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      eHealth Literacy Among College Students: A Systematic Review With Implications for eHealth Education

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          Abstract

          Background

          eHealth literacy refers to the ability of individuals to seek, find, understand, and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem. While the current generation of college students has access to a multitude of health information on the Internet, access alone does not ensure that students are skilled at conducting Internet searches for health information. Ensuring that college students have the knowledge and skills necessary to conduct advanced eHealth searches is an important responsibility particularly for the medical education community. It is unclear if college students, especially those in the medical and health professions, need customized eHealth literacy training for finding, interpreting, and evaluating health- and medical-related information available on the Internet.

          Objective

          The objective of our review was to summarize and critically evaluate the evidence from existing research on eHealth literacy levels among college students between the ages of 17 and 26 years attending various 4-year colleges and universities located around the world.

          Methods

          We conducted a systematic literature review on numerous scholarly databases using various combinations of relevant search terms and Boolean operators. The records were screened and assessed for inclusion in the review based on preestablished criteria. Findings from each study that met inclusion criteria were synthesized and summarized into emergent themes.

          Results

          In the final review we analyzed 6 peer-reviewed articles and 1 doctoral dissertation that satisfied the inclusion criteria. The number of participants in each reviewed study varied widely (from 34 to 5030). The representativeness of the results from smaller studies is questionable. All studies measured knowledge and/or behaviors related to college student ability to locate, use, and evaluate eHealth information. These studies indicated that many college students lack eHealth literacy skills, suggesting that there is significant room for improvement in college students’ ability to obtain and evaluate eHealth information.

          Conclusion

          Although college students are highly connected to, and feel comfortable with, using the Internet to find health information, their eHealth literacy skills are generally sub par. College students, especially in the health and medical professions, would be well served to receive more customized college-level instruction that improves general eHealth literacy.

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          Most cited references39

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          Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association.

          Patients with the greatest health care needs may have the least ability to read and comprehend information needed to function successfully as patients. To examine the scope and consequences of poor health literacy in the United States, characterize its implications for patients and physicians, and identify policy and research issues. The 12 members of the Ad Hoc Committee on Health Literacy, American Medical Association Council on Scientific Affairs, were selected by a key informant process as experts in the field of health literacy from a variety of backgrounds in clinical medicine, medical and health services research, medical education, psychology, adult literacy, nursing, and health education. Literature review using the MEDLINE database for January 1966 through October 1, 1996, searching Medical Subject Heading (MeSH) reading combined with text words health or literacy in the title, abstract, or MeSH. A subsequent search using reading as a search term identified articles published between 1993 and August 1998. Authors of relevant published abstracts were asked to provide manuscripts. Experts in health services research, health education, and medical law identified proprietary and other unpublished references. Consensus among committee members was reached through review of 216 published articles and additional unpublished manuscripts and telephone and Internet conferencing. All committee members approved the final report. Patients with inadequate health literacy have a complex array of communications difficulties, which may interact to influence health outcome. These patients report worse health status and have less understanding about their medical conditions and treatment. Preliminary studies indicate inadequate health literacy may increase the risk of hospitalization. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. Future research should focus on optimal methods of screening patients to identify those with poor health literacy, effective health education techniques, outcomes and costs associated with poor health literacy, and the causal pathway of how poor health literacy influences health.
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            Internet use for health information among college students.

            Use of the Internet to retrieve health information is increasingly common. The authors surveyed 743 undergraduate students at 2 academic institutions to examine their Internet use, health-seeking behaviors, and attitudes related to the use of the Internet to obtain health information. Fifty-three percent of the respondents indicated that they would like to get health information online, and 28% reported that they would like to attend a health program online. Overall, 74% of the students reported having ever received health information online, and more than 40% reported that they frequently searched the Internet for information. They used various search engines and multiple Web sites to find health information. Issues related to the credibility of the information on health Web sites were crucial considerations for students. The study found differences in Internet use for health information by gender and by level of Internet experience.
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              eHealth evaluation and dissemination research.

              This paper reviews key challenges in evaluating eHealth intervention and behavior change programs, and makes recommendations for the types of designs, measures, and methods needed to accelerate the integration of proven eHealth programs into practice. Key issues discussed include evaluation approaches that answer questions that consumers, potential adoptees, and policymakers have. These include measures of participation and representativeness at both patient and healthcare setting levels, consistency of outcomes across different subgroups, tendency of an eHealth program to ameliorate versus exacerbate health disparities, implementation and program adaptation, cost, and quality-of-life outcomes. More practical eHealth trials are needed that use rigorous but creative designs compatible with eHealth interventions and theory. These evaluations should address key dissemination issues, such as appeal, use, and robustness of eHealth programs across different subgroups, settings, conditions, outcomes, and time.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                1438-8871
                Oct-Dec 2011
                01 December 2011
                : 13
                : 4
                : e102
                Affiliations
                [1] 1simpleDepartment of Health Education and Behavior simpleUniversity of Florida Gainesville, FLUnited States
                [2] 2simpleDepartment of Health and Kinesiology simpleTexas A&M University College Station, TXUnited States
                Article
                v13i4e102
                10.2196/jmir.1703
                3278088
                22155629
                033d43c5-d965-4b22-a56e-336298d473a5
                ©Michael Stellefson, Bruce Hanik, Beth Chaney, Don Chaney, Bethany Tennant, Enmanuel Antonio Chavarria. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.12.2011.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), 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.

                History
                : 02 December 2010
                : 01 April 2011
                : 02 June 2011
                : 19 July 2011
                Categories
                Review

                Medicine
                ehealth literacy,college students,health occupations,professional preparation
                Medicine
                ehealth literacy, college students, health occupations, professional preparation

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