Search Results (55)

Background: Digitalization and artificial intelligence-supported clinical decision support systems (AI-DSS), defined here as tools that generate patient-specific alerts, risk estimates, prioritization prompts, documentation suggestions, or related recommendation outputs intended to support rather than replace professional nursing judgment, can improve clinical decision-making, yet they may also amplify technostress and burnout, with downstream effects on missed nursing care and implementation readiness. Methods: We surveyed 239 registered nurses from a tertiary-care hospital in Timișoara, Romania (January–March 2025), including critical care (n = 60) and general wards (n = 179). Measures included a 15-item technostress scale, eHEALS, Maslach Burnout Inventory–Human Services Survey (MBI-HSS), Safety Attitudes Questionnaire (SAQ) teamwork and safety climate subscales, a 10-item missed nursing care inventory, and a six-item AI-DSS acceptance scale reflecting perceived usefulness, trust, and stated willingness to use such tools if available as an attitudinal readiness outcome rather than as routine observed use. Multivariable regression, exploratory mediation models, cluster analysis, and exploratory ROC analysis were performed. Results: Higher technostress was associated with higher emotional exhaustion (r = 0.52) and more missed care (r = 0.41), whereas eHealth literacy correlated with higher AI-DSS acceptance (r = 0.35) and lower technostress (r = −0.34). In adjusted models, technostress (per 10 points) was associated with higher missed care (β = 0.28, p < 0.001) (equivalent to 0.14 points per 5-point increase) and higher odds of low AI-DSS acceptance (OR = 1.38, p = 0.001), while eHealth literacy was associated with lower odds of low acceptance (OR = 0.71 per 5 points, p < 0.001). Burnout and the safety climate statistically accounted for approximately 35% of the technostress–missed care association. Three workflow phenotypes were identified, with the high-strain/low-literacy cluster showing the most missed care (3.5 ± 1.8) and the lowest AI acceptance (19.7 ± 5.2). An exploratory in-sample ROC model for intention to leave achieved an AUC of 0.82. Conclusions: Higher technostress clustered with worse nurse well-being, more care omissions, and lower AI-DSS acceptance, whereas eHealth literacy appeared protective. Interventions combining digital skills support, usability-focused redesign, and a stronger safety climate may reduce missed care and support safer AI implementation. Full article

Background/Objectives: Despite the publication of several systematic reviews on adolescent health literacy, comprehensive evaluations of the relationship between health literacy and health-related behaviors are still limited. This systematic review sought to synthesize and critically appraise the available evidence on associations between health literacy and health behaviors among adolescents. Methods. A systematic search of three databases (Scopus, PubMed, and PsycINFO) was conducted in accordance with PRISMA guidelines. Thirty-seven eligible cross-sectional studies were selected for qualitative synthesis. Methodological quality was evaluated using the Newcastle–Ottawa Scale adapted for cross-sectional studies. Results: The 37 included studies encompassed 71,558 adolescents (mean age range 11.0–17.0 years) and were conducted primarily in Europe (n = 22), with additional studies from the USA (n = 5), Asia (n = 8), and cross-cultural settings (n = 2). Across studies, 11 HL instruments were used (including two eHealth literacy measures), most commonly the Health Literacy for School-aged Children scale (n = 14). Physical activity (n = 22), nutrition-related indicators (n = 26), and smoking/alcohol/drug outcomes (n = 16) were assessed using heterogeneous operationalisations. Overall, higher HL was more often associated with healthier behavioral profiles, with more consistent patterns for nutrition-related outcomes. Findings for physical activity and substance use were more heterogeneous and, in some cases, varied depending on the HL measurement approach (subjective vs. objective) and the behavioral reference period. Conclusions: Current evidence indicates that higher health literacy in adolescents is generally associated with more favorable health behaviors, particularly regarding nutrition-related indicators. However, study heterogeneity and the predominance of cross-sectional designs limit comparability and causal inference. Future research should prioritize standardized measurement tools and longitudinal designs to clarify directionality and underlying mechanisms. Full article

