eHealth Interventions Research Articles

Abstract B143: Associations between the food environment and food insecurity on fruit and vegetable intake among urban-dwelling Latina breast cancer survivors participating in the Mi Vida Saludable trial

Abstract Socioeconomic disparities prevalent in Hispanic populations may cause inequities in cancer outcomes and risk factors. We explored the association of access to healthy foods (AHF) and food insecurity (FI) with changes in fruit and vegetable (FV) intake in Latina breast cancer (BC) survivors living in New York City who participated in the Mi Vida Saludable trial. Mi Vida Saludable was a 2x2 factorial trial (n=167) that tested the effects of an in-person and/or eHealth intervention on FV intake and physical activity (PA). Main study results showed only the in-person intervention had modest increases in FV intake. Eligibility criteria included being female, self-identifying as Latina/Hispanic, ³18 years old, history of stage 0-III BC, >3 months post-treatment, <5 daily serving of FV and/or <150 minutes/week of moderate-vigorous PA. FV intake was assessed via 3 24-hour diet recalls at baseline and 12 months. AHF was from a modified validated Access to Healthy Food scale. FI was assessed via questions about eating less or going hungry due to lack of money. Generalized estimating equations examined whether baseline AHF and FI were associated with change in daily FV intake, adjusting for baseline age, marital status, education, and study arm. Three-way interaction terms (AHF or FI with time and study arm) were included to test if associations of AHF and FI with change in FV intake varied by intervention arms. FV intake was log-transformed due to a non-normal distribution; percent changes from baseline were described. AHF was measured in 86 women with 58% and 42% reporting low-medium and high access, respectively. Women with high AHF were more likely to be older (59 vs. 53 years, p=.002) and scored lower on a 5-point acculturation scale (higher score suggests higher acculturation, 1.8 vs. 2.1, p=.01). FI, measured in 157 participant, was prevalent in 23% of women. Women with FI were more likely to be single (44% vs. 16%, p=.003), renting (100% vs. 86%, p=.02), and have higher mean BMI (31 vs. 29 kg/m2, p=.02). 3-way interactions were not statistically significant, though analyses were likely underpowered. In the control group, the adjusted daily FV intake decreased by 79% (p=.01) from baseline to 12 months for women with low-medium AHF and by 49% (p=.10) for those with high AHF; similarly, daily FV intake decreased by 64% (p=.01) for women with FI and by 58% (p=.01) for women without FI. Most Latina BC survivors in New York City who participated in a 12-month diet and PA intervention trial had low-medium AHF at baseline; nearly 1/4 had FI. Associations of AHF or FI with changes in FV intake did not vary significantly by study arm, although sample sizes across strata were small. In the control arm, women with low-medium AHF and FI had larger decreases in FV intake after 12 months. Future dietary intervention studies in Latina BC survivors, and other underserved or under-resourced populations, should account for AHF and FI in the study design, and develop strategies to connect people to healthy food resources. Citation Format: Zachary O. Kadro, Eileen Rillamas-Sun, Blake Langley, Pam Koch, Isobel Contento, Ann Ogden Gaffney, Allison Meisner, Heather Greenlee. Associations between the food environment and food insecurity on fruit and vegetable intake among urban-dwelling Latina breast cancer survivors participating in the Mi Vida Saludable trial [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B143.

Designing for social relatedness between stroke survivors and eHealth: ‘Edo’ an embodied coach for stroke rehabilitation in the home context

eHealth solutions at home are gaining interest and relevance in healthcare; however, they face challenges in sustaining motivation for therapy due to difficulties in creating meaningful connections between technology and people receiving care. In this article, we explore how embodied agents in eHealth interventions could be designed to establish a motivating relationship with people in the context of home-based stroke rehabilitation. We studied this potential by referring to the need for social relatedness in Self-Determination-Theory (SDT) and how this translates to the design of embodied agents’ characters, the collaborations they afford and the partnerships they establish over time. In co-creative ideation sessions with stroke survivors, this potential was explored, resulting in an interactive prototype of ‘Edo the Coach’, i.e. an embodied agent for home-based upper extremity stroke rehabilitation that was evaluated by stroke survivors in their home contexts. Based on the insights gained, we reflect on the potential of using SDT for designing embodied agents that foster motivational relationships between patient and agent as an answer to the growing demand for eHealth-supported self-care within an increasingly digitized healthcare context.

