Efrat Neter

eHealth Literacy: Extending the Digital Divide to the Realm of Health Information

Background eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care. Objective The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes. Methods We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers. Results Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains. Conclusions The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers.

Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice

The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural medicine who convened to discuss priority issues in planning interventions in health contexts and develop a set of recommendations for future research and practice. The expert group adopted a nominal groups approach and voting system to elicit and structure priority issues in planning interventions and implementation intentions research. Forty-two priority issues identified in initial discussions were further condensed to 18 key issues, including definitions of planning and implementation intentions and 17 priority research areas. Each issue was subjected to voting for consensus among group members and formed the basis of the position statement and recommendations. Specifically, the expert group endorsed statements and recommendations in the following areas: generic definition of planning and specific definition of implementation intentions, recommendations for better testing of mechanisms, guidance on testing the effects of moderators of planning interventions, recommendations on the social aspects of planning interventions, identification of the preconditions that moderate effectiveness of planning interventions and recommendations for research on how people use plans.

The gradient in mammography screening behavior: a lifestyle marker

The study reports a gradient in adhering to a recommended health behavior-mammography screening. Data were collected on 951 Israeli women, aged 50-74, who were mailed an invitation to a prescheduled mammography screening appointment and were later phone interviewed about their background, their other health behaviors and their health perceptions related to cancer, mammography and self-rated health. The main finding that emerged was a gradient consisting of three groups defined by their adherence to mammography screening: women who declined the invitation to undergo screening (nonattenders, 32%), women who attended a screening upon encouragement (attenders, 45%) and women who initiated the test on their own (self-screenees, 23%). This gradient was shown to be related to structural/background variables (e.g. SES, age, education, ethnicity), other health behaviors and perceptual variables related to health in general and to cancer. For example, self-screenees were of a higher SES, engaged in more health behaviors and were closer to other women who performed a mammography. An analysis carried out to discern where the difference between the three groups lied showed that it was more apparent between the self-screenees and attenders, and that the attenders and nonattenders were more similar to each other. These findings are discussed in terms of health behavior as a discrete phenomenon vs. reflecting a lifestyle. Suggestions for intervention possibilities are presented in light of the finer ranking proposed above (as opposed to the dichotomy of engaging/not engaging in a health behavior).

Clustering Women’s Health Behaviors

This study attempts to characterize health lifestyles by subgrouping women with similar behavior patterns. Data on background, health behaviors, and perceptions were collected via phone interview from 1,075 Israeli women aged 50 to 74. From a cluster analysis conducted on health behaviors, three clusters emerged: a “health promoting” cluster (44.1%), women adhering to recommended behaviors; an “inactive” cluster (40.3%), women engaging in neither health-promoting nor compromising behaviors; and an “ambivalent” cluster (15.4%), women engaging somewhat in both health-promoting and compromising behaviors. Clustering was cross-tabulated by demographic and perceptual variables, further validating the subgrouping. The cluster solution was also validated by predicting another health behavior (mammography screening) for which there was an external validating source. Findings are discussed in comparison to published cluster solutions, culminating in suggestions for intervention alternatives. The concept of lifestyle was deemed appropriate to summarize the clustering of these behavioral, perceptual, and structural variables.

Attitudes of Israeli Muslims at risk of genetic disorders towards pregnancy termination.

Objectives: (1) To examine attitudes towards termination of pregnancy (TOP) among high-risk and non-high-risk (for cystic fibrosis) Arab-Muslims, and (2) to examine the effect of an intervention, which among other things related explicitly to TOP. Methods: The study comprised three groups: (1) an intervention group at high risk for CF, which received community genetic counseling; (2) a control group at high risk for CF, and (3) a control group from the general population. The latter two groups were exposed to minimal intervention. Attitudes were measured two or three times during a 1-year period (for the control and intervention groups, respectively). Results: Predictors of an affected fetus being considered a legitimate cause for TOP were religiosity, familiarity with an affected child, and benefits of the test. Predictors of individuals (hypothetically) choosing abortion in the case of an affected fetus were education and age. No change occurred in the attitudes of participants (either experimental or control groups) in the course of 1 year. Conclusions: Other possible intervention options are discussed, and specifically, the advantages of using opinion leaders such as clergy and medical staff.

Goal disengagement and goal re-engagement among multiple sclerosis patients: Relationship to well-being and illness representation

Research on adaptive human behaviour often emphasizes goal attainment, alongside optimism, self-efficacy, and persistence. Recently, it has been suggested that giving up personal goals when the latter are unattainable is equally important. The present study extends previous findings to a clinical population of multiple sclerosis (MS) patients and examines whether goal disengagement and re-engagement are related to psychological well-being, illness representation, and disease characteristics (duration and stage). One hundred and one MS patients filled out questionnaires pertaining to goal disengagement (GD) and goal re-engagement (GR), anxiety, depression, purpose in life, illness intrusion, illness perception, and background variables. GD and GR had good reliability also in this population and were uncorrelated. Regression analyses yielded significant results only on depression. An interaction between goal disengagement and re-engagement on depression was uncovered, so that those who were high on disengagement and low on re-engagement were more affected by depression. Unexpectedly, the least depressed are those low on both disengagement and re-engagement. The difference between populations of healthy individuals as compared to patients is discussed. Limitation of the cross-sectional design is highlighted with respect to directionality between depression and change in goals.