Background/Objectives: Vaccine hesitancy arises from multiple determinants, including individual beliefs, cognitive style, social norms, political identity and the information environment. In this context, health literacy, e-health literacy, susceptibility to health misinformation, conspiracy beliefs and trust in science may be relevant in mediatized societies. Aim: The aim of the study was to examine how susceptibility to health misinformation relates to vaccine hesitancy in Poland and how this association is influenced by health literacy, e-health literacy, trust in scientists and sociodemographic factors. Methods: Data came from a web-based survey conducted in December 2024 among 2200 adults aged 18–75 years. The questionnaire included validated scales of vaccine hesitancy, health literacy, e-health literacy, vaccine conspiracy beliefs and trust in scientists. The susceptibility to health misinformation was measured with ad hoc instrument based on the statement from fact-checking services. Items assessing digital media use, political sympathies, religious practices and sociodemographics were also applied. Multivariable linear regression was applied with continuous vaccine hesitancy as the dependent variable. Results: The model explained 57.8% of the variance in vaccine hesitancy. Susceptibility to misinformation (B = 0.11, 95% CI: 0.08–0.15) and vaccine conspiracy beliefs (B = 0.44, 95% CI: 0.41–0.46) were positive predictors, whereas trust in scientists (B = −0.20, 95% CI: −0.23–−0.17) and e-health literacy (B = −0.07, 95% CI: −0.11–−0.02) were protective. Older age was associated with lower hesitancy (B = −0.02, 95% CI: −0.03–0.00). Secondary education (B = −0.58) and a master’s degree (B = −0.77) predicted lower hesitancy. Health literacy categories were not significantly related to vaccine hesitancy. Conclusions: Susceptibility to health misinformation and vaccine conspiracy beliefs were key predictors of vaccine hesitancy, outweighing the effects of health literacy and the protective impact of trust in scientists and e-health literacy, and indicating a need for interventions that combine prebunking and literacy-focused strategies with efforts to strengthen confidence in health institutions. Full article

Background/Objectives: Digital platforms have increased access to health information. The eHEALS scale evaluates individuals’ capabilities for accessing, assessing, and assimilating health information to help them make well-informed oral health decisions. It would be interesting to examine the association with oral health behavior (OHB), as digital platforms are increasingly seen as a “super social determinant”. Hence, the present study aimed to assess eHealth literacy levels and their association with oral health behaviors among dental outpatients at a dental college in Riyadh, Saudi Arabia. Methods: A cross-sectional survey using the eHEALS questionnaire was conducted after translation into Arabic, with additional questions on oral health behaviors. The internal consistency of the translated questionnaire was good. A total of 213 patients were recruited from the dental college’s outpatient department. Chi-square, followed by multinomial regression, was used in the statistical analysis. Results: The mean total eHEALS score in the sampled population was 26.17 (±7.5) of the 213 participants, with 108 (50.7%) having good oral health behavior practices. The elderly age group (OR 2.67, p = 0.01, CI 1.25–5.68), school-level education (OR 2.82, p = 0.03, CI 1.41–5.66), and low monthly family income (OR 2.53, p = 0.01, CI 1.25–5.11) were significantly associated with inadequate eHealth literacy. Participants with good oral health behavior had significantly lower odds of being categorized into inadequate (OR 0.41, p = 0.01, CI 0.20–0.81) or problematic (OR 0.43, p = 0.01, CI 0.22–0.85) levels of eHealth literacy. Conclusions: There is a significant association between eHealth literacy and individuals’ oral health behavior practices. Age, monthly family income, and education were key predictors of eHealth literacy levels. Full article

Background: Sustainable diets, particularly the Mediterranean diet, are associated with improved human and planetary health. Nutrition literacy influences food choices, yet intergenerational differences in literacy and adherence to sustainable diets remain underexplored. This study examined the relationship between nutrition literacy, adherence to the Mediterranean diet, and sustainable nutrition behaviors among Generation X, Y, and Z adults living in Istanbul. Methods: A cross-sectional online survey was conducted among adults aged 18–60 years. Data were collected through a demographic questionnaire, the E-Healthy Nutrition Literacy Scale, and the Short Questionnaire for Mediterranean Diet Adherence and Sustainable Nutrition. Parametric statistical analyses were performed. Results: Among 1395 participants, adherence to the Mediterranean diet did not significantly differ by generation or gender (p > 0.05). Participants with prior nutrition education were significantly more likely to achieve high nutrition literacy scores and adhere to sustainable eating practices. Adherence to sustainable nutrition increased across generations, with Generation Z exhibiting the highest proportion of low adherence (53%), while Generations Y and X demonstrated progressively higher rates of moderate (39%) and high adherence (31.6%) (p < 0.05). Correlation analyses indicated that adherence to sustainable nutrition was positively associated with the application dimension of nutrition literacy, suggesting that both knowledge and practical skills may influence sustainable nutrition behaviors. Conclusion: Older and more educated participants achieved higher nutrition literacy and sustainable nutrition adherence scores. Knowledge alone is insufficient to ensure healthy or sustainable eating. Enhancing practical skills and providing sustainability-focused nutrition education may improve diet quality and public health. Full article

