Beth H. Chaney

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

Background Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. Objective To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). Methods A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Results Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. Conclusions There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

eHealth Literacy and Web 2.0 Health Information Seeking Behaviors Among Baby Boomers and Older Adults

Background Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. Objective The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. Methods A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. Results Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t 217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R 2 =.17, R 2adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information. Conclusions Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.

A primer on quality indicators of distance education

In the past decade, there has been an enormous growth of distance education courses and programs in higher education. The growth of distance education is particularly evident in the field of health education. However, the enormous potential of distance education is tempered by one overriding question: How does one ensure that distance education coursework and degrees are of high quality? To this end, the purpose of this study is twofold: to identify quality indicators of distance education and to provide implications of the identified quality indicators for health education researchers and practitioners. The results of the study reveal common benchmarks and quality indicators that all parties deem important in designing, implementing, and evaluating distance education courses and programs.

Health Benefits of Digital Videogames for Older Adults: A Systematic Review of the Literature

OBJECTIVE This article is a systematic review conducted of the research literature on digital videogames played by older adults and health outcomes associated with game play. Findings from each study meeting the inclusion criteria were analyzed and summarized into emergent themes to determine the impact of digital games in promoting healthy behaviors among older adults. MATERIALS AND METHODS A systematic review of the research literature was conducted through multiple academic databases for works, published between the years 2000 and 2011, looking at digital videogame interventions with adults 65 years of age and older. Multiple combinations of search terms and Boolean operators relevant to digital videogames and older adults were queried. A criteria matrix was created to code and evaluate studies. RESULTS Thirteen studies met specific criteria for inclusion and were analyzed in the final review. Significant mental, physical, and social health factors, type of digital game platform, study design, and measurements are among emergent themes summarized from the reviewed research literature. Significant mental health outcomes of digital game interventions were found in the majority of the reviewed studies, followed by physical and lastly social health outcomes in older adults. CONCLUSIONS A majority of the studies revealed significant positive effects on health outcomes associated with digital videogame play among older adults. With current advancements in technology, including advanced motion sensing, digital game platforms have significant potential for positive health impact among older populations. More robust and rigorous research designs are needed to increase validity and reliability of results and establish stronger causal relationships on the health benefits of digital videogame play for older adults.

Development of an Instrument to Assess Student Opinions of the Quality of Distance Education Courses

The purpose of this study was to develop a culturally sensitive instrument to assess the quality of distance education courses offered at a university in the southern United States through evaluation of student attitudes, opinions, and perceptions of distance education. Quality indicators, identified in a systematic literature review, coupled with an ecological framework served as the theoretical foundation for the instrument development process. The process of test development, outlined in the Standards for Educational and Psychological Testing (1999), was used and combined with Dillmans (2000) four stages of pretesting to construct the instrument. Results indicated that the model constructed from the quality indicators and ecological framework provided valid and reliable measures of student attitudes, opinions, and perceptions of quality of the distance education courses.

Validity and Reliability Reporting Practices in the Field of Health Education and Behavior A Review of Seven Journals

Health education and behavior researchers and practitioners often develop, adapt, or adopt surveys/scales to quantify and measure cognitive, behavioral, emotional, and psychosocial characteristics. To ensure the integrity of data collected from these scales, it is vital that psychometric properties (i.e., validity and reliability) be assessed. The purpose of this investigation was to (a) determine the frequency with which published articles appearing in health education and behavior journals report the psychometric properties of the scales/subscales employed and (b) outline the methods used to determine the reliability and validity of the scores produced. The results reported herein are based on a final sample of 967 published articles, spanning seven prominent health education and behavior journals between 2007 and 2010. Of the 967 articles examined, an exceedingly high percentage failed to report any validity (ranging from 40% to 93%) or reliability (ranging from 35% to 80%) statistics in their articles. For health education/behavior practitioners and researchers to maximize the utility and applicability of their findings, they must evaluate the psychometric properties of the instrument employed, a practice that is currently underrepresented in the literature. By not ensuring the instruments employed in a given study were able to produce accurate and consistent scores, researchers cannot be certain they actually measured the behaviors and/or constructs reported.

The impact of pregaming on subsequent blood alcohol concentrations: an event-level analysis.

Pregaming has been highlighted as an especially deleterious college drinking ritual. The present study assessed (a) event-level associations between pregaming and biologic samples of blood alcohol concentration (BrAC) and (b) the impact of ones alcohol-related behaviors (measured by AUDIT-C scores) on the likelihood that respondents would report pregaming prior to a night out drinking. The sample included adult (n=1029; collegiate and non-college-affiliated) bar patrons in a southeastern college community. Multiple and linear regressions were conducted to determine the association between pregaming and BrAC levels, and pregaming and the presence of an alcohol use disorder, respectively. After controlling for the influence of time of data collection, gender, age, college student status, and ethnicity, the linear regression model explained 15.5% (R2=.155) of the variance in BrAC levels (F (10, 915)=16.838, p<0.001), of which 10.8% was accounted for by self-reported pregaming alone. Furthermore, pregamers exhibited significantly higher BrACs compared to non-pregamers (β=.332, p<.001). Logistic regression analyses indicated that AUDIT-C scores were the only significant predictor of pregaming status (OR=1.305, Wald=64.843), such that respondents with higher AUDIT-C scores (B=0.266) were more likely to pregame. This event-level study highlights the practice of pregaming as an insidious behavior associated with enhanced levels of drinking behavior and overall intoxication.

