Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey.

Evidence of long-term impacts of COVID-19-related public health restrictions on digital sexually transmitted and blood-borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, and testers' sociodemographic and sexual risk profiles, for the prepandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analyzed. Each outcome was modeled using segmented generalized least squared regression. Overall, 17,215 and 22,646 test episodes were conducted in the prepandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021 (end of the pandemic period), monthly GetCheckedOnline testing increased by 21.24 test episodes per million BC residents (95% confidence interval, -11.88 to 54.84), and GetCheckedOnline tests per 100 tests in corresponding BC regions increased by 1.10 (95% confidence interval, 0.02 to 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, whereas monthly GetCheckedOnline testing increased among people 40 years or older, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.

Funding AcknowledgementsType of funding sources: None.BackgroundThe COVID-19 pandemic has highlighted the role of telemedicine in reducing face-to-face visits. Telemedicine requires either the use of digital support methods and a minimum technological knowledge of the patients. Digital health literacy, defined as the use of digital literacy skills to find and use health information and services, may influence the use of telemedicine in most patients, particularly in specific groups such as those with frailty.AimTo explore the association between frailty status, patients' use of digital tools and digital health literacy to determine whether it would be possible to implement control visits in patients followed in a cardiac arrhythmias outpatient clinic.MethodsWe prospectively enrolled consecutive patients referring to arrhythmias outpatient clinics of our department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into three subgroups: robust, pre-frail, and frail. The degree of health digital literacy was assessed through the Digital Health Literacy Instrument (DHLI) Scale. The DHLI explores 7 digital skill categories measured by 21 self-report questions. The self-report questions require participants to rate on a 4-point scale how difficult different tasks are and how frequently they encounter certain difficulties on the Internet. The total DHLI and each skill category score were calculated by summing the received scores in every single domain (3 questions per each skill category) and reported as mean and median. A multivariable logistic regression analysis was also use to evaluate the association between the non-use of the Internet and frailty status.ResultsA total of 300 patients were enrolled (36.3% females, median age 75 [66-84]) and stratified according to frailty status as: (i) Robust (EFS ≤ 5; n = 212, 70.7%), (ii) Pre-Frail (EFS 6-7; n = 47, 15.7%), and (iii) Frail (EFS ≥ 8; n = 41, 13.7%). Frail patients used less frequently smartphones, PC and emails and had less availability of Wi-Fi at home compared to robust patients (Table 1). At the multivariable logistic regression analysis, frailty was significantly associated with the non-use of the Internet (adjusted odds ratio, 2.58 95% confidence interval 1.92-5.61). Digital health literacy score decreased as the level of frailty increased in all the domains explored (operational skills, navigation skills, information searching, evaluating the reliability of the information, determining the relevance of online information, adding self-generated content and protecting privacy while using the internet, all p<0.001, Table 2).ConclusionsFrail patients are characterized by a lower use of digital tools and access to the Internet even though these patients would benefit the most from telemedicine. Digital skills are strongly influenced by frail status highlighting the need to implement digital health literacy with specific interventions in this population.Internet access and digital toolsDigital Health Literacy Instrument

BackgroundExperts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).ObjectiveThe goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants’ health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants’ subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course.MethodsThe pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement).ResultsTo test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]–0=676,000; δ=–0.316), practical knowledge (BF–0=92,300; δ=–0.294), critical thinking (BF–0=7.42e+13; δ=–0.482), self-awareness (BF–0=11,500,000; δ=–0.345), and citizenship (BF–0=266,000; δ=–0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF–0=2.339; δ=–0.135), evaluating reliability (BF–0=2.03e+11; δ=–0.434), and determining relevance (BF–0=316,000; δ=–0.308). Moreover, participants demonstrated higher subjective (BF–0=3.58e+82; δ=–1.515) and objective knowledge (BF–0=3.82e+97; δ=–1.758) in the domain of (digital) health literacy.ConclusionsThe newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).

BackgroundAcross diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries.MethodsWe searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited.ResultsResearch demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted.ConclusionsThe high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.

Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N=51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

Although digital health promises improved healthcare efficiency and equity, access and uptake might be low indisadvantaged populations. We measured access todigital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness. An existing Australian survey, including a validated digitalhealth literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients. Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner. Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation.