The Japanese version of the eHealth Literacy Scale (J-eHEALS) measure has primarily been applied to younger populations; however, the psychometric properties of the J-eHEALS in older adults have not been investigated. Therefore, in this cross-sectional study, we aimed to evaluate the psychometric properties of the J-eHEALS in community-dwelling older adults. A total of 553 adults aged ≥ 65 years (mean age, 73.5 years) attending routine health checkups in a single Japanese municipality completed the J-eHEALS and the Japanese version of the 12-item Health Literacy Scale (J-HLS-Q12). We examined internal consistency, item characteristics, factorial validity using exploratory and confirmatory factor analyses, measurement invariance by sex, and convergent and criterion-related validity with general health literacy. The J-eHEALS scores indicated moderate to slightly low perceived eHealth literacy in this population. The scale demonstrated excellent internal consistency (Cronbach’s α = 0.94), a stable unidimensional factor structure with acceptable model fit across sexes, and moderate positive associations with general health literacy. Overall, these findings support the J-eHEALS as a reliable and valid instrument for assessing perceived eHealth literacy in older Japanese adults and its suitability for use in research and practice. Full article

Background: eHealth literacy (eHL) is the ability to seek, find, understand, and apply digital health information. Adolescents often overestimate their eHL skills, potentially leading to poor health decisions and posing a public health concern. Objectives: This study aimed to examine the knowledge, attitudes, and behaviors toward eHL and seeking health information online among a sample of Italian adolescents aged 10–19 to identify the sociodemographic characteristics and other variables that are associated with the outcomes of interest. Methods: A cross-sectional study was conducted using a structured questionnaire, including the eHealth Literacy Scale (eHEALS). Results: A total of 793 Italian adolescents from seven public schools in Naples, southern Italy, participated in the survey. Among the participants, 58.6% had an eHEALS score below 27. A higher eHL was associated with being male, perceiving the Internet as useful for health decisions, the use of electronic devices for seeking health information, consulting institutional/scientific sources, having a mother with lower education, and having parents without underlying chronic conditions. Additionally, a higher eHL, male sex, younger age, and Internet use for seeking health information in the last three months were linked to perceiving the Internet as a helpful tool for health decision making. Conclusions: Overall, Italian adolescents reported suboptimal eHL with sex, attitudes, and parental factors playing significant roles. Targeted educational interventions are needed to enhance eHL in this specific age group. Full article

Background/Objectives: Psychosocial factors (e.g., adherence, substance use) contribute to increased morbidity and mortality after heart transplantation. We investigated alcohol consumption patterns and their associations with psychosocial factors in adults, who underwent heart transplantation surgery (HTX recipients). Methods: Our cross-sectional study was conducted at the Semmelweis University Heart and Vascular Centre between 2023 and 2025. In total, 201 HTX recipients (75.6% male, mean age: 56.33 ± 11.46 years) completed the Alcohol Use Disorders Identification Test (AUDIT), Brief Health Literacy Screening Tool (BRIEF), Medication Adherence Report Scale (MARS-5) modified to immunosuppressive medication, and 9-item Beck Depression Inventory (BDI-9). Statistical analysis included Pearson’s correlation tests and Multivariate Regression Analyses. Results: The AUDIT had a higher proportion of non-evaluable responses than other questionnaires (AUDIT 19.9% vs. 5.5–9%), with 41.0% of the participants abstinent, 54.7% low-risk, 4.3% medium-risk, and 6.5% at-risk drinkers. AUDIT correlated negatively with MARS-5 (r = −0.326; p = 0.000) and positively with BDI-9 (r = 0.208; p = 0.010). At-risk drinking was associated with a lower MARS-5 (r = −0.231; p = 0.002). Multivariate regression models significantly predicted the AUDIT (F = 5.106; p < 0.001, R² = 0.216) and AUDIT-C (F = 3.804; p = 0.002; R² = 0.146), with sex and adherence as independent predictors. Conclusions: The high proportion of non-evaluable AUDIT responses suggests limitations in multi-questionnaire use but does not diminish its clinical relevance. The presence of 6.5% at-risk and 4.3% medium-risk drinkers highlights the relevance of consumption pattern screening, beyond diagnosing alcohol use disorder. Associations between AUDIT, MARS-5, and BDI-9 emphasize the necessity for multidisciplinary care. Full article

