eHealth Literacy Scale Research Articles

The eHealth literacy scale (eHEALS): is it suitable for health education nursing officers in Sri Lanka?

The eHealth literacy scale (eHEALS): is it suitable for health education nursing officers in Sri Lanka?

EVERYDAY DIGITAL LITERACY QUESTIONNAIRE (EDLQ): DEVELOPMENT AND VALIDATION FOR KOREAN OLDER ADULTS

Abstract Aging in the digitalizing society demands digital literacy, a core competency that involves identifying, evaluating, and communicating information using various digital devices or relevant programs. This study aimed to develop the Everyday Digital Literacy Questionnaire [EDLQ], a scale to assess digital literacy, and to evaluate its psychometric properties among community-dwelling older adults in South Korea. The EDLQ was developed using an instrument development design. A nationwide survey was conducted in 1,016 community-dwelling older adults aged 60 to 94 years. To evaluate psychometric properties, following analyses were conducted in two randomly selected subsamples (n=508 per each): internal consistency (Cronbach’s alpha), construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]), and concurrent validity with the eHealth Literacy Scale (e-HEALS). Among initial 30 items of the EDLQ, 22 items with a 3-factor solution showed 77% of explained variance in total. The subscales includes “Information and Communication” (9 items), “Contents Creation and Management” (4 items) and “Safety and Security” (9 items). CFA was conducted with this 3-factor solution (χ²/df=1.675, CFI=0.997, TLI=0.997, RMSEA=0.036, SRMR=0.050, CR=0.903-0.959, AVE=0.699−0.724, r²=0.616−0.773). Concurrent validity with the e-HEALS demonstrated a strong correlation (r=0.75). The Cronbach’s α coefficient was .98. Our study findings suggest psychometric properties of the 22-item EDLQ is valid and reliable to assess digital literacy for everyday technology use in Korean older adults. The EDLQ will be useful while developing technology-based interventions for community-dwelling older adults.

Construct Validity and Measurement Invariance of the eHEALS in a Diverse US High School Sample

Abstract: Although the eHealth Literacy Scale (eHEALS) is a widely used measure of eHealth literacy (eHL), it has not been validated in a diverse sample of US adolescents. This study assessed the construct validity and item and measurement invariance of the eHEALS using both Rasch analyses and classical test theory (CTT). Data were collected from adolescents at a US Northeastern high school ( N = 355, 64.9% were 16–18-years old, 54.8% male, 76.4% from a racially minoritized group, and 50.5% Latinx). Adolescents completed a survey that included demographic variables (i.e., age in years, gender, and ethnicity) and the eHEALS. Using Rasch and CTT methodologies, the dimensionality of the eHEALS and item and measurement invariance across gender, age, and ethnicity were assessed. The unidimensional structure of the eHEALS as well as item and measurement invariance across gender, age, and ethnicity were supported. Rasch analyses also suggested that responses to eHEALS items can be summed to determine eHL abilities, although there was a ceiling effect. The eHEALS is a unidimensional measure of eHL that may provide information in health education settings about adolescents’ eHL skills. It performs similarly across male and female as well as older and younger adolescents. However, given the ceiling effect and changes in adolescents’ Internet use since its development, future studies should revise the eHEALS to better capture adolescents’ eHL abilities. Future studies should also examine item and measurement invariance by age (in years), race, family income, and longitudinally to determine the usefulness of the measure across groups and time.

Structural Validation and Measurement Invariance Testing of the Chinese Version of the eHealth Literacy Scale Among Undergraduates: Cross-Sectional Study.

The eHealth Literacy Scale (eHEALS) was introduced in China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention, although its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multigroup measurement properties. This study aimed to evaluate the Chinese version of the eHEALS in terms of its measurement properties. A cross-sectional survey was conducted in a university setting in China. Item statistics were checked for response distributions and floor and ceiling effects. Internal consistency reliability was confirmed with Cronbach α, split-half reliability, Cronbach α if an item was deleted, and item-total correlation. A total of 5 representative eHEALS factor structures were examined and contrasted using confirmatory factor analysis. The study used the item-level content validity index (I-CVI) and the average of the I-CVI scores of all items on the scale to assess the content validity of the dominance model. Furthermore, the validated dominance model was subsequently used to evaluate the relevance and representation of elements in the instrument and to assess measurement invariance across genders. A total of 972 respondents were identified, with a Cronbach α of .92, split-half reliability of 0.88, and item-total score correlation coefficients ranging from 0.715 to 0.781. Cronbach α if an item was deleted showed that all items should be retained. Acceptable content validity was supported by I-CVIs ≥0.80. The confirmatory factor analysis confirmed that the 3-factor model was acceptable. The measurement model met all relevant fit indices: average variance extracted from 0.663 to 0.680, composite reliability from 0.810 to 0.857, chi-square divided by the df of 4.768, root mean square error of approximation of 0.062, standardized root mean squared residual of 0.020, comparative fit index (CFI) of 0.987, and Tucker-Lewis index of 0.979. In addition, the scale demonstrated error variance invariance (Δnormed fit index=-0.016, Δincremental fit index=-0.012, ΔTucker-Lewis index=0.005, Δcomparative fit index=-0.012, Δrelative fit index=0.005, and Δroot mean square error of approximation=0.005). A 3-factor model of the Chinese version of the eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender.

