Digital Literacy Research Articles

A long journey from telemedicine to digital (public) health: the vision of different stakeholders

Abstract The healthcare system willingly adopts new innovative means of communication and solutions offered by computer science. Telemedicine was one of the first terms used in this context. It was initially associated with providing medical services but quickly extended to other areas of health-related activities, including public health. The growth of the global web yielded new prospects for the provision of health services, also resulting in new terms to name the use of information and telecommunication technologies in healthcare. E-health, stemming from the end of 90ies in the 20th century, was initially defined as a new domain strongly associated with public health, especially in the context of access to health information. Quickly, its understanding was extended to all health-related interventions based on innovative digital technologies. Today, digital health and digital public health have emerged as the key terms, signifying the next phase of emerging applications that leverage the advancements made on the technical front. The medical community is probably more inclined to use the former term, while public health professionals are dedicated to the latter. But do these terms carry distinct meanings? Or is it merely a matter of the professional group’s background? Is the focus on individual or population health a differentiating factor? In the meantime, business and technical communities have developed the concept of Health 4.0. This concept emphasizes using technologies like the Internet of Things, cloud computing, big data, and artificial intelligence. However, digital (public) health benefits hugely from these solutions. One can ask whether every professional community needs other concepts and new terms for naming fields, resulting from the multidisciplinary effort. And where are the plain people in this landscape? Do they have sufficient digital and health literacies to accept new modes of health service delivery?

Characteristics predisposing to the utilization of Internet websites offering e-prescriptions

Abstract Background The introduction of e-prescriptions in the Polish healthcare system was accompanied by the emergence of websites offering easy access to medication without adequate medical assessment. This study aimed to analyze the characteristics of Polish users of such services. Methods The analysis presented here is based on the online survey conducted in June 2023 among 1661 adult Internet users. The multivariable logistic regression model (MLRM) was developed for the variable reflecting the use of e-prescribing web services (EPWS). Sociodemographic variables, self-assessed health status, the presence of chronic disease (CHR) and disabilities (DIS), the frequency of Internet (IU) and social media use (SMU), and finally, digital health literacy (DHL) were included in MLRM as independent variables. Results The percentage of respondents who used EPWS was equal to 18.2% (n = 303). MLRM revealed that age, vocational and income status, CHR, SMU, and DHL were significant predictors of EPWS use. Older respondents were less likely than younger ones to use EPWS (odds ratio (OR), 95% confidentiality interval (95%CI): 0.97, 0.97-0.99. Persons suffering from the chronic disease, when compared to those without such disease, used EPWS less frequently (OR, 95CI: 0.59, 0.43-0.80) and unemployed when compared to employees (OR, 95%CI: 0.53, 0.32-0.88). A higher likelihood of using EPWS was observed among respondents with the highest income in comparison to those from the group with the lowest income (OR, 95%CI: 1.52, 1.02-2.52) and among more frequent social media users (OR, 95%CI: 3.88, 1.90-7.93). Finally, the increase of DHL score by 1 unit was associated with the increase of the likelihood of EPWS use by 9% (OR, 95%CI: 1.09, 1.05-1.12). Conclusions A significant number of adult Internet users utilize EPWS in Poland. Lower age, unemployment, and chronic diseases are negative predictors of EPWS use. More intense SMU and unexpectedly higher DHL predispose to the use of such services. Key messages • Even persons with high e health literacy are inclined to use web portals offering e-prescriptions. • The high prevalence of the utilization of e-prescribing websites requires awareness campaigns warning about related potential risks.

