Don Chaney

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.

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.

Engaging Community Stakeholders to Evaluate the Design, Usability, and Acceptability of a Chronic Obstructive Pulmonary Disease Social Media Resource Center

Background Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. Objective The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. Methods A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). Results The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. Conclusions Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education.

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey

Background Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Methods Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Results Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than –2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.

Examining the Relationship between Online Social Capital and eHealth Literacy: Implications for Instagram Use for Chronic Disease Prevention among College Students

ABSTRACT Background: College students actively seek online health information and use Instagram, an image- and video-based social networking website, to build social networks grounded in trust and behavioral norms (social capital), which have the potential to prevent chronic disease. Purpose: This study aimed to (1) examine how intensity of Instagram use moderates the relationship between eHealth Literacy and online social capital in college students and (2) discuss how Instagram can be used as a social awareness platform for chronic disease prevention among college students. Methods: Hierarchical regression analyses were conducted to analyze web-based survey data from a random sample of college students (N = 327). Results: Online bridging social capital was associated with greater ehealth literacy (P < .05) and intensity of Instagram use (P < .001), when controlling for sociodemographic variables. The relationship between ehealth literacy and online bridging social capital was strongest among respondents with average-intensity (P < .01) and high-intensity (P < .01) Instagram use compared to low Instagram intensity. Discussion: High intensity of Instagram use may strengthen college students’ low ehealth literacy, especially when interacting with heterogeneous connections with weaker ties. Translation to Health Education Practice: Health Education Specialists should continue to explore how college students’ intensity of Instagram use can be strengthened to build bridging online social capital and ultimately prevent chronic disease.

Utilizing a Multi-level Approach to Support Advocacy Efforts in the Advancement of Health Education

Abstract Advocacy is an integral component of health education. Although the use of advocacy is continually cited in the literature as an essential and crucial factor in the success of health intervention strategies, the gap between what health education practitioners know they should do and what they actually do still exists. The purposes of this article are threefold: 1) to propose an ecological approach to advocacy efforts; 2) to provide selected examples of approaches to health advocacy that have worked in the field; and 3) to provide practical guidelines on how health education practitioners can participate in advocacy efforts. This article intends to bring attention to individual, social, and environmental factors that support advocacy efforts in the advancement of the profession.

What's in a Name? Changing Names and Challenges to Professional Identification

Name changes of university departments that have professional preparation health education programs have been ongoing and significant. This study analyzes changes in the names of health education degree-offering departments between 1974 and 2009. It also discusses the implications for the health education discipline going forward with respect to personal and professional identification, as well as credentialing and employment opportunities for health educators. A large change was seen in many of the department names between 1974 and 2009. The greatest changes were seen in the increasing use of community health, kinds of health, public health, and health and something else. A large decrease was noted in the use of health education. Name changes present potential challenges for the professional and educational development of the field, employment opportunities, and personal and professional identification. This article does not purport to provide a prescription or solution but rather suggests that health education professionals and organizations should consider this concern.