The Development Of An E Health Literacy Intervention Program Among Community-dwelling Older Adults Based On Social Ecosystems Theory

Objective: The purpose of this study is to understand the current level of e Health literacy;to explore the relationship between social support,attitudes about ageing,and e Health literacy based on social ecosystems theory;and to clarify the influencing factors of e Health literacy among older adults using questionnaire surveys.The qualitative research method was used to explore the influencing factors of e Health literacy and to describe the intervention needs for e Health literacy among older adults in China.Based on the results of quantitative and qualitative research and a summary of the best evidence,an intervention program for e Health literacy among older adults was constructed,with the goal of providing a reference for e Health literacy interventions among communitydwelling older adults in China.Methods: A mixed-methods studyPart I: Current status and influencing factors of e Health literacy among communitydwelling older adultsThis part used a cross-sectional design.From April to August 2022,the multi-stage sampling method was used to survey 263 community-dwelling older adults in a major district of Shenyang.Data was collected using general-information questionnaires,multidimensional perceived social support,the e Health literacy scale,and questionnaires on attitudes towards ageing.SPSS version 26.0 was used for statistical analysis using the methods of descriptive statistical analysis,univariate analysis,correlation analysis,and multivariate analysis.Part II: Influencing factors and intervention needs of e Health literacy among community-dwelling older adults: A qualitative studyIn this portion,descriptive qualitative research methods were used.In September and October 2022,older adults from Part I were selected for semi-structured interviews using the purpose sampling method combined with the maximum difference sampling strategy.NVivo11.0 content analysis software was used to organize and analyse the transcribed text.Part III: The development of an e Health literacy intervention program for communitydwelling older adultsIn this section,evidence-based methods were used to summarise the best evidence for e Health literacy interventions among community-dwelling older adults,and the results of the quantitative and qualitative studies were integrated to construct the initial version of an e Health literacy intervention program for community-dwelling older adults.Through expert meetings,the initial version was revised and refined into a final version of the e Health literacy intervention program for community-dwelling older adults.SPSS version26.0 was used to evaluate the experts’ enthusiasm,authority coefficient,coordination coefficient,and item variation coefficient.Results:Part I: Current status and influencing factors of e Health literacy among communitydwelling older adults(1)e Health literacy results: The average score of e Health literacy was(20.74±6.72)and the average score of items was(2.59±0.84),which represents a moderate to low level of e Health literacy.The average scores for items in each dimension,from highest to lowest,were: decision-making ability(2.75±1.06),application ability of network health information and service(2.63±0.86),and evaluation ability(2.43±0.98).(2)Univariate analysis results: There were statistically significant differences(P<0.05)in e Health literacy score among community-dwelling older adults in the 13 variables: age,education,pre-retirement occupation,residence status,monthly income per capita,medical insurance,self-rated health status,number of chronic diseases,duration of internet use,frequency of internet use,frequency of health information search,attitude towards online health information,and channel of health resources search.There were statistically significant differences(P<0.05)in the score of application ability of network health information and service among community-dwelling older adults in the 15 variables:gender,age,education,pre-retirement occupation,residence status,monthly income per capita,medical insurance,self-rated health status,number of chronic diseases,duration of chronic diseases,duration of internet usage,frequency of internet use,frequency of health information search,attitude towards online health information,and channel of health resources search.There were statistically significant differences(P<0.05)in the score of evaluation ability among community-dwelling older adults in the 10 variables: age,education,pre-retirement occupation,residence status,monthly income per capita,medical insurance,life stress,self-rated health status,duration of internet use,and frequency of health information search.There were statistically significant differences(P<0.05)in the score of decision-making ability among community-dwelling older adults in the 10variables: age,education,pre-retirement occupation,monthly income per capita,medical insurance,self-rated health status,duration of internet use,frequency of internet use,frequency of health information search,and attitude towards online health information.(3)Correlation analysis results: The score of perceived social support correlates(r=0.462～0.593,P<0.001)with the scores of e Health literacy and each dimension among community-dwelling older adults.The score of attitudes towards ageing correlates(r=0.374～0.491,P<0.001)with the scores for e Health literacy and each dimension among community-dwelling older adults.