BACKGROUND Digital health tools are increasingly prevalent in post-operative care management, yet limited research exists on digital health literacy and tool adoption among safety-net hospital populations. Understanding these factors is crucial for developing effective digital health solutions for historically underserved communities. OBJECTIVE To evaluate digital health literacy, assess technology adoption readiness, and examine the relationship between patient-reported capabilities and demographic factors in a post-operative care context at a safety-net hospital. METHODS We conducted a mixed-methods study with 71 post-operative patients and 29 healthcare providers. Participants completed a modified eHealth Literacy Scale (eHEALS) assessment and demographic questionnaire, followed by usability testing of a digital health prototype. Digital health literacy was evaluated using a 10-point Likert scale, and correlations between demographic factors and digital health literacy were analyzed. RESULTS Despite common assumptions about technology barriers in safety-net populations, 69% of patients reported high confidence (score ≥3 on a 5-point scale) in finding health resources online, and 60.6% expressed confidence in using the internet for health-related questions. However, only 49.3% felt confident in using digital resources for health decision-making. Patient comfort with technology did not significantly correlate with age, but rather with prior technology exposure, with 78.9% reporting ≥10 years of digital device experience. CONCLUSIONS Digital literacy and health literacy have been studied in safety-net contexts, but there is a dearth of research on digital health literacy in post-operative care and safety-net populations specifically. Our findings suggest that digital health tools may be more feasible in safety-net settings than previously considered. However, the gap between patients' ability to find health resources and their confidence in using these resources for health decision-making highlights the need for targeted support in translating digital capabilities into healthcare management skills.

Sexually transmitted and blood borne infection (STBBI) testing is recommended for people who are incarcerated (PWAI). We sought to determine the rate of STBBI testing during admissions to provincial correctional institutions in Newfoundland and Labrador (NL). This retrospective cohort study collected the identification of all admissions records in provincial correctional facilities in NL between July 1, 2020 and June 31, 2021 using the Provincial Corrections Offender Maintenance System database. Admissions to provincial detention centers were excluded. Records were linked with STBBI results, when available, within the electronic medical record (Meditech) using demographics. Testing rates, STBBI positivity rates, and univariate analysis of predictors for STBBI testing were completed. Of the 1,824 admissions identified, 1,716 were available for linkage to laboratory results. Admissions to detention centers (n = 105) were excluded. Any STBBI test result was available for 72 (4.5%) of admissions. No admission had complete testing for all STBBI. Facility testing rates ranged from 1.9 to 11.2% and 37.5% of STBBI tests had any positive results. Sixteen out of the 21 (76.2%) hepatitis C virus (HCV) antibody positives received HCV RNA testing, and 11/16 (88.8%) were HCV RNA positive. Institution (p = 0.001) and sex (p = 0.004) were found to be significant predictors of STBBI testing, while age was not significant (p = 0.496). STBBI testing rates were low in provincial correctional facilities in NL, and STBBI prevalence, especially for HCV, was high among those tested. Strategies to increase the rate of testing could contribute to STBBI control in corrections facilities.

BackgroundIn April of 2016, a provincial sexually transmitted infections (STI) outbreak was declared in Alberta. In response to sharply rising rates, Alberta formed the Alberta Sexually Transmitted and Blood Borne...

BackgroundWearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context.ObjectiveThis study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator.MethodsA cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use.ResultsOverall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1–2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18–40: 36%; 41–64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18–40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41–64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001).ConclusionsThis study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

BackgroundDigital health literacy is a key factor in enabling users to navigate in an increasingly digitalized health care system. Low levels of digital health literacy are associated with higher age, low education, and income, as well as low functional health literacy. Around 6.2 million adults living in Germany have low reading and writing skills. Due to their low literacy, this group is often underrepresented in research studies and therefore little is known about their digital health literacy and use of digital health tools.ObjectiveThe objectives of this study were to assess digital health literacy in adults with low reading and writing skills and to explore which digital health tools they use in daily life.MethodsAn interviewer-administered survey and focus groups were conducted with adult residents of Bremen, Germany, who were aged 18‐64 years and had low reading and writing skills. In addition, a stakeholder workshop was held to derive recommendations on how digital health literacy could be improved. The survey questionnaire included 21 items addressing the use of digital health technologies and digital health literacy (eHealth Literacy Scale). Focus group participants completed several tasks on web-based health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and linear regression. Qualitative content analysis was applied to analyze the focus group data and the written documentation of the stakeholder workshop.ResultsSurvey participants (n=96) were on average 43 (SD 10.7) years old, 72% (69/96) were female, and 92% (88/96) were not born in Germany. Participants reported mainly using information-related digital health technologies such as health apps (40/96, 42%), health websites (30/96, 31%), or activity trackers (27/96, 28%). The mean digital health literacy score was 22 (SD 8) points, with 35% (34/96) of participants classified as having a low digital health literacy (score between 8-19/40 points). Digital health technology use was associated with higher digital health literacy. For participants in the 5 focus groups (total n=39; mean age 43, SD 12.6 years; n=34, 87% female), limited technical skills and language problems were the most important challenges. Furthermore, focus group participants reported that they favor videos when searching for web-based health information and prefer to seek support from family members or local organizations for health issues. Stakeholders (n=15) recommended that health websites should be available in multiple languages, contain simple and easy-to-read language, and use images, symbols, and videos.ConclusionsWhile adults with low reading and writing skills use digital health technologies, many find it challenging to search for health information on the internet due to lacking technical skills and language problems. To ensure that adults with low reading and writing skills are not further left behind, future research should focus on developing tailored interventions to promote digital health literacy.