Digital Health Literacy Enhancement Strategies Across Diverse Groups: A Scoping Review

Abstract Background The COVID-19 pandemic has accelerated the use of digital health technologies. Digital health literacy (DHL) is essential for effectively understanding and applying electronic health information. However, unequal access and use of these technologies require interventions to improve DHL for fair healthcare access. Objectives This scoping review aimed to identify strategies to enhance DHL in patients and the general population. Methods The review used the Joanna Briggs Institute Scoping Review Methodology and PRISMA-ScR guidelines. Eligibility criteria included a wide population, interventions aimed at improving DHL, with no restrictions on outcomes. The search strategy included electronic databases (MEDLINE, PsycINFO, Web of Science), and AI-based software, AS Review, was used for screening. Results The review found 5149 articles, 44 met the eligibility criteria. Studies focused on different demographic groups and health conditions. Most interventions were in North America and Europe. The study designs varied. Interventions via mobile apps, online platforms, and in-person sessions aimed at various conditions yielded positive results, including increases in DHL, self-management skills, and health-related behaviors. These interventions involved either independent interventions that focused on DHL or integrated interventions that were part of another intervention that aimed at a health outcome and had an element of DHL enhancement. Conclusions The review highlights the importance of DHL in informed decision-making and navigating digital health environments. While many interventions had positive outcomes, methodological limitations challenge the findings, emphasizing the need for more rigorous study designs. Future research should address sustainability, scalability, and the impact of DHL on health disparities, considering cultural sensitivity when developing interventions. Key messages • Scoping review identifies strategies to enhance Digital Health Literacy (DHL), crucial for effective use of health technology. • Despite positive outcomes, methodological limitations exist. Future research should focus on sustainability and scalability.

Food and nutrition literacy in Austria - results of a representative study

Abstract Background A healthy diet is a key factor in people’s long-term health. The nutritional health literacy and food literacy of the population play a crucial role in this. In 2021, comprehensive data on these competences were collected for the first time in Austria. Methods Almost 3,000 people were surveyed online. Nutrition health literacy was assessed with the newly developed Nutrition Health Literacy Scale (NHLS) and food literacy with the Self-Perceived Food Literacy Scale Short-Form (SPFL-SF). Scores and subscores were calculated. Associations between socio-demographic and socio-economic factors and the competences surveyed were assessed using t-tests, variance analysis, correlations, and multivariate regression models. Results In terms of nutritional health literacy, respondents score an average of 60 out of 100 points, with judging (51 points) and applying (60 points) nutritional information being the most difficult. In the area of food literacy, respondents score an average of 62 out of 100 points. The most challenging areas are ‘healthier choices’ (44 points), ‘healthy snacking’ (52 points) and ‘healthy eating in exceptional circumstances’ (54 points). In both areas, men and people with less formal education score lower. In the case of nutritional health literacy, people aged 65 and over have greater difficulties. Conversely, this group performs better in the area of food literacy. Differences by income can only be seen for nutritional health literacy, to the detriment of low-income groups. Conclusions Possible options for action include the provision of quality-assured and target-group-specific information, the implementation of appropriate tools to facilitate the assessment of foods, and measures to strengthen assessment skills, digital health literacy, food and nutrition skills. Key messages • The survey showed that there is potential for improvement in both nutritional health literacy and food literacy. • The biggest challenge is to evaluate and use nutritional information and to stick to a healthy diet without making exceptions.

Adapting Group Prenatal Care for Telehealth: A COVID-Era Innovation to Address Barriers to Care for Latinx Clients.

The use of telehealth prenatal care increased exponentially during the coronavirus disease 2019 (COVID-19) pandemic, but there is no literature describing its use for group prenatal care during this time. The COVID-19 pandemic also exacerbated structural barriers to care that disproportionately affect Black and Latinx people. Telehealth enabled pregnant people to access health care and minimize infectious risks. Telehealth group prenatal care (T-GPNC) incorporated the essential elements of CenteringPregnancy with telehealth is an innovative care delivery method borne out of necessity during the COVID-19 pandemic that has potential to mitigate structural barriers to care. Mary's Center is a federally qualified health center (FQHC) in Washington, DC, and Maryland that rapidly pivoted to individual telehealth prenatal care early in the pandemic. Mary's Center used our experience with group care and guidance from the Centering Healthcare Institute on virtual Centering to launch T-GPNC. This new model included home self-monitoring equipment and video classrooms, mixed with in-person individual care visits. We used a team-based approach with nurses, midwives, and community health workers to provide holistic care to pregnant people. Our robust care coordination team also connected them to home visiting, mental health services, and nutrition counseling. The purpose of this article is to describe how Mary's Center modified the CenteringPregnancy model of group prenatal care for telehealth, following the hallmarks of CenteringPregnancy, and met the needs of Spanish-speaking clients, henceforth Latinx clients. A secondary purpose is to demonstrate how telehealth can expand access to health care and remove structural barriers that may prevent pregnant people from attending in-person appointments. We also discuss the structural inequities in digital access and literacy in the context of program implementation.

The status of health information systems and digital transformation in the European Region

Abstract Although there have been investments in health information systems (HIS) and digitalization, WHO/Europe’s work with Member States (MS) shows that much can be improved still. Typically, there is a strong focus on data collection, but less on analysis and knowledge translation, resulting in available data not being optimally used to support decision making. Standards for data exchange and interoperability have not yet been fully implemented. Efforts are underway to train healthcare professionals, yet only half of MS have developed policies for digital health literacy. Fewer still have implemented a comprehensive digital inclusion plan, leaving disadvantaged populations at risk of falling behind. In line with the traditionally strong focus on HIS strengthening in WHO’s work, the European Programme of Work 2020-2025 (EPW) emphasises the need for MS to improve and modernise their HIS to ensure that decisions are data driven. One of the EPW flagship initiatives is Empowerment through Digital Health, promoting the leveraging and scaling up of digital transformation for better health. The Regional digital health action plan for the WHO European Region 2023-2030 outlines the strategic actions needed to achieve this, while fully respecting the values of equity, solidarity and human rights. Collaboration with MS and international partners is vital in this work. WHO/Europe has established several MS-driven health information networks in the past, most notably the European Health Information Initiative (the EHII). The EHII in 2023 has made a restart in the form of the European Health Information Network (HIN). The HIN will guide the work under the EU-funded action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’, which will be implemented by WHO/Europe. This strong European Commission and WHO/Europe partnership will be a main catalyst for HIS improvement in the Region the coming years.

Inequities to the access to and use of telemedicine among cancer patients in Europe: A scoping review

Abstract Background Over the last few years, telemedicine services (TMs) have increasingly been used in European health and care systems. TMs include remote assistance with teleconsultation and telemonitoring. The expected benefits to individuals include easier access to information and personalized care. However, while the effectiveness and utility of TMs among cancer patients are well-established in Europe, several evidences highlighted the fact that TMs may widen existing inequities in health. Therefore, the aim of this study is to identify barriers and facilitators contributing to inequities to TMs among cancer patients in Europe. Methods Medline (via Ovid) and Scopus databases were searched in March 2023 for all publications providing evidence on factors influencing the access to and use of TMs services among cancer patients aged 18 and over in Europe published between January 2018 and March 2023. The PROGRESS-plus framework was used to stratify health opportunities, patients characteristics and outcomes. Results A total of 1683 peer reviewed publications were identified and after screening, 26 articles were retained in our scoping review. All included studies focused on TMs used by cancer patients through mobile or web-based applications. On one hand, socioeconomic status and language were the most cited influential factors as well as having an internet connection and a (mobile) device to the access to TMs. On the other hand, factors that influence the use of TMs are the level of education with digital skills and (e-)health literacy, social support, age and presence of comorbidities. Conclusions Identifying and addressing factors influencing access to and use of TMs among cancer patients will enable the development and tailoring of TMs that align more effectively with the needs and expectations of cancer patients. Integration of patient-centered care in TMs is necessary to enhance equity and allow a better implementation of TMs in European health and care systems. Key messages • The main factors influencing the access to and use of TMs are socioeconomic status and level of education respectively. • TMs must be developed and used to tackle inequities already present among cancer patients instead of widening the gap.

KardioNet Digital - a structured care model involving digital tools for intersectoral communication and a patient-focused strategy for treatment of heart failure

Abstract Introduction Inefficiencies and discontinuities in care at the interfaces within Germany's healthcare system, especially between acute and outpatient care, present significant challenges in managing patients with heart failure (HF). The management complexity of HF has increased with the advent of new digital tools, though patient acceptance of these tools remains contentious. The prevention of loss of diagnostic and therapeutic information for this complex disease is crucial for cross-sectoral communication (hospital - office-based cardiologist - general practitioner) and quality of care. Purpose Our goal was to examine the impact of digital app-supported coordination of HF management across different healthcare providers from hospital discharge to the ambulatory sector and to assess patients' acceptance of a structured care program. A patient-focused digital strategy, supported by a Heart Failure Nurse (HFN), aimed to facilitate structured follow-up and patient empowerment, focusing on patient-reported outcomes and experiences (refer to Table 1). Results Out of 401 patients screened during their hospital stay for HF, only 57 (14.9% male, 12.6% female) participated in the KardioNet Digital (KND) program. NYHA classifications were I (3.5%), II (49.1%), III (40.4%), and IV (7.1%); Diagnoses included CMP (26, 45.6%), CAD (19, 33.3%), valvular HF (8, 14.0%), and others (4, 7.0%). The mean age was 55.03 years, with a notable difference in participation based on age (≥70 years: 9.5% male, 33.3% female; <70 years: 90.5% male, 66.7% female). Age was a significant determinant of program participation. Patients who regularly used the app benefited from several features: A total of 35 alerts (17 patients) were triggered for reasons such as bodyweight increase (2kg or more) and device-induced alerts (i.e. false shock delivery, 3x slow-VT, Syncope), leading the HFN to contact the patients. This early intervention prevented rehospitalization due to decompensation of heart failure in 11 patients (64.7%) and addressed device-related alarms for organizing an emergency hospital visit by HFN. Despite substantial incentives, such as support from an HFN and expedited appointments with specialists for follow-up therapy, refusal rates were high (refer to Table 2). Conclusion A structured, digitally supported cross-sectoral care model for heart failure patients can potentially improve care coordination and outcomes. However, the success of such programs critically depends on patient willingness and the seamless integration into existing healthcare structures. Despite valuable incentives, we observed low acceptance of the program. Even among motivated participants (14.1%), there is a significant need for substantial support and education on digital literacy for the widespread implementation of digital tools in real-world settings for the treatment of heart failure.Workflow of structured digital supportReasons for Declining Participation

Health information seeking and health literacy in midwife-led care and the modern information environment

Abstract Background This review reports on how midwives are affected by the modern digital information environment, including health misinformation, and how their knowledge or competencies assist them in navigating this for themselves and their clients, especially those who are more vulnerable and experience inequities in healthcare. Methods Leveraging a PRISMA-based systematic review, the project identifies the facilitators and barriers that the modern digital information environment poses to midwives and the care they provide to their clients. The search strategy of the peer-reviewed literature examines articles related to midwives and misinformation, social media, information environment, digital health, health information, migrant women and other related keywords that surface in searches. The timeframe from which published articles will be identified for possible inclusion are from Jan 1, 2020 to March 31, 2024. Results Both midwives and the clients they care for experience challenges in navigating the digital information environment and addressing health-related misinformation on reproductive health and pregnancy-related topics. Conclusions Midwives should receive strengthened training on digital literacy to improve the care they provide to clients and help their clients navigate a confusing and rapidly evolving information environment. Through digital and in-person interactions with their clients, midwives can improve their clients’ digital information, and health literacies.

Integrating telemedicine in European healthcare settings: Key enablers for healthcare professionals

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action (JA), we aimed to understand the facilitating factors for the use of telemedicine services in healthcare organisations (HCOs) involved in cancer care, such as comprehensive cancer centres and hospitals. eCAN JA runs pilot studies in 18 HCOs across 10 EU Member States (MS) to test the integration of telemedicine into the daily practice of healthcare professionals. Methods Based on a literature review, we identified 26 facilitators to implement telemedicine services at the organisational level; these were integrated to an online survey and sent to healthcare professionals working in cancer care. Next, they were invited to a foresight workshop to complement the quantitative survey data with qualitative insights. Results 24 healthcare professionals across 12 EU MS, predominantly from the pilot sites of the eCAN JA, responded to the survey. They advocate for trainings on telemedicine, emphasising the importance of user-friendly and interoperable platforms, alongside sufficient technological support, time, and financial resources to effectively implement telemedicine in HCOs. Trial periods for both healthcare professionals and patients should offer first-hand experience, while harmonising telemedicine protocols ensure consistency. In addition, promoting digital literacy among physicians and providing IT education from an early age could facilitate adoption. These strategies, coupled with awareness campaigns and infrastructure investments in HCOs, can pave the way for telemedicine adoption. Conclusions Based on the quantitative and qualitative outcomes, it can be concluded that policies should establish telemedicine training for healthcare professionals, support interoperability and user-friendliness of these services in HCOs. They should also address hospital workload challenges, create harmonised protocols, provide incentives, and invest in digital infrastructure in HCOs for telemedicine adoption. Key messages • Telemedicine implementation in HCOs requires equipping healthcare professionals with the necessary skills, ensuring system compatibility, and addressing resource constraints in HCOs for success. • Financial and infrastructural support to HCOs is crucial for the seamless integration of telemedicine services into the daily workflows of healthcare professionals, enhancing health service delivery.

A new digital model for Italian Integrated Home Care: strengths, barriers, and future implications

Abstract Issue/Problem After the COVID-19 pandemic, Italy’s National Health Service (NHS) is transforming by adopting telemedicine through its National Recovery and Resilience Plan, aiming to modernize healthcare delivery and ensure equity. In this plan Territorial Coordination Centers (COT) were designed to improve patient access and continuity of care. However, regulatory challenges hinder the widespread adoption of telemedicine. Our work describes the technical, structural, and operational aspects of the new Italian Integrated Home Care (IHC) digital model, addressing strengths, barriers, and future implications. Description of the problem The implementation of the IHC digital model faces multiple challenges. Italy’s poor technical infrastructure, especially in rural areas, hampers access to critical services. Resistance to change among rural systems and the elderly, coupled with low digital literacy, inhibits telemedicine adoption. Fragmentation in the NHS leads to resource disparities, particularly disadvantaging southern regions. Italy also grapples with a severe shortage of healthcare professionals, posing a threat to the model’s sustainability. Results The National Digital Health Agency enacts the IHC model by overseeing telemedicine services through a cloud-based protocol. Each Region provides “Basic Telemedicine Services”: healthcare professionals’ and patient teleconsultation, telemonitoring, teleassistance. Communication between services, infrastructures, and local health authorities is facilitated by a modular interoperability layer, ensuring data standards and quality. A national telemedicine dissemination portal will contain data on all telemedicine solutions provided. Lessons Clear communication is essential for telemedicine acceptance. COTs enhance coordination and management. Bridging the technology gap for disadvantaged groups, supporting frontline employees and addressing adoption factors is vital to overcome the challenges faced. Key messages • The National Digital Health Agency drives telemedicine services under the IHC model. Each region offers Basic Telemedicine Services, ensuring data standards, quality and interoperability of data. • Italy’s telemedicine adoption faces poor infrastructure, resistance and workforce shortages. Focusing on equity, healthcare workers support and bridging the technology gap will be key.

BRIDGING THE DIGITAL GAP: ANALYSING THE IMPACT OF ICT DIFFUSION ON INCOME INEQUALITY IN INDONESIA

The development of information and communication technology (ICT) has significantly transformed the socio-economic structure of society, particularly in terms of income distribution. This study aims to analyse the impact of ICT development on income inequality across 34 provinces in Indonesia from 2012 to 2020, employing econometric methods based on panel data through a fixed effects model. Empirical findings reveal that ICT readiness and ICT skills tend to exacerbate income inequality, while ICT use and its quadratic form contribute to reducing it. These results suggest that although ICT infrastructure and skills are crucial, their uneven distribution and utilisation can widen income disparities. Consequently, this study highlights the importance of ensuring equitable access to ICT across Indonesia to mitigate economic inequality. The study's recommendations stress the pivotal role of the government in expanding ICT infrastructure, fostering a research and innovation climate conducive to digital transformation, and formulating policies that enhance ICT skills nationwide. These measures would improve digital literacy, upgrade workforce capabilities, and promote inclusive digital economic growth. Ultimately, comprehensive and equitable ICT development can play a critical role in reducing income inequality across Indonesia.

Leveraging digital tools to enhance diversity and inclusion in clinical trial recruitment

Clinical research is pivotal in assessing the safety and efficacy of new treatments in healthcare. However, the success of such research depends on the inclusion of a diverse and representative participant sample, which is currently lacking. This lack of diversity in biomedical research participants has significant repercussions, limiting the real-world applicability and accessibility of medical interventions, especially for underrepresented groups. Barriers to diverse participation include historical mistrust, logistical challenges, and financial constraints. Recent guidelines by government agencies and funding bodies emphasize the need for diversity in clinical trials, but specific strategies for inclusive recruitment are often lacking. This paper explores the use of digital methods to enhance diversity and inclusion in research recruitment. Digital tools, such as electronic medical records, social media, research registries, and mobile applications, offer promising opportunities for reaching diverse populations. Strategies include culturally tailored messaging, collaborations with community organizations, and the use of SEO to improve visibility and engagement. However, challenges such as privacy concerns, digital literacy gaps, and ethical considerations must be addressed. The promotion of diversity in clinical research recruitment is crucial for advancing health equity. By leveraging digital tools and adopting inclusive strategies, study teams can improve the diversity of study participants, ultimately leading to more applicable and equitable healthcare outcomes.

Reform Paths of College English Course Teaching in the Digital Age

With the rapid development of digital technology, the teaching mode of English courses in colleges and universities is facing profound changes and challenges. This paper takes the significance of the reform of English course teaching in colleges and universities in the digital era as the starting point and aims at the problems existing in the teaching concept, digital teaching infrastructure, and digital literacy of the teaching staff in the current construction of English courses in colleges and universities. It proposes strategies such as changing teaching thinking, strengthening infrastructure construction and resource integration, and improving the digital ability of the teaching staff, which provides some references for promoting the modernization transformation of English course teaching in colleges and universities in China.

Public Perceptions and Engagement in mHealth Across Eight European Countries

Abstract Background Mobile health technologies have the potential to revolutionize healthcare delivery and patient engagement. This study explores public attitudes toward health app usage and data sharing across eight European countries, addressing a significant gap in understanding the public’s perspective on mHealth adoption. Methods A cross-sectional survey was conducted involving 6,581 participants from Italy, the Netherlands, France, Germany, Spain, Poland, Romania, and Hungary. The survey assessed current health app usage, future interest, willingness to share health data, and concerns about data privacy and security. Results 21.87% of respondents currently use health apps, with 42.71% expressing interest in future use. Regarding data sharing, 52.82% are willing to share health data with healthcare providers, and 25.48% would share data with research institutions. However, 53.18% fear unauthorized use or hacking of their health data. Significant generational and geographical differences in mHealth engagement were observed, with older generations showing higher willingness to adopt health apps OR 1.22 (CI 1.03 - 1.46) for Baby Boomers, OR 1.45 (CI 0.97 - 2.16) for Silent Generation. Education level emerged as a crucial factor, with tertiary-educated individuals more likely to use health apps (OR 1.41 CI 1.24 - 1.58) and demand transparency (OR 1.61 CI 1.45 -1.78). Conclusions The findings underscore the need for targeted strategies to enhance digital literacy, ensure data privacy, and promote equitable access to mHealth technologies across Europe. Policymakers and healthcare stakeholders should prioritize these areas to foster greater public trust and engagement in mHealth, ultimately improving health outcomes and patient care. Key messages • Public attitudes toward mHealth vary significantly across generations, countries, and education levels in Europe. • Addressing data privacy concerns and enhancing digital literacy are crucial for widespread mHealth adoption.

