Schulz Peter Johannes, Fitzpatrick Mary Anne, Hess Alexandra, Sudbury-Riley Lynn, Hartung Uwe
Institute of Communication and Health, Faculty of Communication Science, Università della Svizzera italiana, Lugano, Switzerland.
Waikato Management School, University of Waikato, Hamilton, New Zealand.
J Med Internet Res. 2017 May 16;19(5):e166. doi: 10.2196/jmir.6317.
Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people's ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context.
We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking.
Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one's general practitioner (GP). Path analysis was employed for data analysis.
We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared.
The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.
大多数（并非全部）证据表明，健康素养水平较高的个体比健康素养水平较低的个体更少使用医疗保健系统。尽管在互联网上广泛提供健康信息的情况下，人们独立获取健康信息的能力在这方面被提及，但这种影响的潜在原因在很大程度上尚不清楚。
我们提出并检验电子健康素养对医疗保健利用产生负面影响的两个潜在中介因素：（1）健康信息寻求；（2）通过信息寻求获得的赋权感。
在新西兰、英国和美国收集数据，使用一家专门提供在线样本小组的公司管理的基于网络的调查。三个样本加起来共有996名出生于1946年至1965年之间的婴儿潮一代，他们在过去6个月内使用互联网搜索和分享健康信息。测量变量包括电子健康素养、互联网健康信息寻求、通过该信息自我感知的赋权感，以及与全科医生（GP）的咨询次数。采用路径分析进行数据分析。
我们发现了一系列间接效应路径，显示健康素养与医疗保健利用之间存在正相关关系：通过健康信息寻求（路径1）、通过赋权感增加（路径2）以及通过两者（路径3）。除了这些间接效应的出现，健康素养对医疗保健利用的直接效应消失了。
从健康素养通过信息寻求和赋权到全科医生咨询的间接路径可以被解释为一个动态过程，以及在必要时查找、处理和理解相关信息能力的一种体现。