Digital Technology Characteristics and Literacy Among Families With Children With Asthma: Cross-Sectional Study.

The use of digital technology in pediatric asthma management has emerged as a potential tool for improving asthma management. However, the use of digital tools has the potential to contribute to the inequitable delivery of asthma care because of existing social factors associated with asthma disparities. Our study focused on parents' chosen language and sociodemographic factors that might shape the use of digital technology in asthma self-management. This study aims to estimate and compare patient, family, and technology-related characteristics by parents' chosen language (English or Spanish) and compare a digital literacy measure by sociodemographic factors. Survey data were collected from July to December 2021 from parents of children with asthma who were seen by a Chicago pediatric health system pulmonary provider. Questions assessed patient and family characteristics, digital technology use, and digital literacy, measured using the validated eHealth Literacy Scale (eHEALS). Chi-square tests and multivariable logistic regression were used for comparisons, and Kruskal-Wallis tests were used for comparing median eHEALS scores by social characteristics. Of the 197 parents surveyed, 24.4% (n=49) of parents identified as a race categorized as other, 37.1% (n=67) as White, and 38.6% (n=75) as Black; 47.2% (n=93) identified as Hispanic/Latino/Latina. Additionally, 79.7% (n=157) of parents preferred English, and 20.3% (n=40) preferred Spanish. English-speaking parents were more likely to report having a data plan for their smartphone (117/157, 74.5%) or high-speed internet (138/157, 87.9%) compared to Spanish-speaking parents (smartphone: 23/40, 58%; P=.03; internet: 27/40, 68%; P=.002). Compared with Spanish-speaking parents, English-speaking parents were less likely to report having a lot or some concern about paying for internet (28/40, 70% vs 83/157, 52.9%; P=.046) or about data privacy (35/40, 88% vs 105/157, 67.5%; P=.01). Digital literacy scores differed significantly by race, income, education level, and language. In a multivariable model, language was not a significant factor for having high-speed internet service (P=.12) or concern about paying for internet at home (P=.60), but it was a significant factor for concerns about data privacy (P=.04). The significant differences in technology-related characteristics suggest that digital connectivity, affordability, and data privacy may also be important factors in considering digital technology use in asthma care.

Data management in the digital health environment scale development study*

PurposeThis study aims to develop a scale that measures individuals' perceptions of privacy, security, use, sharing, benefit and satisfaction in the digital health environment. MethodWithin the scope of the study, in the scale development process; The stages of literature review, creation of items, getting expert opinion, conducting a pilot study, ensuring construct and criterion validity, and reliability analyses were carried out. The literature was searched for the formation of the question items. To evaluate the created question items, expert opinion was taken, and the question items were arranged according to the feedback from the experts. In line with the study's purpose and objectives, the focus group consisted of individuals aged 18 and above within the community. The convenience sampling method was employed for sample selection. Data were collected using an online survey conducted through Google Forms. Before commencing the survey, participants were briefed on the research's content. A pilot study was conducted with 30 participants, and as a result of the feedback from the participants, eliminations were made in the question items and the scale was made ready for application. The research was conducted by reference to 812 participants in the community. Expert evaluations of the question items were obtained, and a pilot study was conducted. A sociodemographic information form, a scale developed by the researcher, Norman and Skinner's e-Health Literacy Scale, and the Mobile Health and Personal Health Record Management Scale were used as data collection tools. Results: The content validity of the research was carried out by taking expert opinions and conducting a pilot study. Exploratory factor analysis and confirmatory factor analysis were performed to ensure construct validity. The total variance explained by the scale was 60.43%. The results of confirmatory factor analysis indicated that the 20-Item 5-factor structure exhibited good fit values. According to the analysis of criterion validity, there are significant positive correlations among the Data Management in the Digital Health Environment Scale, Norman and Skinner’s e-Health Literacy Scale and the Mobile Health and Personal Health Record Management Scale (p < 0.01; r = .669, .378). The Cronbach's alpha value of the scale is .856, and the test–retest reliability coefficient is .909. Conclusion: The Data Management in the Digital Health Environment Scale is a valid and reliable measurement tool that measures individuals' perceptions of privacy, security, use, sharing, benefit and satisfaction in the digital health environment.

Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

Association Between eHealth Literacy and Health Education Experiences and Confidence Regarding Online Health Information Among Nurses: A Cross-sectional Study.

This cross-sectional study examined nurses' eHealth literacy, health education experiences, and confidence in health education regarding online health information and explored their association. A self-administered questionnaire was distributed among 442 nurses in Japan from September 2020 to March 2021. The survey items were the Japanese version of the eHealth Literacy Scale, health education experiences and confidence in health education regarding online health information, and sociodemographic variables. The final analysis comprised 263 responses. Nurses' mean eHealth literacy was 21.89. Most nurses had never received questions regarding online health information in search (66.9%), evaluation (85.2%), and utilization (81.0%) from their patients. Further, most nurses lacked experience (84.0%-89.7%) and confidence (94.7%-97.3%) in health education regarding online health information. The factor associated with having health education experience regarding online health information was eHealth literacy (adjusted odds ratio, 1.08; 95% confidence interval, 1.02-1.15). Factors associated with having confidence in health education regarding online health information were eHealth literacy (adjusted odds ratio, 1.10; 95% confidence interval, 1.10-1.43) and having learning experiences regarding eHealth literacy (adjusted odds ratio, 7.36; 95% confidence interval, 2.06-26.39). Our findings suggest the importance of enhancing eHealth literacy among nurses and a proactive approach by nurses to improve patients' eHealth literacy.

Digital health literacy among the ageing population: A comparative cross-sectional study between rural and urban Telangana, India

BackgroundDigital health literacy (DHL) is the confluence where health literacy meets digital literacy. DHL has been labelled as one of the digital determinants of health by the World Health Organization. The present study estimated and compared the DHL between Telangana's urban and rural ageing adults, and their potential determinants. MethodsA cross-sectional study was undertaken among 318 of the ageing individuals (≥45 years) of Hyderabad, visiting the primary health centres in the rural and urban field practice during March 2023. A Telugu version of the eHealth literacy scale (eHEALS) and health literacy scale tools were administered by the interviewers. Adjusted analysis was conducted by multiple linear regression method. ResultsOverall, 20.4% of the study participants had good DHL, with a similar proportion between rural and urban areas (rural-20.1% and urban-20.8%, p value-0.889). The median eHealth literacy score among the study participants was 8. While 36.5% and 45.9% had smartphones and standard analogue phones, respectively in urban areas, only 19.5% and 38.4% had smartphones and standard analogue phones, respectively in rural areas. Computer usage in the past month, higher educational qualification, and ownership of mobile phones were significant determinants of DHL. A mild but significant correlation between DHL and health literacy screening scores was found. ConclusionConsidering the low DHL among the ageing population, enabling environment with enhanced access to mobile phones/smartphones and familiarity with information and communication technology gadgets must be established to improve their DHL.

EHealth literacy among hospital health care providers: a systematic review

BackgroundeHealth literacy is a key concept in the implementation of eHealth resources. However, most eHealth literacy definitions and frameworks are designed from the perceptive of the individual receiving eHealth care, which do not include health care providers’ eHealth literacy or acceptance of delivering eHealth resources.AimsTo identify existing research on eHealth literacy domains and measurements and identify eHealth literacy scores and associated factors among hospital health care providers.MethodsThis systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. A systematic literature search was conducted in MEDLINE, Cinahl, Embase, Scopus, PEDro, AMED and Web of Science. Quantitative studies assessing eHealth literacy with original research, targeting hospital health care providers were included. Three eHealth literacy domains based on the eHealth literacy framework were defined a priori; (1) Individual eHealth literacy, (2) Interaction with the eHealth system, and (3) Access to the system. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data.ResultsFourteen publications, of which twelve publications were conducted in non-Western countries, were included. In total, 3,666 health care providers within eleven different professions were included, with nurses being the largest group. Nine of the included studies used the eHealth literacy scale (eHEALS) to measure eHealth literacy, representing the domain of individual eHealth literacy. A minority of the studies covered domains such as interaction with the eHealth system and access to the system. The mean eHEALS score in the studies ranged from 27.8 to 31.7 (8–40), indicating a higher eHealth literacy. One study reported desirable eHealth literacy based on the Digital Health Literacy Instrument. Another study reported a relatively high score on the Staff eHealth literacy questionnaire. eHealth literacy was associated with socio-demographic factors, experience of technology, health behaviour and work-related factors.ConclusionsHealth care providers have good individual eHealth literacy. However, more research is needed on the eHealth literacy domains dependent on interaction with the eHealth system and access to the system. Furthermore, most studies were conducted in Eastern and Central-Africa, and more research is thus needed in a Western context.Trial registrationPROSPERO International Prospective Register of Systematic Reviews (CRD42022363039).

