eHealth and People with Schizophrenia Spectrum Disorders

eHealth is the transfer of health services and health care by information and communications technology. People with schizophrenia-spectrum disorders (SSD) use the Internet for general and health-related reasons. Yet, it is unclear what kind of schizophrenia-related health information this population finds online. eHealth literacy is the ability of Internet users to find, understand, and apply the health information they acquire, to make appropriate health decisions. People with SSD exhibit cognitive deficits and consequently, their eHealth literacy can be affected. The goal of the study was to describe schizophrenia-related health information, to investigate eHealth use among adults with SSD in Finland and Greece, and to compare the country groups. The methodology consisted of three principle procedures. First, a mixed methods study was conducted with descriptive, cross-sectional design, in order to describe and compare schizophrenia-related health information and videos found online when searched in Finnish and Greek language. Content analysis was performed. Data were analyzed with quantitative and descriptive statistics. Second, a survey study with a descriptive, cross-sectional design was conducted to describe and compare eHealth use among Finnish and Greek people with schizophrenia-spectrum disorders (SSD). Data were collected by a structured questionnaire and analyzed with quantitative, descriptive statistics, partially, group comparisons were made with logistic regression techniques. Third, a systematic literature review and meta-analysis were performed to assess the potential effectiveness of social media interventions for people with SSD. Our findings, first, showed that assessed online schizophrenia-related health information tended to be of low quality, with no significant differences between the two countries. Furthermore, schizophrenia-related videos tended to present mental illness in a negative, not medically-oriented way, again, without significant differences between the countries. Second, Internet use (FI: 87% vs. GR: 33%) and eHealth literacy (FI: mean 27.05 vs. GR: mean 23.15) of Finnish people with SSD was significantly higher (P<.0001) than their Greek counterparts. The interest component of attitudes toward computer/Internet was significantly higher (P=.006) among the Greek group (FI: mean 2.60 vs. GR: mean 3.16). Third, the systematic review and meta-analysis did not show superiority of social media mental health interventions than treatment as usual. In conclusion, it is recommended that in the future, better quality mental health information and videos need to be made available in several languages and to be easily accessible through the most popular search engines and social media sites. eHealth literacy instruction and training is necessary so that people with SSD can find, understand, and apply the health information they retrieve online.Sähköiset terveyspalvelut skitsofreniaspektrin sairauksien hoidossa eHealth –käsite tarkoittaa terveyspalveluja, jotka välitetään informaatio- ja kommunikaatioteknologian avulla. Skitsofreniaspektrin häiriöitä sairastavat henkilöt käyttävät Internetiä yleisiin ja terveyteen liittyviin tarkoituksiin. On kuitenkin epäselvää, minkälaista skitsofreniaan liittyvää terveystietoa he löytävät Internetistä. Sähköinen terveyslukutaito kuvaa Internetin käyttäjien kykyä löytää ja ymmärtää löytämäänsä terveystietoa sekä käyttää sitä tarkoituksenmukaisesti terveyteen liittyvissä päätöksissä. Koska henkilöillä, joilla on skitsofreniaspektrin häiriö, ilmenee usein kognitiivisia vajavaisuuksia, heidän terveyslukutaitonsa saattaa olla alentunut. Tämän tutkimuksen tarkoituksena oli kuvata skitsofreniaan liittyvää terveystietoa sähköisissä palveluissa, selvittää näiden terveyspalvelujen käyttöä aikuisten, skitsofreniaspektrin häiriöitä sairastavien henkilöiden keskuudessa sekä Suomessa että Kreikassa ja verrata maiden ryhmiä toisiinsa. Aluksi toteutettiin tutkimus eri tutkimusmenetelmiä yhdistämällä (mixed methods) deskriptiivisellä, poikkileikkaavalla tutkimusotteella. Tarkoituksena oli kuvata ja verrata Internetistä suomeksi ja kreikaksi löytyvää terveystietoa ja videoita skitsofreniaa koskien. Aineisto analysoitiin sisällönanalyysin sekä kuvailevin tilastomenetelmin. Seuraavaksi suoritettiin kysely samalla tutkimusasetelmalla, jossa kuvattiin ja verrattiin sähköisten terveyspalvelujen käyttöä suomalaisten ja kreikkalaisten skitsofreniaspektrin häiriöitä sairastavien henkilöiden keskuudessa. Aineisto kerättiin strukturoidulla kyselylomakkeella ja analysoitiin kuvailevin tilastomenetelmin. Ryhmien väliset vertailut tehtiin logistisen regressioanalyysin avulla. Kolmanneksi tehtiin systemaattinen kirjallisuuskatsaus ja meta-analyysi, jossa arvioitiin sosiaalisen median vaikuttavuutta skitsofreniaspektrin häiriöitä sairastavien henkilöiden hoidossa. Tulokset osoittivat, että skitsofreniaan liittyvää terveystieto oli yleisesti ottaen huonolaatuista molemmissa maissa; tutkittavien maiden välillä ei ollut tilastollisesti merkitseviä eroja. Skitsofreniaan liittyvät videot kuvasivat mielisairauksia negatiivisessa, ei-lääketieteellisessä valossa; tulokset eivät eronneet tilastollisesti maiden välillä. Suomalaisten skitsofreniaspektrin häiriöitä sairastavien henkilöiden Internetin käyttö (Suomi 87% vs. Kreikka 33%) ja sähköisen terveystiedon lukutaito (ka 27.05 vs. ka 23.15) oli korkeampi suomalaisilla kuin kreikkalaisilla potilailla; maiden väliset erot olivat tilastollisesti merkitsevät (P<.0001). Tietokoneisiin/Internetiin kohdistuvat asenteet olivat merkittävästi positiivisimmat kreikkalaisen keskuudessa (ka 2.60 vs. ka 3.16, P=.006). Systemaattinen kirjallisuuskatsaus ja meta-analyysi eivät osoittaneet sosiaalisen median olevan tehokkaampi kuin perinteiset hoitomenetelmät. Tulevaisuudessa korkealaatuista mielenterveysinformaatiota ja videoita olisi oltava helposti löydettävissä eri kielillä suosituimpien hakukoneiden ja sosiaalisen median avulla. Potilaat tarvitsevat koulutusta sähköisten palvelujen medialukutaitoon.Siirretty Doriast

Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: Randomized controlled trial

Background Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. Objective This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes. Methods A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden. Results All patients completed the study. Overall, the intervention had a moderate effect (F =2.83, P=.03, η =0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=−1.5, P=.04, d=0.28; final assessment: mean difference=−1.6, P=.03, d=−0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups. Conclusions Results suggest that interactive sections as part of Internet-based interventions can positively alter patients’ feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. Trial Registration ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR)

An Exploration of How Health Professionals Create eHealth and mHealth Education Interventions

The purpose of this study was to explore how health education professionals create ehealth and mhealth education interventions. Three research questions led this qualitative study. The first research question focused on the use of learning theories, instructional models, and instructional design models. The second research question focused on the use of elearning and mlearning design principles. The third research question focused on the use of health behavior theories and models. Twelve health professionals selected for their involvement in the creation of ehealth and mhealth education interventions participated in this study. The themes emerging from the research questions showed a variability in how the participants used education theories and models, principles of elearning and mlearning design, and health behavior and health education theories and models to create ehealth and mhealth interventions. On education theories and models, the participants used elements of instructional design (i.e., analysis, design, evaluation) but did not use any specific instructional design model. Moreover, they invested efforts in creating instructional strategies that reflected instructional models of different learning theories but did not specify particular models or theories. Four themes emerged on the instructional strategies they used in the interventions: (1) connections to behaviorist approaches to learning, (2) connections to cognitivist approaches to learning, (3) connections to constructivist approaches to learning, and (4) unspecified learning theories. On the use of elearning design principles, seven patterns emerged: (1) interaction, (2) learner control, (3) provision of help, (4) use of multimedia, (5) engagement, (6) user friendliness, and (7) visual appeal. On the use of health behavior theories and models, three themes emerged (1) no use of health behavior theory or model, (2) use of a mix of health behavior theories or models, and (3) use of a particular health behavior theory or model. The variability of the findings and the resulting themes suggested implications for practice and further research. These implications concern all health professionals creating ehealth and mhealth interventions as well as scholars in the field of instructional design and health education and heath behavior. The implications and limitations of the study were also discussed