Promoting precision health using fitness wearable and apps among breast cancer survivors: Protocols of a smart health management trial

BackgroundAnnually, approximately 1.7 million women are diagnosed with breast cancer worldwide. Engaging in regular physical activity (PA) post-diagnosis brings significant health benefits, enhancing breast cancer survivors' (BCS) prognosis and overall health-related quality of life (HRQoL). Despite these benefits, a low percentage of Chinese BCS adhere to the recommended moderate-to-vigorous PA levels. This highlights the need for innovative PA interventions tailored for BCS management. eHealth technology, such as fitness wearables and apps, presents an opportunity to improve BCS healthcare by offering personalized exercise programs. MethodsThis study focuses on developing a precision eHealth PA program for 200 Chinese BCS in Guangdong Province, using a custom micro-application and a smart band for a 12-month trial. All participants will receive a Huawei Smart Band and be divided into 1) a personalized intervention group, receiving daily PA tracking and feedback, and 2) a control group receiving standard care. The primary outcome is PA and secondary outcomes include biomarkers, weight and body composition, functional fitness, HRQoL, and individual beliefs. Outcomes will be assessed at baseline, 6 months, and 12 months (endpoint). Successful outcomes could revolutionize PA programs for Chinese BCS, providing a model for future eHealth interventions.

Attrition of older adults in web-based health interventions: Survival analysis within an observational cohort study.

To identify demographics and personal motivation types that predict dropping out of eHealth interventions among older adults. We conducted an observational cohort study. Participants completed a pre-test questionnaire and got access to an eHealth intervention, called Stranded, for 4 weeks. With survival and Cox-regression analyses, demographics and types of personal motivation were identified that affect drop-out. Ninety older adults started using Stranded. 45.6% participants continued their use for 4 weeks. 32.2% dropped out in the first week and 22.2% dropped out in the second or third week. The final multivariate Cox-regression model which predicts drop-out, consisted of the variables: perceived computer skills and level of external regulation. Predicting the chance of dropping out of an eHealth intervention is possible by using level of self-perceived computer skills and level of external regulation (externally controlled rewards or punishments direct behaviour). Anticipating to these factors can improve eHealth adoption.

Engagement analysis of a persuasive-design-optimized eHealth intervention through machine learning

The challenge of sustaining user engagement in eHealth interventions is a pressing issue with significant implications for the effectiveness of these digital health tools. This study investigates user engagement in a cognitive-behavioral therapy-based eHealth intervention for procrastination, using a dataset from a randomized controlled trial of 233 university students. Various machine learning models, including Decision Tree, Gradient Boosting, Logistic Regression, Random Forest, and Support Vector Machines, were employed to predict patterns of user engagement. The study adopted a two-phase analytical approach. In the first phase, all features of the dataset were included, revealing ‘total_minutes’—the total time participants spent on the intervention and the eHealth platform—as the most significant predictor of engagement. This finding emphasizes the intuitive notion that early time spent on the platform and the intervention is a strong indicator of later user engagement. However, to gain a deeper understanding of engagement beyond this predominant metric, the second phase of the analysis excluded ‘total_minutes’. This approach allowed for the exploration of the roles and interdependencies of other engagement indicators, such as ‘number_intervention_answersheets’—the number of completed lessons, ‘logins_first_4_weeks’—login frequency, and ‘number_diary_answersheets’—the number of completed diaries. The results from this phase highlighted the multifaceted nature of engagement, showing that while ‘total_minutes’ is strongly correlated with engagement, indicating that more engaged participants tend to spend more time on the intervention, the comprehensive engagement profile also depends on additional aspects like lesson completions and frequency of platform interactions.

Exploring the impact of digital distrust on user resistance to e-health services among older adults: the moderating effect of anticipated regret

This study investigates the factors influencing user resistance to e-health services among older adults, focusing on the role of information inequality, digital distrust, low self-efficacy, perceived risk, and social influence. Structured questionnaires were used to gather data from 301 older adult participants, and the structural equation modeling method was used to analyze the results. The results show that digital distrust, perceived risk, and user resistance have a significant positive relationship, underscoring the significance of resolving trust and risk concerns in e-health interventions. The study also finds that the association between digital distrust and user resistance is moderated by anticipated regret, indicating that people who anticipate regretting not adopting electronic health services are less likely to oppose digital technologies despite their distrust. Surprisingly, the study did not find support for the hypothesized relationship between information inequality and user resistance, indicating the need for further exploration of this complex relationship. The study contributes to a better understanding of the factors influencing user resistance to e-health services among older adults, offering valuable insights for policymakers and practitioners seeking to promote the adoption of digital health technologies in aging populations.