The impact of digital health literacy on anxiety and preventive behaviors during the pandemic

Abstract Background From the pandemic's beginning, many authors suggested that digital health literacy (DHL) may be an important factor in protecting against araising misinformation and enhancing compliance with preventive behaviors. In this study, we analyzed the effect of DHL on future anxiety and generalized anxiety, as well as on adherence to preventive measures and COVID-19 vaccination uptake after adjusting for sociodemographic factors. Methods Data used in the analysis originated from the web-based survey carried out in a representative sample of 2189 Polish Internet users in the later phase of the COVID-19 pandemic. The effect of DHL on FA, GA, and APM after adjusting for SD factors was analyzed with multivariable linear regression and on C19VU with multivariable logistic regression. DHL was measured with an eHealth Literacy Scale (eHEALS) consisting of 8 items. The effects of predictors in MLiR models were expressed as B coefficients and 95% confidence intervals (B; 95%CI) and in MLoR model as odds ratio and 95%CI (OR; 95%CI). Results Mean age (standard deviation, SD) of respondents was 44.1 (15.25) years, mean DHL measured with eHEALS was 28.91 (5.17). The analysis demonstrated that higher DHL was significantly associated with a higher level of FA (B; 95%CI: 0.07; 0.02-0.12) but with lower GA (B; 95%CI: -0.01; -0.016 - 0.03). Interestingly, higher DHL favored greater compliance with general PM (wearing the mask, washing hands, and keeping a social distance) (B; 95%CI: 0.04; 0.02 - 0.05). However, no effect was observed concerning C19VU (OR, 95%CI: 0.99; 0.97 - 1.01). Conclusions The effect of DHL on the outcomes related to the pandemic is not consistent. Higher DHL seems to predict the perception of long-term consequences of the pandemic reflected by higher levels of FA. However, the level of GA shows the status of current anxiety is lower with persons with higher DHL. Key messages • The effects of digital health literacy are not fully consistent with predictions from the beginning of the COVID-19 pandemic. • Digital health literacy is significantly associated with adherence to general pandemic preventive measures but not with readiness to get vaccinated against COVID-19.

EXAMINING THE RELATIONSHIP BETWEEN E-HEALTH LITERACY AND RATIONAL DRUG USE: A STUDY ON UNIVERSITY STUDENTS

It is desired to provide rapid access to health information on the Internet and to determine the relationship between rational drug use that affects people's quality of life. In this study, it is aimed to examine the relationship between e-health literacy and rational drug use in university students. In line with the purpose of the research; The sample of the study consisted of 541 people determined by simple random sampling method among the students continuing their education at the university, and the data were collected by applying a face-to-face questionnaire. In the study, "Personal Information Form", "E-Health Literacy Scale" and "Rational Drug Use Scale" were used. The data were analyzed with the SPSS program. In addition, as an analysis method, it was determined that the data were normally distributed; t test, ANOVA and pearson correlation analyzes were applied in independent groups. 541 students participated in the research.As a result of the research, it was determined that there is a positive and significant relationship between the level of e-health literacy and rational drug use. It is predicted that as the level of e-health literacy increases, the level of rational drug use will increase.

Digital literacy as a new determinant of health: A scoping review.

Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation. A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley. A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support. Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.

Rational Drug and Antibiotic Use Status, E-Health Literacy in Syrian Immigrants and Related Factors: A Cross-Sectional Study.

Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals' health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 ± 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 ± 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.

