Status And Influencing Factors Of Electronic Health Literacy In Stoma Patients Based On Anderson Model

Objectives1.Based on the Anderson model,to understand the status quo and influencing factors of electronic health literacy of patients undergoing enterostomy.2.To construct the structural equation model of influencing factors of electronic health literacy in patients undergoing enterostomy,clarify the path relationship between the influencing factors,and analyze the impact of electronic health literacy on health-related quality of life.Methods1.Using the convenient sampling method,we selected patients undergoing enterostomy surgery in a Grade-A tertiary hospital in Yangzhou from December 2021 to December 2022 as the study subjects,and conducted a cross-sectional survey of patients who met the inclusion criteria.2.A self-designed general information questionnaire was used to assess the sociodemographic data,disease-related data,accessibility of community medical resources,and use of intelligent devices in patients undergoing enterostomy.The eHealth Literacy Scale(eHEALS),Internet-specific epistemological questionnaire(ISQE),Multidimensional Scale of Perceived Social Support(MSPSS),Age-adjusted Charlson comorbidity index(ACCI),the 10-item Kessler Psychological Distress Scale(K10)and European Quality of Life 5dimensions Index(EQ-5D Index)were adopted to evaluate enterostomy patients’ e-health literacy,Internet-based cognitive belief,perceived social support,comorbidity burden,mental health status,and health-related quality of life.3.This study used Excel to establish database,and two researchers checked the input data.SPSS 25.0 and AMOS 23.0 were used to analyze the data.Statistical methods mainly include:descriptive analysis,Mann-Whitney U test,Kruskal-Wallis test,Spearman correlation analysis,multiple linear regression analysis,structural equation model,and mediator effect test.Results1.This study investigated 228 patients undergoing enterostomy surgery for the first time,and found that the level of e-health literacy of enterostomy patients was low.The median and quartile of total score of the e-health literacy scale were 23.00(21.00,26.00).Taking 32 points as the qualification standard,the qualification rate of e-health literacy in this study was 12.72%(29/228).The results of Mann-Whitney U test and Kruskal-Wallis test showed that there were significant differences in e-health literacy scores among enterostomy patients with different age,gender,residence,primary caregiver,education level,occupation,monthly income per capita,medical payment,whether to use devices such as smart phone tablets,daily use time of smart devices,health information seeking frequency,and stoma site(P<0.05).The results of Spearman correlation analysis showed that the e-health literacy of patients with enterostomy were positively correlated with the total scores of Internet-based cognitive belief(r=0.371,P<0.01),knowledge certainty and source belief(r=0.349,P<0.01),knowledge judgment beliefs(r=0.510,P<0.01),perceived social support(r=0.641,P<0.01),family support(r=0.533,P<0.01),friend support(r=0.460,P<0.01),and other support(r=0.5 82,P<0.01).It was negatively correlated with the Age-adjusted Charlson comorbidity index(r=-0.412,P<0.01).The results of multiple linear regression showed that perceived social support,Internet-based cognitive belief,health information seeking frequency,daily use of intelligent devices,and educational level were influential factors for electronic health literacy in patients with enterostomy,accounting for 72.4%of the total variation in e-health literacy.2.A structural equation model was created,based on the first part’s research findings and Anderson model,to identify factors influencing electronic health literacy in patients with stomas.The modified model fits well,with specific fitting indicators as follows:χ2=34.3387,df=17,χ2/df=2.020,GFI=0.969,AGFI=0.918,CFI=0.983,NFI=0.967,RFI=0.930,IFI=0.983,TLI=0.963,RMSEA=0.067.In the final structural equation model,Internet-based cognitive belief(β=0.182,P<0.001),perceived social support(β=0.440,P<0.001),health information seeking frequency(/3=0.464,P<0.001)can directly affect the electronic health literacy of patients undergoing enterostomy.In addition,Internet-based cognitive belief can indirectly affect the electronic health literacy of patients undergoing enterostomy through the following three pathways:Path 1:Internet-based cognitive belief→perceived social support→ e-health literacy(indirect effect:0.090);Path 2:Internet-based cognitive belief→ health information seeking frequency→ e-health literacy(indirect effect:0.112);Path 3:Internet-based cognitive belief→ perceived social support→ health information seeking frequency→ e-health literacy(indirect effect:0.034).Perceived social support can also indirectly predict the e-health literacy of patients with enterostomy through health information seeking frequency(indirect effect:0.164).The direct effect of education level on electronic health literacy is not significant(P>0.05).E-health literacy can directly affect health-related quality of life(β=0.234,P<0.001).The Bootstrap method was used to repeatedly sampling for 5000 times to further verify the intermediary effect.The results showed that the upper and lower limits of the 95%confidence interval for each path did not contain zero,and the intermediary effect was significant.Conclusion1.The electronic health literacy of enterostomy patients is at a relatively low level and needs to be improved.Perceived social support,Internet-based cognitive belief,frequency of health information seeking,daily use of intelligent devices,and educational level are predictive factors for e-health literacy in enterostomy patients.Clinical nursing personnel should focus on patients with low education and less use of intelligent devices,pay attention to the information needs of patients,provide safe and reliable health information platforms,and develop personalized intervention programs to improve the e-health literacy of enterostomy patients.2.Internet-based cognitive belief,perceived social support,and health information seeking frequency can positively predict the electronic health literacy of patients undergoing enterostomy.Internet-based cognitive belief and perceived social support can also indirectly affect patients’ e-health literacy.Education level can only affect e-health literacy through indirect path.Meanwhile,e-health literacy can directly affect health-related quality of life of patients with stoma.It is suggested that medical personnel should pay attention to the evaluation of social support for patients and their online cognitive belief,and formulate corresponding e-health literacy interventions based on the interaction between various influencing factors,so as to improve the e-health literacy of enterostomy patients.