Background/Objectives: This study aimed to examine the utilization of dental care services according to the health information literacy among Korean adults. Methods: This study used secondary raw data from the 9th National Health and Nutrition Examination Survey (2023), which included 3356 adults aged 20 years and older. Frequency analysis, cross-analysis, and logistic regression were performed (p < 0.05). Data were analyzed using IBM SPSS software (ver. 22.0). Results: Using cross-analysis to identify the relationship between health information understanding and oral examinations within the last year, statistically significant differences were confirmed for all questions (p < 0.05). A statistically significant association was identified between individuals’ level of health information literacy and their engagement in preventive dental care, particularly the utilization of scaling procedures (p < 0.05). The higher their understanding of health information, the more likely they were to have undergone an oral examination in the previous year (nearly twice as likely higher; p = 0.003). The higher the understanding of health information regarding preventive treatment (scaling), the more likely the participant was to receive it (i.e., 2.2 times higher; p < 0.001). Conclusions: Educational interventions and policy support to improve the ability to understand health information can be important strategies for promoting the practice of preventive oral health and improving oral health level in people. Full article

Low rates of actively contributing to the Social Health Insurance Fund (SHIF) under the Social Health Authority (SHA) could be due to health insurance knowledge inadequacies, possibly because of poor electronic health (eHealth) literacy. This study assesses whether eHealth literacy is associated with SHA/SHIF knowledge among undergraduate healthcare students in Kenya. An analytical cross-sectional study was conducted using the eHealth Literacy Scale (eHEALS) and an adapted Kaiser Family Foundation quiz. A total of 207 students in mainly six health-related academic programs in 21 institutions of higher learning in Kenya responded to the online survey. Only 54% and 21.7% of the participants had high (median ≥ 4 out of 5) levels of eHealth literacy and knowledge of SHA/SHIF, respectively. About 9.2% of the students had never heard of SHA/SHIF. Only high eHealth literacy compared to low eHealth literacy (OR = 6.2, p < 0.0001) and pursuing nursing, public health, and other programs compared to pursuing Bachelor of Medicine and Bachelor of Surgery (MBChB) (OR = 4.9–5.1, p = 0.01–0.03) significantly predicted SHA/SHIF knowledge. Thus, eHealth literacy levels and SHA/SHIF knowledge require improvement among undergraduate healthcare students in Kenya to prepare them as SHA ambassadors in their communities. Full article

Background: Digital health literacy is crucial for navigating social media as a primary health information source. However, its interactive and unregulated nature fosters misinformation, requiring critical evaluation skills. Existing tools assess general internet use, but no validated instrument measures competencies specific to social media. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for this context. Methods: A content validation process was conducted with 33 experts, who evaluated the clarity, coherence, and relevance of the adapted questionnaire using item-level (I-CVI) and scale-level (S-CVI) content validity indices. A pilot study was then carried out with 250 participants to assess the instrument’s reliability and feasibility, measured through Cronbach’s alpha and McDonald’s Omega. Results: The adapted eHEALS demonstrated excellent content validity (S-CVI > 0.90) and high internal consistency (Cronbach’s α = 0.92; McDonald’s Ω = 0.92). The tool effectively captures key competencies for evaluating and applying health information in social media contexts, with exploratory factor analysis confirming a unidimensional structure that explained over 60% of the variance, supporting its robustness for use in population-based studies. Conclusions: This validated instrument provides a reliable method for assessing digital health literacy in social media, supporting the development of educational interventions to enhance critical appraisal skills and mitigate the impact of misinformation. Full article

Background: Telepsychiatry expanded rapidly during the COVID-19 pandemic, yet patient experience data from mixed urban and rural areas in Saudi Arabia remain scarce. Objective: We aimed to quantify the perception of telepsychiatry among adults with major depressive disorder [MDD] in Madinah City, the KSA, and to identify associated demographic and clinical factors. Methods: A cross-sectional survey was conducted at Madinah Mental Health Hospital between December 2024 and March 2025. Eligible participants were Arabic-speaking adults [≥18 years] with a clinician-confirmed diagnosis of major depressive disorder [MDD] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], following a scheduled video- or audio-based telepsychiatry consultation. Perception of telepsychiatry was assessed using the validated 10-item Arabic version of the Telehealth Satisfaction Scale [TeSS], which evaluates audiovisual quality, communication, and support. Variables associated with perception at p < 0.20 in the bivariable analyses were entered into a multiple linear regression model to identify independent predictors. Results: Of the 218 eligible patients, 207 participated [response rate = 95%], with similarly high participation rates being reported in comparable telepsychiatry surveys [e.g., 90–91%]. The majority were male [59%], with a mean [SD] age of 38.4 [11.2] years. The mean satisfaction score was 32.3 ± 6.3, and 36% of participants were classified as highly satisfied. In the multivariable analysis, higher satisfaction was independently associated with male gender [B = 3.0, 95% CI: 1.3–4.7], intermediate versus elementary education [B = 4.3, 95% CI: 1.1–7.6], and the presence of a chronic illness [B = 2.1, 95% CI: 0.3–3.8]. Conclusions: Telepsychiatry is generally well-accepted among adults with depression in Madinah. However, women and individuals with lower educational attainment report lower satisfaction. Targeted interventions such as improving privacy, offering digital literacy support, and tailoring communication may help improve the telepsychiatry experience for underserved groups. Full article