Assessment of Electronic Health Literacy among Patients in an Urban, Academic Radiation Therapy Department

The COVID-19 pandemic dramatically affected health outcomes and healthcare access, especially with the abrupt transition to virtual care. Cancer patients in the New York City borough of the Bronx, a potentially marginalized community with high rates of poverty and non-English speakers, may be particularly vulnerable to healthcare disparities, given their advanced age and possible difficulty navigating telemedicine appointments due to decreased electronic health literacy (EHL). We investigated EHL levels using both subjective and objective measures and associated predictors of EHL in patients within an academic, urban radiation oncology department. We conducted a prospective IRB-approved study of patients aged ≥18 presenting for care in our department. Patients' internet access and established habits were surveyed via Health Information National Trends Survey (HINTS). Subjective EHL, self-reported comfort using the internet for health information, was assessed via the eHealth Literacy Scale (eHEALS), which calculates a score by adding participants' answers for 8 questions (each on a 1 to 5-point Likert scale). Subjective EHL was categorized as low (8-23), moderate (24-31), or good (32-40). Objective EHL was determined by the eHealth Literacy Objective Scale (eHeLiOS), which tests responses to 9 common scenarios on gathering and assessing electronic health information via multiple-choice questions. The numbers of correct answers were totaled and categorized into low (1-4), moderate (5-7), or good (8-9) EHL. Patients were enrolled between December 2020 and December 2022. 56 patients completed the subjective eHEALS assessment, while 49 completed the eHeLiOS objective test. 52% and 27% of patients identified as Black and Hispanic, respectively; 66% were male, and the median age was 67 (range 28-86). 76% reported accessing the internet regularly, of which 92% reported doing so via broadband network. The prevalence of good EHL was 10% using objective and 29% using subjective surveys. Using a proportional odds logistic model, only age was associated with EHL. For every increased year of age, there was an 11% decrease in objective (OR 0.89, p = 0.02) and 5% decrease in subjective (OR 0.95, p = 0.08) EHL odds, respectively. Gender, race/ethnicity, income, insurance, and employment status were not significantly associated with EHL. Few study patients, who represent an older and potentially marginalized population, showed good EHL levels; more perceived good EHL via subjective testing than we observed using our objective measure. These data suggest implementation of an objective EHL assessment would aid in identifying patients who may benefit from learning activities to improve EHL and support to navigate telehealth visits effectively. Further research is needed to optimize telemedicine strategies for older cancer patients with low EHL.

Hastaların e-sağlık okuryazarlıklarının preoperatif kaygı düzeyleri ve anesteziye ilişkin korkularına etkisi

The aim of this study is to examine the effect of e-health literacy on preoperative anxiety levels and fears about anesthesia of individuals who will undergo surgery. The research was carried out with 219 patients waiting in the preoperative waiting unit. The Amsterdam Preoperative Anxiety Scale (APAIS) was used to evaluate the preoperative anesthesia anxiety, the E-Health Literacy Scale was used to determine the e-health literacy, and the questionnaire form was used to determine the fear of anesthesia, which was created by using the items in the literature in previous studies on anesthesia fear. According to the results of the research, the three items that patients fear the most about anesthesia are; “feeling pain during surgery”, “feeling pain after the effect of post-operative anesthesia” and “waking up in the middle of surgery”. There is no significant difference in anesthesia-related fears of patients with low, medium and high e-health literacy, only a significant difference in preoperative anxiety scores between patients with low and high e-health literacy. Study results were interpreted as the ability of individuals with high e-health literacy to evaluate the data obtained through digital channels in terms of reliability prevents them from experiencing unnecessary anxiety based on erroneous information.

Are health promotion activities and preventive health practices predictors of adolescent eHealth literacy?

Adolescents' general health status and health behaviors have been closely monitored in recent years. It is estimated that adolescents comprise one-sixth of the world's population. This study examined whether eHealth literacy was predicted via health promotion activities and preventive health practices among Turkish adolescents. This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face-to-face questionnaire form was used, including socio-demographic characteristics, preventive health practices, eHealth literacy scale and Adolescent Health Promotion Scale. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis, and multiple regression analysis were used in the analyzes. The p < 0.05 value was considered statistically significant in the evaluations. In the study, 55.8% were female, and the mean age of the whole group was 16.09 ± 2.63 years. The mean score on the eHealth literacy scale was 29.40 ± 6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97 ± 21.87. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p < 0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy positively and significantly predicts health promotion activities (β = 0.27, t (695) = 7.54, p < 0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β = 0.13), annual blood iron measurement by more than 0.16 (β = 0.16) and annual dental examination by more than 0.11 (β = 0.11). Developing eHealth literacy interventions will be necessary for environments with a high concentration of adolescents (schools and courses). Also, primary health care services should be integrated with the school environment.