EHealth Platforms Facilitate Prostate Cancer Shared Care: A Systematic Review.

Prostate cancer survivorship care is essential for the early identification of cancer recurrence and progression and the monitoring of adverse effects. Prostate cancer survivorship programs have enabled care to be shared between specialists using digital healthcare platforms. We systematically reviewed the literature to examine if prostate cancer survivorship care had been successfully digitalised. English language articles were searched on PubMed, Embase, and Cochrane Libraries. The search terms included combinations of "eHealth", "digital health", "prostate cancer", "shared care", and related keywords (studies published between [1 January 1946 and 20 March 2023]). Our search strategy yielded 1722 publications, of which 17 studies were included in our final review. Diverse eHealth interventions (web platforms, apps, patient portals) for digital prostate cancer shared care enabled communication, symptom management, and holistic assessment, with potential for reducing anxiety, enhancing outcomes, and increasing engagement. The studies (9 months to 5 years duration) involved participants across different care phases (16 to 3521 participants). We identified ten eHealth platforms, which provided successful symptom tracking, needs assessment, and communications. The platform-based interventions improved some aspects of communication, symptom management, and care delivery. The ongoing clinical need for a robust digital platform that caters to all domains of shared care was identified. eHealth will certainly play a central role in digital prostate cancer shared care, providing better health outcomes and care delivery. Future larger studies in this field should address the implementation barriers, including cost-effectiveness and primary care remuneration. It is also crucial to refine application useability and workflow, focusing on standardization and patient-centred approaches.

The SoCAP (Social Communication, Affiliation, and Presence) Taxonomy of Social Features: Scoping Review of Commercially Available eHealth Apps.

eHealth interventions have proven to be valuable resources for users with diverse mental and behavioral health concerns. As these technologies continue to proliferate, both academic researchers and commercial app creators are leveraging the use of features that foster a sense of social connection on these digital platforms. Yet, the literature often insufficiently represents the functionality of these key social features, resulting in a lack of understanding of how they are being implemented. This study aimed to conduct a methodical review of commercially available eHealth apps to establish the SoCAP (social communication, affiliation, and presence) taxonomy of social features in eHealth apps. Our goal was to examine what types of social features are being used in eHealth apps and how they are implemented. A scoping review of commercially available eHealth apps was conducted to develop a taxonomy of social features. First, a shortlist of the 20 highest-rated eHealth apps was derived from One Mind PsyberGuide, a nonprofit organization with trained researchers who rate apps based on their (1) credibility, (2) user experience, and (3) transparency. Next, both mobile- and web-based versions of each app were double-coded by 2 trained raters to derive a list of social features. Subsequently, the social features were organized by category and tested on other apps to ensure their completeness. Four main categories of social features emerged: (1) communication features (videoconferencing, discussion boards, etc), (2) social presence features (chatbots, reminders, etc), (3) affiliation and identity features (avatars, profiles, etc), and (4) other social integrations (social network and other app integrations). Our review shows that eHealth apps frequently use resource-intensive interactions (eg, videoconferencing with a clinician and phone calls from a facilitator), which may be helpful for participants with high support needs. Furthermore, among commercially available eHealth apps, there is a strong reliance on automated features (eg, avatars, personalized multimedia, and tailored content) that enhance a sense of social presence without requiring a high level of input from a clinician or staff member. The SoCAP taxonomy includes a comprehensive list of social features and brief descriptions of how these features work. This classification system will provide academic and commercial eHealth app creators with an understanding of the various social features that are commonly implemented, which will allow them to apply these features to enhance their own apps. Future research may include comparing the synergistic effects of various combinations of these social features.

Evaluating the SEND eHealth Application to Improve Patients' Secure Message Writing.

Secure messaging (SM) is an important aspect of communication for patients with cancer. SM fosters patient-clinician communication and helps patients with symptom management and treatment support. However, patients are uncertain about how to phrase messages appropriately and have expressed the need for guidance. In response, we designed a user-centered, web-based application named SEND The application focuses on specificity, expression, needs, and directness through interactive video tutorials and quizzes. Our objective was to comprehensively evaluate SEND based on its levels of engagement, satisfaction, acceptability, and appropriateness. We recruited 101 patients with various cancer diagnoses to use SEND and then fill out a survey 1 to 2weeks later about their experience. Patients' mean age was 64years; most were male (55%), white (83%), diagnosed with cancer in 2020 with high levels of self-efficacy, and 51% had a bachelor's degree or higher. 65% were engaged in the application, and respondents spent an average of 15min interacting with SEND Satisfaction was 90.4%, 85.4% found it acceptable, and 88.6% appropriate. There were no statistically significant differences across age, sex, race, education, or year of diagnosis. Results underscore the potential of eHealth interventions, like SEND, in enhancing patient-clinician communication in cancer care. By empowering patients with effective message-writing techniques, SEND has the potential to improve the quality of SM, which can lead to faster response times and more patient-centered responses.

Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis

ABSTRACT The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.

User-Centered Design of Neuropsychological eHealth Interventions

User-Centered Design of Neuropsychological eHealth Interventions

The roadblocks to success – Identifying challenges in implementing a surgery support E-health solution: A qualitative interview study

BackgroundSurgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application. MethodsThis study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts. ResultsA total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs. ConclusionThis paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.

Towards a best practice framework for eHealth with Aboriginal and Torres Strait Islander peoples - important characteristics of eHealth interventions: a narrative review.

This narrative review discusses the important characteristics of electronic health (eHealth) interventions and critiques the cultural quality of eHealth research with Aboriginal and Torres Strait Islander peoples. Thirty-nine publications reporting on a variety of eHealth modalities to address health challenges with Aboriginal and Torres Strait Islander people were identified. Content analysis signified authentic co-design, governance and strong partnerships as foundational qualities of eHealth interventions that are culturally safe and sustainable. The pragmatics of eHealth setting, content and engagement must be underscored by trust, responsiveness and cultural values. The application of the Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) revealed higher scores for studies with two or more Aboriginal and Torres Strait Islander authors. This narrative review is fundamental to the development of a best practice framework for eHealth interventions with Aboriginal and Torres Strait Islander people that are culturally safe, sustainable and effective. With a foundation of Aboriginal and Torres Strait Islander governance with strong partnerships for authentic co-design, eHealth interventions are more likely to meet the priorities and values of the Aboriginal and Torres Strait Islander communities for which they are intended.

Factors influencing use of eHealth services during and after the COVID-19 pandemic.

The rapid advancement of information and communication technologies has made eHealth applications increasingly available and accessible. The COVID-19 pandemic has accelerated the need for remote health service provision. This research aims to explore the usage, perceptions, and knowledge of eHealth interventions during and after the COVID-19 pandemic. A cross-sectional survey was conducted in 2021 (during the pandemic) and 2023 (post-pandemic) using a structured questionnaire based on the Technology Acceptance Model (TAM) and the eHealth Literacy Scale (eHEALS). The survey, conducted in Greece, included 638 participants in total (277 in 2021 and 361 in 2023). Structural equation modeling was employed to assess the factors influencing eHealth adoption. The findings indicate a slight increase in positive perceptions of eHealth usefulness, intention to use, and actual usage over the 2years. However, concerns remain regarding the ease of use and eHealth literacy. eHealth literacy significantly predicts the perceived usefulness and ease of use of eHealth services, both of which predict the intention to use them. Additionally, higher education levels are positively associated with eHealth literacy, while older age is negatively associated with ease of use. Gender did not significantly impact these factors. These findings were consistent across both surveys. Policy-makers should focus on simplifying eHealth services, removing technical barriers, and enhancing the population's eHealth literacy to promote wider adoption of eHealth services.

Physicians' Views of a Digital Intervention to Support Respiratory Patients: Take-a-Breath Pre-Pilot Usability Study.