BRCA1/2 mutation carriers: living with susceptibility.

Objectives: To examine whether being a BRCA1/2 mutation carrier affects a wide array of aspects of life, and if so, how. Methods: Participants were grouped according to their carrier status (carrier and noncarrier status), health status (affected or unaffected by cancer), and their enrollment at the counseling service (probands and other family members). One hundred and sixty-five women completed a self-administered questionnaire following their genetic consultation session. Results: Probands/nonprobands and carriers/noncarriers did not differ with regard to demographic characteristics, health behaviors including medical checkups, the distress they experience or their resources (sense of coherence, social integration, religiosity). Individuals affected by cancer did differ on some of these aspects from participants without cancer. Conclusions: From the results of this study, being a carrier could not be considered a psychosocial risk factor, nor does it seem to have an effect on carriers’ resources and lifestyle.

Harnessing the Question–Behavior Effect to Enhance Colorectal Cancer Screening in an mHealth Experiment

OBJECTIVES To assess whether asking questions about a future behavior changes this behavior (i.e., the question-behavior effect) when applied to a population-level intervention to enhance colorectal cancer screening. METHODS In 2013, text-message reminders were sent to a national sample of 50 000 Israeli women and men aged 50 to 74 years following a fecal occult blood test invitation. Participants were randomized into 4 intervention groups (2 interrogative reminders, with or without reference to social context; 2 noninterrogative reminders, with or without social context) and a no-intervention control group. The outcome was fecal occult blood test uptake (n = 48 091, following attrition). RESULTS Performance of fecal occult blood test was higher in the interrogative-reminder groups than in the other 3 groups (odds ratio = 1.11; 95% confidence interval = 1.05, 1.19); the effect size was small, varying in the different group comparisons from 0.03 to 0.06. CONCLUSIONS The question-behavior effect appears to be modestly effective in colorectal cancer screening, but the absolute number of potential screenees may translate into a clinically significant health promotion change.

Self-rated health is prospectively associated with uptake of screening for the early detection of colorectal cancer, not vice versa.

Self-rated health (SRH) is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors. The present study examined the prospective association between SRH and performance of a recommended colorectal cancer (CRC) screening test. One thousand four hundred and seventy-six men and women aged 50–74 years, eligible for CRC screening, who had undergone the test a year before were interviewed 1–2 weeks (long interview, before testing) or 2 months (short interview, after testing) following the mailing of a test kit. Test performance was ascertained using an HMO’s computerized data set. Respondents in the long interview group who rated their health as ‘higher than others’ performed the screening test 2 months following the invitation more than those who rated their health as similar to or lower than that of others (65.4, 61.6, and 49.1%, respectively, &khgr;2=8.02, P=0.018). At the same time, these respondents perceived the risk of CRC as significantly lower than that of those who rated their health as comparable with or lower than that of others. In a multivariate logistic regression of CRC screening behavior that included demographic and perceptual variables, age, intentions, and SRH were found to be significant predictors. Among respondents in the short interview, who tested before the interview, there was no significant association between SRH and behavior. SRH prospectively predicts uptake of CRC screening better than other perceptual variables, after accounting for demographic variables.

Stereotypical thinking as a mediating factor in the association between exposure to terror and post-traumatic stress disorder symptoms among Israeli youth

ABSTRACT Background and Objectives: The negative impact of exposure to terror on mental health, as well as on the perceptions of each side of the conflict toward the other, is well-documented. However, the association between stereotyping, concomitant with perceived threat, and anxiety, was rarely investigated. The current study examined information processing attributes and exposure to terror as predictors of PTSD symptoms among youth at inter-group conflict, with stereotypical thinking toward a threatening out-group as a possible mediator. Design: Cross-sectional, with exposure to terror, need for cognitive structure (NCS), efficacy at fulfilling the need for closure (EFNC) and self-esteem, predicting stereotypical thinking and PTSD symptoms. Method: Ninth graders (N = 263) from two residential areas in Israel, varying in their degree of exposure to terror, responded to a self-report questionnaire tapping the above variables. Results: Stereotypical thinking was found to mediate the association between exposure to terror and PTSD symptoms, but not the association between the NCS and EFNC interaction and PTSD symptoms. Conclusions: The findings support terror management theory, so that a negative and rigid perception makes it difficult to construct coherent world-view, thus contributing to aggregation of existential anxiety and PTSD symptoms.