Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups

Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized...

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Published in:	Journal of medical Internet research Vol. 22; no. 8; p. e18476
Main Authors:	Cheng, Christina, Beauchamp, Alison, Elsworth, Gerald R, Osborne, Richard H
Format:	Journal Article
Language:	English
Published:	Canada Gunther Eysenbach MD MPH, Associate Professor 13.08.2020 JMIR Publications
Subjects:	Adults At risk populations Cognition & reasoning Disadvantaged Ethnic groups Ethnicity Feasibility studies Health disparities Health education Health literacy Health Literacy - methods Health status Humans Internet Internet access Internet-Based Intervention - trends Intervention Literacy Low income groups Marginality Minority groups Multimedia Older people Personal health Public health Research Design Review Rural areas Rural communities Skill development Socioeconomic factors Systematic review Telemedicine Telemedicine - methods Usability User involvement Vulnerable Populations - statistics & numerical data health literacy digital divide health equity eHealth health care internet telecommunications
ISSN:	1438-8871, 1439-4456, 1438-8871
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Abstract	Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
AbstractList	BackgroundElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. ObjectiveThis systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. MethodsA systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. ResultsA total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. ConclusionsThe findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity. Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities.BACKGROUNDElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities.This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.OBJECTIVEThis systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis.METHODSA systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis.A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.RESULTSA total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.CONCLUSIONSThe findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity. Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity. Background: Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. Objective: This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. Methods: A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. Results: A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. Conclusions: The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
Author	Beauchamp, Alison Osborne, Richard H Elsworth, Gerald R Cheng, Christina
AuthorAffiliation	4 Department of Medicine - Western Health The University of Melbourne Melbourne Australia 5 Australian Institute for Musculoskeletal Science Sunshine Hospital St Albans Australia 3 Department of Rural Health Monash University Melbourne Australia 2 Deakin University School of Health and Social Development Faculty of Health Burwood Australia 1 Centre for Global Health and Equity Faculty of Health, Arts and Design Swinburne University of Technology Hawthorn Australia
AuthorAffiliation_xml	– name: 2 Deakin University School of Health and Social Development Faculty of Health Burwood Australia – name: 1 Centre for Global Health and Equity Faculty of Health, Arts and Design Swinburne University of Technology Hawthorn Australia – name: 5 Australian Institute for Musculoskeletal Science Sunshine Hospital St Albans Australia – name: 3 Department of Rural Health Monash University Melbourne Australia – name: 4 Department of Medicine - Western Health The University of Melbourne Melbourne Australia
Author_xml	– sequence: 1 givenname: Christina orcidid: 0000-0002-8950-7689 surname: Cheng fullname: Cheng, Christina – sequence: 2 givenname: Alison orcidid: 0000-0001-6555-6200 surname: Beauchamp fullname: Beauchamp, Alison – sequence: 3 givenname: Gerald R orcidid: 0000-0001-6306-7593 surname: Elsworth fullname: Elsworth, Gerald R – sequence: 4 givenname: Richard H orcidid: 0000-0002-9081-2699 surname: Osborne fullname: Osborne, Richard H
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32788144$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Christina Cheng, Alison Beauchamp, Gerald R Elsworth, Richard H Osborne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020. 2020. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Christina Cheng, Alison Beauchamp, Gerald R Elsworth, Richard H Osborne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020. 2020
Copyright_xml	– notice: Christina Cheng, Alison Beauchamp, Gerald R Elsworth, Richard H Osborne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020. – notice: 2020. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Christina Cheng, Alison Beauchamp, Gerald R Elsworth, Richard H Osborne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020. 2020
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License	Christina Cheng, Alison Beauchamp, Gerald R Elsworth, Richard H Osborne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
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Snippet	Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be... Background: Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of... BackgroundElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users...
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SubjectTerms	Adults At risk populations Cognition & reasoning Disadvantaged Ethnic groups Ethnicity Feasibility studies Health disparities Health education Health literacy Health Literacy - methods Health status Humans Internet Internet access Internet-Based Intervention - trends Intervention Literacy Low income groups Marginality Minority groups Multimedia Older people Personal health Public health Research Design Review Rural areas Rural communities Skill development Socioeconomic factors Systematic review Telemedicine Telemedicine - methods Usability User involvement Vulnerable Populations - statistics & numerical data
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