Evaluating the psychometric properties of the AUDIT-C among college students

Abstract Aims: Despite the various settings and diverse populations in which the utility of the AUDIT-C has been examined, college students have remained conspicuously absent from the vast majority of these studies. We evaluated the psychometric properties of the AUDIT-C with a sample of college student bar patrons. Methods: Intercept interviews were used to recruit currently enrolled college students (n = 347) exiting bars. A brief face-to-face interview assessed demographic data, alcohol-related behaviors (AUDIT-C), and breath alcohol concentration (BrAC). AUDIT-C responses were subjected to a principal component analysis. BrAC was used as a measure of concurrent validity against two distinct gender-based AUDIT-C cut-off scores. Results: All AUDIT-C items loaded on a single factor, accounting for 68% of total variance. Pearson’s product–moment correlation coefficients between BrAC and both hazardous drinking AUDIT-C cut-offs (r = 0.32; r = 0.38) were statistically significant (p < 0.001). Moreover, those meeting each hazardous drinking gender-based criteria exhibited significantly higher (p < 0.001) BrAC readings than those not meeting these criteria. Effect sizes for these group differences were considerable (Cohen’s d > 0.70). Reliability and stability statistics indicated strong internal consistency. Conclusions: Results reported herein highlight the sound psychometric qualities of the AUDIT-C and its ability to produce valid and reliable scores among college students.

New Media for Health Education A Revolution in Progress

In a 2001 editorial titled, “Health Education and the Internet: The Beginning of a Revolution,” the authors noted that the Internet had the potential to completely revolutionize health education research and practice by providing far more powerful ways of “. . . compiling, facilitating, developing, packaging and delivering health information to and between individuals and communities” (Bernhardt & Hubley, 2001, p. 643). In 2013, Internet-enabled new media continue to have enormous potential to revolutionize health education with diverse populations by enhancing our ability to implement evidence-based behavior change strategies in manners that are often far more effective and efficient than were possible in the past. For example, new media can now be used to do the following: improve the ability to deeply engage large numbers of targeted individuals and communities over a sustained period of time; facilitate the real-time solicitation and analysis of in-depth health-related data and feedback from participants and collaborators to identify and aggregate health needs and priorities for planning health education programs; design and deliver highly relevant and personalized health education messages that are sent through the most accessible and persuasive channels at the most appropriate and influential times; and assess the effectiveness of interventions by enabling the electronic collection and storage of process and impact data from participants. Therefore, new media can contribute to and improve on virtually all steps in the health education planning, intervention development, and evaluation process. In 2001, there were an estimated 500 million Internet users throughout the world (Bernhardt & Hubley, 2001) and more than 20,000 health-related websites (Eng et al., 1998). The International Telecommunication Union (2013) currently estimates that there are more than 2.3 billion global Internet users; and there are almost 3.5 billion results available when searching for “health” on Google. In 2001, the dominant Internet-based channels besides the web and e-mail included newsgroups, chat rooms, instant messaging, and file exchange servers (Bernhardt & Hubley, 2001). In 2013, social media and information sharing sites, such as Facebook, YouTube, and Twitter, are among the most accessed websites on the Internet with more than 1 billion, 800 million, and 500 million users, respectively (Facebook, 2013; Lawler, 2012; Lunden, 2012). The technology revolution has spawned the rapid growth of new media channels, tools, devices and gadgets that leverage the Internet’s access to vast collections of information. The Pew Internet & American Life Project (2013) data show that laptop computer use is now favored over desktop computer use, and music players, video game consoles, electronic book readers, and tablet computers have all grown rapidly since their introduction (see Figure 1). However, the most explosive growth has been in the use of mobile phones, most of which feature the ability to make voice phone calls and send and receive SMS (or text) messages. At the turn of the millennium, it was estimated that nearly two thirds of the world’s population did not and would not possess the ability to make a phone call (Wang, 2000). Yet total mobile cellular subscriptions reached almost 6 billion by the end of 2011, representing a global penetration of 86% (International Telecommunication Union, 2013). Smartphones, which contain many features in addition to voice and SMS, such as mobile web access, sending and receiving e-mails, and running small downloadable programs called “apps,” have also grown rapidly. According to Nielsen, smartphones represent approximately half of all mobile phones used in the United States and two thirds of new phones that are purchased (Pollicino, 2012). Additionally, there were more than 1 billion mobile-broadband subscriptions globally by the end of 2011 (International Telecommunication Union, 2013). Health education researchers have continued to explore creative new ways to leverage the Internet and diverse new media applications to increase the efficacy of their interventions. The number of new media and health education studies continues to grow, as does the number of manuscripts related to new media that are submitted to Health Education & Behavior. In this issue, we selected five articles (each were submitted and accepted through the journal’s standard peerreview process) to be published together as a “theme section” on the topic of New Media for Health Education. These articles explore many of the most popular new media channels available for health education research and practice today, including smartphone apps, mobile-based text messages, webbased tailored messages, and video games. Together, these 483140 HEBXXX10.1177/1090198113483140 Health Education & BehaviorBernhardt et al. 2013

The Digital Divide in Health Education: Myth or Reality?.

Abstract Although e-health interventions provide new opportunities for health education, there has been cause for concern regarding the purported information technology gap between those who have access to digital applications and those who do not-termed the “digital divide.” The literature suggests, however, that this divide may now be illusory, driven primarily by a myriad of societal divides such as income, education, and literacy inequities. Such disparities may be the true propagators of what is now becoming a mythical digital divide. The purpose of this article is to identify the evolutionary nature of the digital divide and speculate as to how and why it has become a mirage in today’s increasingly technological world. Based on this discussion, suggestions are made regarding how health educators can enable the use of technology to better health through the study of consumer health informatics and e-health behavioral support.