Effects of Physical Activity on Mobile Phone Addiction Among College Students: The Chain-Based Mediating Role of Negative Emotion and E-Health Literacy.

Smartphones have become an important tool for college students' study and life, but mobile phone addiction caused by excessive dependence use of cell phones can have serious negative impacts on college students' mental health, life behaviors, and so on. It is urgent to explore the causes and influence mechanisms of college students' cell phone addiction. The purpose of this study was to investigate the relationship between physical exercise and mobile phone addiction among Chinese college students and the mediating role of negative affect and e-health literacy between the two. The stratified sampling method was used to investigate the physical activity, mobile phone addiction, negative emotion and e-health literacy of 4621 university students in Jiangsu Province using the Physical Activity Rating scale, Mobile Phone Addiction scale, Depression-anxiety-stress scale and E-Health Literacy scale, Thus the data were statistically analysed using SPSS 26.0 and AMOS 23.0. (1) Physical exercise was significantly negatively correlated with mobile phone addiction and negative emotion among college students (r=-.713, P<0.01; r=-.571, P<0.01), and physical exercise was significantly positively correlated with e-health literacy (r=0.616, P<0.01); (2) Negative emotion and e-health literacy played independent mediating roles between physical exercise and mobile phone addiction, respectively; (3) Negative emotion and e-health literacy played chain mediating roles between physical exercise and mobile phone addiction. This study explored the potential mechanisms of cell phone addiction in college students and found that physical activity can influence Internet addiction through the independent mediating effect including the chain mediating effect of negative emotions and e-health literacy. This study further reveals the mechanism of action of physical exercise affecting college students' cell phone addiction, and provides some reference value for the prevention and intervention of college students cell phone addiction.

The Impact of Symptom Burden, Social Support, Self-Efficacy, and eHealth Literacy on the Quality of Life of Patients Undergoing Breast Cancer Treatment: A Cross-Sectional Study

Purpose: The number of breast cancer patients in Korea has steadily increased. However, there are few studies addressing quality of life of patients undergoing breast cancer treatment in Korea. This study aimed to identify predictors of quality of life among patients undergoing breast cancer treatment.Methods: This descriptive, cross-sectional study included 142 patients with breast cancer undergoing treatment in a cancer hospital. Data were collected using the MD Anderson Symptom Inventory, Multidimensional Scale of Perceived Social Support, Breast Cancer Survivors Scale, eHealth Literacy Scale, and the Functional Assessment of Cancer Therapy-Breast Cancer through self-administered questionnaires from January 12 to December 6, 2022. Differences in the level of quality of life according to demographic and clinical variables and correlations among continuous variables were identified using univariate statistics, and hierarchical multiple regression was used to identify predictors of quality of life.Results: Employment status, comorbidities, disease duration, and cancer stage were demographic and clinical variables that showed significant associations with quality of life. Symptom burden, social support, self-efficacy, and eHealth literacy were also significantly associated with quality of life. The predictors of quality of life were employment status (β=.13, p=.009), cancer stage (β=.12, p=.033), symptom severity (β=-.14, p=.044), symptom interference (β=-.30, p&lt;.001), social support (β=.13, p=.025), and self-efficacy (β=.46, p&lt;.001). The explanatory power was approximately 69% (F=26.90, p&lt;.001).Conclusion: Nursing interventions should be implemented for patients undergoing breast cancer treatment to improve their quality of life while reducing the symptom burden and enhancing self-efficacy and social support.

ADÖLESANLARDA E-SAĞLIK OKURYAZARLIĞI ILE COVID-19’UN KONTROLÜ ALGISI ARASINDAKI İLIŞKI

Aim: The purpose of this study was to determine the associations between eHealth literacy in adolescents and their levels of perception of control over COVID-19. &#x0D; Method: This descriptive and correlational study was conducted with 303 adolescents who volunteered to participate in the research between April and August 2021. Data were collected online through the Participant Information Form, eHealth Literacy Scale in Adolescents and COVID-19 Control Perception Scale (PCo-COVID-19). &#x0D; Results: The mean age of the participants was 19.36±2.29 years, 76.6% were female, 23.4% were male, and 71.3% were university graduates. The mean score of the eHealth Literacy Scale in Adolescents was 27.49±6.51. The mean total score of the PCo-COVID-19 was 2.85±0.50. There was a positive correlation between adolescents’ eHealth literacy and perception of COVID-19 control (r=0.262, p