Assessing the Importance of Digital Literacy as a 21st Century Skill among TVET Educators

Assessing the Importance of Digital Literacy as a 21st Century Skill among TVET Educators

Exploring the Relationship between Individual Information Technology Ethics and Netizenship Behaviors

In the digital age, information technology (IT) ethics plays a critical role in shaping netizenship behavior within online communities. This concept paper examines the relationship between individual IT ethics and netizenship behavior and emphasizes how ethical principles guide responsible and constructive participation in digital spaces. Based on theoretical frameworks such as the Theory of Planned Behavior (TPB) and Digital Citizenship, the article examines the influence of ethical IT practices on positive netizenship, including factors such as digital literacy, hierarchical influence and cultural or religious values. The review shows that people with strong IT ethics are more likely to engage in responsible online behavior, promoting healthier digital environments. By identifying gaps in the existing literature, the paper proposes a conceptual model to guide future empirical research on how ethical IT use influences digital citizenship. The findings highlight the importance of promoting IT ethics and digital literacy to improve online interactions and contribute to more engaged, respectful and responsible digital communities.

The Impact of Social Media on Mental Health of Young Adults: A Literature Review

This concept paper explores the complex relationship between social media usage and the mental health of young adults. The paper introduces the notion of social media and its significance in the lives of young adult, emphasizing the importance of studying its effects on their mental health and psychological well-being. Social media platforms have become an integral part of daily activities in the lives of young people. It has also become an invasive element in the lives of youth, shaping their social interactions, self-perception, and access to lots of information. Even though these platforms offer opportunities for social connection, creative expression, and educational engagement, they also present significant mental health challenges, including anxiety, depression, and low self-esteem, which are often driven by social comparison, cyberbullying, and the pressure to maintain an idealized online image. The paper investigates key areas of concern, including the rise of anxiety, depression, and low self-esteem linked to social comparison, cyberbullying, and the relentless pursuit of online validation. It also examines the addictive nature of social media, its impact on sleep, and the destruction of face-to-face social skills. By analysing existing literature and identifying research gaps, this paper aims to provide a comprehensive framework for understanding the two-edged nature of social media's influence on mental health. It advocates for the development of digital literacy programs, mental health support systems, and balanced usage strategies to help young people navigate the challenges posed by social media while maximizing its potential benefits.

The Impact of Student Attitude on Information, Communication, Creation Skills and Student Engagement

The Malaysian education system is guided by the Malaysia Education Blueprint, which drives the overall quality and effectiveness of education in the country. This study provides insights and assists in forming informed guidelines for the Ministry of Education regarding the impact of skill factors. The relationship between the direct effects of these three primary skills and attitudes is supported by Self-Efficacy Theory (SET). The indirect relationship, where attitude mediates the effects of these skills on student engagement, is supported by Self-Determination Theory (SDT) and Social Cognitive Theory (SCT). A questionnaire was distributed to local university students currently in their fourth semester and analyzed using the Structural Equation Model using Partial Least Square (PLS). The structural model results direct relationship between attitude and student engagement and between information skills and attitude. In addition, the mediation analysis shows that the relationship between information skills and student engagement, mediated by student attitude, was significant. Based on these results, it is recommended that the Ministry of Education focus on providing supportive resources, such as learning environments and training for educators, in the upcoming Malaysia Education Blueprint for 2026 to 2036. Additionally, offering Digital Literacy Programs to equip students with information skills can positively influence student attitudes and thereby increase the level of student engagement, which is crucial for improving the academic performance and achievement of Malaysia’s educational system. Future research should include a cross-cultural comparison to reconsider educational theories for Asian countries, as many theories are currently based on Western educational settings and contexts.

The Influence of Social Media on the Formation of Student Morals in the Digital Era

This study aims to investigate the influence of social media use on the formation of students' morals in the digital era. The problem raised is how social media affects students' moral values and character. The method used in this study was a survey involving 60 respondents from among students. The results of the study showed that the use of social media has a significant and positive influence on the formation of students' morals, where the more often students use social media, the greater the impact on the development of their character and moral values. The conclusion of this study confirms that social media not only functions as a means of communication and entertainment, but also as a socialization agent that plays an important role in the development of students' character. The implications of these findings indicate the need for integration of digital literacy into the school curriculum, parental involvement in monitoring children's use of social media, and recommendations for policy makers to design regulations and educational programs that encourage healthy use of social media. Thus, the positive impact of social media on the formation of students' morals can be maximized, while its negative potential can be minimized.