Background: It is well-established that, for adolescents to adopt sustainable healthy lifestyle behaviors, not only access to information but also the skills required to translate that information into action are critical. In this field, research that examines the relationship between e-health literacy and sustainable healthy lifestyle behaviors within the context of physical literacy is notably scarce. In this context, the aim of this study is to examine the effect of e-health literacy on a sustainable healthy lifestyle and to evaluate the mediating role of physical literacy in this relationship. Methods: A total of 835 adolescents from high schools across Türkiye voluntarily participated in this study. During the data collection process, the e-Health Literacy Scale, the Perceived Physical Literacy Scale, and the Healthy and Sustainable Lifestyle Scale were utilized. Data were analyzed using the JASP (version 0.18.3.0) software. Correlation analysis and structural equation modeling were conducted, and the bootstrap method (n = 5000) was employed for mediation analysis. Results: The effect of e-health literacy on a sustainable healthy lifestyle was found to be positive and statistically significant (β = 0.452, p < 0.001). Similarly, e-health literacy significantly predicted physical literacy (β = 0.755, p < 0.001), and physical literacy significantly predicted a sustainable healthy lifestyle (β = 0.310, p < 0.001). The mediating effect was also statistically significant (β = 0.234, p < 0.001). The model explained 32% of the variance in healthy lifestyle behaviors. Conclusions: The findings indicate that evaluating e-health literacy and physical literacy together provides a holistic approach to fostering sustainable healthy lifestyle habits among adolescents. It is recommended that intervention programs be structured to encompass both areas of competence. Full article

Retrofitting the existing housing stock to a high level of energy efficiency will not be limited to achieving the decarbonisation of 80.3 MtCO2e residential emissions and reducing fuel poverty in 4.16 million households, but also improving the health and well-being of UK residents and their overall quality of life. The current progress of housing retrofitting is poor, at less than 1%. The UK expects to achieve net zero by 2050, and the challenge is immense as there are more than 30 million houses. The challenge is similar in other global contexts. Even if the required technology, supply chain, skilled labour, and finance could have been provided, the retrofitting would not move forward without positive engagement from the clients. Proper strategies are required to retrofit at scale. Focusing on the challenges of stakeholder engagement in housing retrofitting, this study focused on developing a hybrid one-stop shop solution through design science research. A theoretical artefact and an empirical system requirement specification document were developed to propose a one-stop shop solution. This was tested through retrofit industry stakeholders. Findings reveal that the one-stop shop model will be a good answer to retrofitting at scale, providing the resident engagement of 30.1 million households. The model can support residents with or without computer literacy due to its hybrid approach. The proposed theoretical and industrial models can be used as base models for developing one-stop shops for housing retrofitting by adapting them for context-specific requirements. Full article

To effectively mitigate the health impacts of climate change, future nurses must be equipped with the requisite knowledge and competencies. Knowing their levels of eco-literacy would help to make them more effective. Background/Objectives: This descriptive study will use a three-round, multicentre, modified e-Delphi survey to establish an expert panel’s consensus on the Climate, Health, and Nursing Tool’s (CHANT) item-level and scale-level content validity indices. It will also examine potential associations between the expert panel members’ sociodemographic and professional characteristics and their content validity index assessments of the CHANT. Methods: The study will be conducted in the French-speaking regions of Switzerland, running its three-round e-Delphi survey between January and April 2025. After each round, the CHANT’s overall scale-level and individual item-level content validity indices will be computed. Comparisons between different types of healthcare professionals’ profiles will also be conducted. Results: The three-round modified e-Delphi survey should allow the expert panel to reach a consensus on the CHANT’s overall content validity index. The tool should then be considered suitable for pilot testing. The first round brought together 16 experts from different regions, namely French-speaking Switzerland, France, and Belgium. Conclusions: To ensure that the nursing discipline is well positioned to meet future challenges, the development of eco-literacy must be integrated into nursing education. Ensuring the CHANT’s conceptual and psychometric validity will be essential in strengthening nursing competencies in and knowledge about planetary health and in implementing future educational interventions. Full article