Luca Camerini

Defining and measuring health literacy: how can we profit from other literacy domains?

When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement exists about which dimensions to include in the concept. To contribute to the development of a consistent and parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.

Effects of functional interactivity on patients' knowledge, empowerment, and health outcomes: an experimental model-driven evaluation of a web-based intervention.

Background The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented. However, there is a need to understand not only whether eHealth interventions work, but also what kind of functions and mechanisms enhance their effectiveness. The present investigation contributes to tackling these challenges by investigating the role played by functional interactivity on patients’ knowledge, empowerment, and health outcomes. Objectives To test whether health knowledge and empowerment mediate a possible relationship between the availability of interactive features on an eHealth application and individuals’ health outcomes. We present an empirical, model-driven evaluation of the effects of functional interactivity implemented in an eHealth application, based on a brief theoretical review of the constructs of interactivity, health knowledge, empowerment, and health outcomes. We merged these constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with fibromyalgia syndrome (FMS). Methods This study used a pretest–posttest experimental design. We recruited 165 patients and randomly assigned them to three study groups, corresponding to different levels of functional interactivity. Eligibility to participate in the study required that patients (1) be fluent in Italian, (2) have access to the Internet, (3) report confidence in how to use a computer, and (4) have received a diagnosis of FMS from a doctor. We used structural equation modeling techniques to analyze changes between the pretest and the posttest results. Results The main finding was that functional interactivity had no impact on empowerment dimensions, nor direct observable effects on knowledge. However, knowledge positively affected health outcomes (b = –.12, P = .02), as did the empowerment dimensions of meaning (b = –.49, P < .001) and impact (b = –.25, P < .001). Conclusion The theoretical model was partially confirmed, but only as far as the effects of knowledge and empowerment were concerned. The differential effect of interactive functions was by far weaker than expected. The strong impact of knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by eHealth applications.

Design and implementation of a web-based Tailored Gymnasium to enhance self-management of Fibromyalgia

The aim of this article is to describe the design and development of an online gymnasium that proposes personalized exercise videos to users affected by fibromyalgia. Fibromyalgia syndrome is a chronic condition characterized by widespread pain in muscles, ligaments and tendons, usually associated with sleep disorders and fatigue. Physical exercise is considered as an important component of non-pharmacological treatments of this pathology, and the internet is praised as a powerful resource to promote and improve physical exercise. Yet, while online personalization of health interventions to consumers must be grounded on empirically based guidelines, guidelines for fibromyalgia-targeted exercises are scant. The achievements presented in this paper are twofold. Firstly, we illustrate how we reached definition of the relevant factors for tailoring exercise videos in relation to fibromyalgia. Secondly, we explain the general framework of the application that is composed of an interview module (that investigates the determinant values of a specific user), an adaptation module (presenting the tailored set of exercises) and a logging component (used to monitor users’ interactions with the website). The paper concludes with a discussion on the strengths and weaknesses of the proposed approach.