Young adults are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs), and rates of STBBI screening in this population are persistently low. The present study examined the effectiveness of Club Sexu's social marketing campaign, DépistaFest, in increasing STBBI screening, screening intentions, and general STBBI and STBBI screening knowledge among young adults in Quebec, Canada. Grounded in the health belief model, the campaign provided practical and scientifically accurate information on STBBIs and screening using an inclusive, positive, and playful approach. A sample of 686 participants (M = 28.0years old) was recruited through Club Sexu's social media to complete an online survey assessing campaign exposure, recent STBBI screening, screening intentions, and general STBBI and screening knowledge. Logistic regressions and ANCOVAs were performed to examine group differences on outcome variables. Compared to nonexposed participants, those who were exposed to the campaign were 2.11 times more likely to report having been tested in the past 6months, and 2.07 times more likely to report planning to get tested in the next 6months. Exposed participants were also more likely to correctly answer general STBBI knowledge questions and reported higher levels of self-perceived STBBI screening knowledge than nonexposed participants. The findings support the effectiveness of an STBBI prevention campaign grounded in the health belief model. Future STBBI prevention campaigns aimed at young adults would benefit from destigmatizing STBBIs and normalizing STBBI screening using an inclusive, positive, and playful approach.

BackgroundRoutine surveillance for sexually transmitted and bloodborne infections (STIBBI) are generally based on case reports. Additional data sources are needed to understand STIBBI syndemics, such co-infections, testing patterns, and timing...

Stigma is widely recognized as a significant barrier to the prevention, management and treatment of sexually transmitted and blood-borne infections (STBBIs) in Canada. Despite major advances in STBBI prevention and treatment, and global efforts to reduce stigma, people living with or affected by STBBIs continue to experience stigma within health and social service settings in Canada. To describe the development, content and evaluation of knowledge translation resources and training workshops designed to equip health and social service professionals with the knowledge and skills needed to provide more respectful and inclusive sexual health, harm reduction and STBBI services. After conducting a literature review, environmental scan and key informant interviews, and developing a conceptual framework, the Canadian Public Health Association (CPHA) developed four knowledge translation resources and three training workshops in partnership with a number of community-based organizations and experts. The resources were drafted and reviewed by both service providers and individuals affected by STBBIs. The workshops were developed, piloted and then evaluated using post-workshop questionnaires. The four resources developed were a self-assessment tool related to STBBIs and stigma; a service provider discussion guide to facilitate respectful and inclusive discussions on issues related to sexuality, substance use and STBBIs; a toolkit focused on stigma reduction, privacy, confidentiality and the criminalization of HIV non-disclosure; and an organizational assessment tool related to STBBIs and stigma for health and social service settings. These knowledge translation resources were subsequently integrated into the content of three face-to-face trainings that were piloted and evaluated across the country. Post-workshop evaluation had an overall 85% response rate; 88% of participants noted increased awareness of various forms of stigma, 87% noted increased comfort discussing sexuality, substance use and harm reduction with their clients/patients, 90% reported increased awareness of organizational strategies to reduce stigma, and 93% reported being able to integrate workshop learnings into practice. In addition, there was strong support for professional development on issues related to STBBI stigma reduction. These knowledge translation resources and training workshops represent a comprehensive set of tools developed in Canada that service providers can use to help reduce stigma when caring for clients/patients with STBBIs and related conditions. Evaluation indicates there is a strong willingness among health and social service providers to engage in educational opportunities in this area and that participation in the training workshops led to increased awareness and a willingness to adopt best practices.

Digital health literacy has emerged as a critical skill set to navigate the digital age. This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: "measured digital health literacy," "digital literacy," "ehealth literacy," "e-health literacy," "electronic health literacy," or "internet health literacy" in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation.