemic transformed healthcare delivery with the rapid adoption of telehealth and digital technologies to access healthcare. Interventions are needed to ensure that older people in underserved communities do not face new technology-driven healthcare disparities. This article describes pioneering electronic medical record (EMR) embedded tools to assess and support each diverse patient's digital health literacy. METHODS: We designed and validated a rapid EMR-embedded Digital Health Engagement Tool (DHET) to assess each patient's digital literacy in English and Spanish. We built a separate, EMR-generated auto-scoring function to assess patient use of telehealth and healthcare navigation as recorded within the EMR. Combined, the tools created a complete digital literacy assessment for each patient. We then deployed the tools to conduct a pilot study to elucidate disparities. RESULTS: A total of 112 ethnic/racial diverse older patients were enrolled (mean age was 78, ranging from 57 to 96) years (SD = 8.04). The female participants were 72.3%. Among the participants, non-Hispanic Whites were 47.3%; Hispanic 25.0%; non-Hispanic Asian 19.6%; non-Hispanic others (including multi-race and non-Hispanic Black/African Americans) 8.0%. Digital literacy disparities were revealed for older adults, particularly those over 70 years old, female gender, and those reporting relying on a helper. CONCLUSION: New EMR-embedded tools enable healthcare systems to assess the ability of patients to navigate and utilize EMR capabilities, such as video telehealth appointments, messaging providers, reviewing labs/radiology reports, and requesting prescriptions. The study identified significant challenges for older patients in navigating EMRs and calls for healthcare systems to better support patient learning.

Patients' experiences and perspectives regarding the use of digital technology to support exercise-based cardiac rehabilitation: a qualitative interview study.

Introduction: Despite the well-known benefits of exercise-based cardiac rehabilitation for the secondary prevention of cardiovascular disease, participation in cardiac rehabilitation programmes and adherence to secondary prevention recommendations remain limited. Digital technologies have the potential to address low participation and adherence but attempts at implementing digital health interventions in real-life clinical practice frequently encounter various barriers. Studies about patients' experiences and perspectives regarding the use of digital technology can assist developers, researchers and clinicians in addressing or pre-empting patient-related barriers. This study was therefore conducted to investigate the experiences and perspectives of cardiac rehabilitation patients in Austria with regard to using digital technology for physical activity and exercise. Methods: Twenty-five current and former cardiac rehabilitation patients (18 men and 7 women, age range 39 to 83) with various cardiac conditions were recruited from a clinical site in Salzburg, Austria. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. The analysis followed a descriptive phenomenological approach, applying the framework analysis method. Results: The sample was diverse, including interviewees who readily used digital devices to support their physical activity, exercise and health monitoring, and interviewees who did not. Simplicity, convenience and accessibility were highlighted as important facilitators for the use of digital technology, while annoyance with digital devices, concerns about becoming dependent on them, or simply a preference to not use digital technology were commonly stated reasons for non-use. Interviewees' views on data protection, data sharing and artificial intelligence revealed wide variations in individuals' prior knowledge and experience about these topics, and a need for greater accessibility and transparency of data protection regulation and data sharing arrangements. Discussion: These findings support the importance that is attributed to user-centred design methodologies in the conceptualisation and design of digital health interventions, and the imperative to develop solutions that are simple, accessible and that can be personalised according to the preferences and capabilities of the individual patient. Regarding data protection, data sharing and artificial intelligence, the findings indicate opportunity for information and education, as well as the need to offer patients transparency and accountability in order to build trust in digital technology and digital health interventions.