(4)Multivariate analysis results: There were 10 variables included in the regression equation: age,education,residence status,medical insurance,self-rated health status,frequency of health information search,attitude towards online health information,family support,friend support,and psychological growth.These variables were predictors of e Health literacy among older adults,accounting for 58.0% of the cumulative variation.There were 10 variables included in the regression equation: age,education,residence status,medical insurance,self-rated health status,duration of internet use,frequency of health information search,family support,friend support,and psychological growth.These variables were predictors of the application ability of network health information and service among older adults,accounting for 56.8% of the cumulative variation.There were eight variables included in the regression equation: age,education,pre-retirement occupation,residence status,self-rated health status,family support,friend support,and psychological growth,indicating that the above variables were predictors of e Health literacy among older adults,accounting for 40.6% of the cumulative variation.There were six variables included in the regression equation: age,education,duration of internet use,family support,other support,and psychological growth,indicating that the above variables were predictors of e Health literacy among older adults,accounting for 34.5% of the cumulative variation.Part II: Influencing factors and intervention needs of e Health literacy among community-dwelling older adults: A qualitative studyIn this section,a total of 18 community-dwelling older adults were included,with an average age of(68.11 ± 6.43).After interviewing,summarising,and refining,four themes and 14 sub-themes were obtained.The four themes were:(1)Intervention content needs of e Health literacy: basic skills,information-seeking ability,media awareness,information and communication technology,professional help,and scientific awareness.(2)Intervention model needs of e Health literacy: personnel,arrangement,forms,and auxiliary forms of intervention.(3)Facilitating factors of e Health literacy: social support and health needs.(4)Hindering factors of e Health literacy: physical function loss and psychosocial loss.Part III: The development of an e Health literacy intervention program for communitydwelling older adultsIn this section,a total of 10 e Health literacy studies were extracted and summarised.The evidence content was formed based on six aspects: assessment,intervention personnel,intervention arrangement,intervention content,intervention strategy,and evaluation.The results of the quantitative and qualitative research were integrated with the evidence to create an initial version of the intervention program.Five experts were invited to participate in the meeting to evaluate the initial version.The authority coefficient of experts was 0.92,the positive coefficient of experts was 100%,the coordination coefficient was0.297,and the items variation coefficient was 0.09～0.31.The initial version of the intervention program was modified and refined to create the final version of an intervention program for e Health literacy among community-dwelling older adults.Conclusions:(1)The e Health literacy of older adults in China is at a moderate to low level,with low scores in each dimension.The results showed that interventions should be implemented to improve e Health literacy among community-dwelling older adults.Age,education,pre-retirement occupation,residence status,medical insurance,self-rated health status,duration of internet use,frequency of health information search,attitudes to health information,social support and psychological growth were predictors of e Health literacy among older adults.Therefore,the above factors should be used as an objective basis for selecting the intervention population and intervention content.(2)Qualitative research was conducted to understand the need for intervention content and intervention models and to identify the facilitating factors and hindering factors of e Health literacy among community-dwelling older adults.Therefore,when constructing an e Health literacy intervention program for community-dwelling older adults,relevant intervention content and model needs proposed by older adults can be incorporated into the intervention program.Enhancing social support,meeting health needs,and overcoming physical functioning and psychosocial loss can be used to further improve the e Health literacy of older adults.(3)This study is based on the theoretical framework of e Health literacy among community-dwelling older adults,which was developed based on the Lily model and social-ecological systems theory.Based on this theoretical framework,an e Health literacy intervention program was constructed by integrating quantitative research,qualitative research,and best evidence summary results.Four modules,nine topics,and 21 items were included in this intervention program.This program is scientific and feasible and can provide a reference for interventions and related studies of e Health literacy among community-dwelling older adults.