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Experiences of Online COVID-19 Information Acquisition among Persons with Type 2 Diabetes and Varying eHealth Literacy
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0003-0661-8269
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0003-1543-6512
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-2803-8006
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2021 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 24, article id 13240Article in journal (Refereed) Published
Abstract [en]

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the ‘infodemic’, which includes the overabundance of online information and the spread of misleading information. Adequate eHealth literacy skills among world citizens have therefore been emphasized as vital during the pandemic. Persons with type 2 diabetes have been at increased risk of severe outcomes of COVID-19 disease. 

This study aimed to explore online COVID-19 information acquisition experiences among persons with type 2 diabetes and varying eHealth literacy. Fifty-eight participants filled out the eHealth Literacy Scale (eHEALS), along with a qualitative questionnaire with free-text questions. Additionally, 10 participants were interviewed. Thematic analysis was applied to identify patterns in participants’ experiences. Two domains were identified: perceived challenges with online information about COVID-19, and coping strategies to manage challenges. The perceived challenges were: being exposed to information overload, dealing with conflicting information, and being strongly emotionally affected. The related coping strategies were: protecting oneself, trusting authorities, taking command, and using common sense. 

These strategies often involved triangulation of the information obtained, including participants consulting their common sense, various sources, or family and friends. This paper highlights the crucial role of authorities in delivering online information, that according to health literacy principles, is easy to access, understand, and use. Furthermore, our results reinforce the importance of diabetes nurses, as well as healthcare professionals in general, in encouraging patients to share their Internet findings, promote information from reliable sources, and deliver tailored information that suits individual needs. Because our results underline the importance of social support in eHealth literacy and the assessment of online health information, the inclusion of family and friends needs to be increasingly considered in diabetes care. Due to the small homogenous sample, the results of this study cannot be generalized. However, the reader can assess the transferability to other situations and settings based on our contextual descriptions.

Place, publisher, year, edition, pages
MDPI, 2021. Vol. 18, no 24, article id 13240
Keywords [en]
COVID-19, eHealth literacy, type 2 diabetes, online health information, health literacy, distributed health literacy, nursing
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-190739DOI: 10.3390/ijerph182413240ISI: 000737910700001Scopus ID: 2-s2.0-85121114972OAI: oai:DiVA.org:umu-190739DiVA, id: diva2:1622626
Funder
Swedish Diabetes AssociationAvailable from: 2021-12-23 Created: 2021-12-23 Last updated: 2023-12-09Bibliographically approved
In thesis
1. eHealth literacy and internet use for health information: a study in Swedish primary healthcare
Open this publication in new window or tab >>eHealth literacy and internet use for health information: a study in Swedish primary healthcare
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
eHälsolitteracitet och internetanvändning för hälsoinformation : en studie inom svensk primärvård
Abstract [en]

Background: Primary healthcare (PHC) is facing significant challenges in Sweden and around the world. One way to address such challenges is through health-related Internet information (HRII) and other eHealth services, which are resources for high-quality, accessible and cost-effective care. Such re­sources have been found to assist in improving individual health, especially for people with chronic conditions such as type 2 diabetes. More specifically, eHealth services may play an important role in increasing patients’ knowledge, engagement and autonomy in health management, as well as enhancing their self-care practices. However, patients must have adequate capabilities – collectively known as eHealth literacy (eHL) – in order to use eHealth services effectively. 

Aim: The overall aim of this thesis was to explore eHL and HRII use in the context of Swedish PHC. 

Methods: Data collection for paper I was conducted through individual interviews with PHNs, which were then analysed using qualitative content analysis. Paper II involved patients with type 2 diabetes who were interviewed individually or responded to open-ended survey questions; the data were analysed using thematic analysis. In paper III, which was a translation and validation study, the data consisted of cognitive interviews and questionnaires predominantly answered by PHC visitors, and employed psychometric analysis methods. The same data from PHC visitors were used in paper IV, in which descriptive and comparative statistics and logistic regression analyses were employed. 

Results: In paper I, the interviewed PHNs expressed mixed feelings regarding consultations with Internet-informed patients. While they recognised benefits such as increased patient engagement and the support of self-care, their responses focused on the challenges they encountered. These challenges included patient confusion and unwarranted anxiety stemming from HRII, as well as conflicted, time-consuming and unnecessary healthcare consultations. In paper II, patients with type 2 diabetes outlined their challenges associated with online COVID-19 information, which encompassed information overload, conflicting content and notable emotional impact. They described employing diverse coping strategies to address these challenges, including restricting their information consumption, relying on authoritative sources, actively evaluating source credibility, engaging in discussions with others and applying common sense. In paper III, the eHealth Literacy Questionnaire (eHLQ) was translated and culturally adapted to assess eHL in a Swedish context. The Swedish version of the eHLQ was found to demonstrate robust psychometric properties. In paper IV, it was determined that older age groups (>60) were assessed with lower eHL in several eHLQ domains, including those regarding motivation and ability to use HRII and digital technology. In addition, older age groups reported that eHealth services did not suit their individual needs. Variables that were found to be independently associated with lower eHL across several domains were advanced age and the perception that HRII was not useful or important. 

Conclusion: Both the patients and PHNs in this thesis encountered challenges related to patients’ acquisition of HRII and utilisation of eHealth services. A collective and important objective for healthcare professionals and authorities should be to facilitate patients’ HRII and eHealth service usage. Therefore, PHNs and other healthcare professionals should actively encourage open discussions with patients about the latter’s HRII findings, recommend credible websites, explore potential barriers to patients’ eHealth usage, motivate patients to use eHealth services and suggest ways for patients to enhance their eHL. Healthcare authorities and eHealth developers are suggested to increasingly involve end-users in the development of eHealth services and provide opportunities for customisation based on individual needs. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 99
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2277
Keywords
eHealth, eHealth literacy, health literacy, nursing, primary healthcare, person-centred card care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-217574 (URN)9789180702195 (ISBN)9789180702201 (ISBN)
Public defence
2024-01-12, Aula Biologica, Biologihuset, Linnaeus väg 7, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareDiabetesfondenThe Kempe Foundations
Available from: 2023-12-15 Created: 2023-12-09 Last updated: 2023-12-11Bibliographically approved

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Sjöström, Anna E.Hajdarevic, SenadaHörnsten, ÅsaÖberg, UlrikaIsaksson, Ulf

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