Web-based support for young adults with reproductive concerns following cancer : development, process and outcome evaluation of a self-help psychoeducational intervention

AIM: To describe the development process and explain the outcomes of Fex-Can Fertility, a self-help web-based psychoeducational intervention aiming to alleviate reproductive concerns in young adults with cancer. METHODS: The thesis comprises five papers; one cross-sectional survey study of oncologists’ and hematologists’ fertility-related communication (I), one study describing the development of the Fex-Can intervention in a participatory process (II), one feasibility study testing the preliminary version of the web-based program (III), and one RCT testing the effect of the final intervention (IV). Study V was a qualitative interview study examining participants’ experiences in relation to the theory behind the intervention. RESULTS: The results of the five papers are presented according to the structure of a process evaluation. The context of the intervention was one where physicians in cancer care often but not always talk about fertility with their patients. Persons contributing to, requesting and participating in the Fex-Can intervention were predominantly female and well educated. The intervention was developed in a participatory process with people representative of the target group while keeping with theoretical underpinnings in psychology and eHealth technologies. Feasibility testing indicated that the intervention would be acceptable to users, but recruitment and retainment was below the anticipated figures. The RCT was underpowered and had modest outcomes, with significant effects only on concerns about genetic risks and on treatment-related fertility knowledge, where the effect sizes were moderate. Mechanisms of impact were investigated mainly in the interview study. Participants described how the intervention had supported their needs for competence, relatedness and autonomy, but also that some missed tailoring to their specific needs and that keeping up with the intervention was too time-consuming. Degree of activity did not seem to have a clear relationship with effect of the intervention. CONCLUSIONS: Despite meticulous preparation and adherence to every step of the framework for intervention development, the present intervention did not meet our expectations for efficacy in reducing fertility-related distress. Challenges include refining recruitment strategies, finding appropriate main outcome measures and ways to further ensure active participation. Still, the Fex-Can Fertility intervention was appreciated by most users and no adverse events were recorded, suggesting it can be of value if offered as a supplement to standard psychosocial support in clinical cancer care

Sex Ed to Go- An Analysis of Comprehensive Sexual Education Mobile Phone Applications

The United States has one of the highest teen pregnancy rates among developed countries and the numbers of STIs have increased during the last few years. Mobile phone applications constitute a promising platform to disseminate sexual health information and to reduce adverse health outcomes, particularly among teens. In order to be effective, apps have to follow a comprehensive approach to sexuality education, include concepts of behavior change theories, and adhere to health literacy principles. This study used a mixed-methods approach consisting of a quantitative content analysis and qualitative thematic analysis to assess the quality of sexual education apps available to users on the iOS and Android app market. The results show that there is a dearth of health literate, evidence- and theory-based sexual education apps available to teenagers in the United States. The focus remained on the negative consequences of sex and their prevention, while other topics such as identity or personal safety were hardly addressed. Interactive features were used in only 40% of apps. Furthermore, content was female-oriented and reinforced negative stereotypes and perceived norms that may have a negative impact on the sexual health of teens. These findings suggest that the potential of apps has not yet been fully realized in the context of sexual health promotion. This thesis provides suggestions and guidelines for individuals interested in developing theory-and evidence-based sexual education apps

Social Cognitive Theories and Electronic Health Design: Scoping Review

Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution

Designing a Personalized Health Risk Communication Website to Motivate User Attention and Systematic Processing

A web-based diabetes “risk calculator” is being developed and evaluated to determine the impact of personalized risk estimates and interactive feedback on user attention and systematic information processing. Preliminary experiments that randomized participants to two different health websites suggested that a risk calculator with personalized risk estimates did not increase (and may have decreased) systematic processing, focused immersion and information seeking. We describe a series of think aloud user studies which were conducted to provide a qualitative evaluation of the experimental protocol and explore alternate explanations for these unexpected findings. User study results suggested that the prior findings may have been driven by a lack of perceived novelty of the risk information, selective attention, and an expectation of personalization in both experimental conditions. Findings are consistent with satisficing in information search and have implications for the design of health information and future experiments that evaluate these types of interventions