Although eHealth interventions are increasingly recognized as a useful tool to support healthcare, relatively few studies focus on the physician-end's usability. This study aims to evaluate the Healthcare Professional's (HCP) platform of the Take-A-Breath project, a Greek initiative for personalized respiratory disease monitoring, training and self-management. The pre-pilot usability study, involving 10 participants, combines qualitative methods, behavioral observations, and standardized measures of user experience and usability. While relatively high scores indicate overall acceptance, concerns are also discussed, particularly related with the volume of information provided and actions available to the users, hindering the usability of the system due to an overload effect. Findings emphasize also the need for more tailored in-app wordings as well as the integration of similar systems with the already set up electronic health record systems. This study contributes to understanding digital intervention success among HCPs in respiratory healthcare.

RESTART: a stepped-care approach to facilitate return to work for employees with psychological distress: design of a randomized controlled trial

BackgroundCommon mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees’ cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process.MethodsRESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted.DiscussionEarly intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole.Trial RegistrationISRCTN: 90663076. Registered on 5 October 2023.

E-Health Family Interventions for Parents of Children With Autism Aged 0-6 Years: A Scoping Review.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in infancy. Early intervention is critical to improve the prognosis for these children. E-health interventions have tremendous potential. This review aimed to determine the status and effectiveness of family interventions for parents of children aged 0-6 years with ASD in the context of e-health. The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Web of Science, and China National Knowledge Infrastructure were searched from inception to June 2022. The searches were limited to children with ASD of the age range between 0 and 6 years. We collated the available information and used descriptive statistics to analyze the synthesized data. Our initial search identified 3,672 articles, of which 30 studies met the inclusion criteria. The 30 articles selected were released between 2012 and 2022. All articles are in English. Most articles reviewed were from high-income countries (27/30, 90.0%), especially from the United States (16/30, 53.3%). Four major themes emerged from the 30 studies that matched the inclusion criteria, as follows: 1) type of e-health interventions, 2) duration of interventions, 3) clinical aspects of e-health interventions, and 4) evidence for intervention effectiveness, looking into the positive, negative, and mixed findings of previous studies. These findings suggest that a wide variety of e-health interventions may actually help support both children with ASD aged 0-6 years and their parents.

Economic evaluations of eHealth interventions targeting mental health problems in the workplace: a systematic review.

Work-related mental health problems impose significant economic and personal burdens. eHealth interventions may offer low-cost, practical solutions, but guidance on their cost-effectiveness in workplace mental health is limited. The objective of this study was to systematically review economic evaluations of workplace eHealth interventions for mental health, offering insights into methodologies and cost-effectiveness outcomes. Adhering to PRISMA guidelines, searches were conducted in Embase, MEDLINE, Web of Science, Google Scholar, Cochrane library, PsycInfo and EconLit databases in May 2022, selecting peer-reviewed papers that performed economic evaluations on workplace eHealth interventions for adult mental health. Quality was assessed using the Drummond checklist. From 3213 references, eight met the inclusion criteria. These studies varied in economic perspective, types of economic analysis type, primary outcome measures, intervention focus (e.g. stress, alcohol, insomnia & return-to-work) and direct non-medical costs. Five eHealth interventions were found to be cost-effective and/or have a positive return on investment, with seven studies rated as high quality according to the Drummond checklist. The study outcomes unveiled the potential cost-effectiveness of eHealth interventions targeting mental health issues, particularly these focusing on workplace stress. However, generalization is challenging due to variations in the methodologies across studies.

Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey.

eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02-15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community.

E-Health Interventions to Improve Health Outcomes in Patients with Systemic Lupus Erythematosus: A Systematic Review.

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that involves damage to one or more organs and systems. E-Health technologies have been used to improve the quality of care and to minimize the cost of rehabilitation services. This study aimed to provide the most recent and convincing evidence on the rehabilitation effects of e-Health interventions compared to conventional treatments. A systematic review was conducted. Inclusion criteria were defined following PICO recommendations (i.e., populations, intervention, comparison and outcome measures). Methodological quality and risk-of-bias were assessed for each study. Six studies met the inclusion criteria, providing data on 743 individuals with SLE. Results indicated that e-Health interventions improved health outcomes, such as disease management or emotional status. Methodological quality was moderate and low risk-of-bias was found in the majority of the studies included. For patients with SLE, e-Health interventions are a safe rehabilitation intervention to improve health outcomes. However, more high-quality studies with large samples are needed, with a focus on the long-term outcomes of e-Health interventions for patients with SLE.