Reder Maren, Soellner Renate, Kolip Petra
School of Public Health, Bielefeld University, Bielefeld, Germany.
Institute for Psychology, Department of Education and Social Sciences, University of Hildesheim, Hildesheim, Germany.
Front Public Health. 2019 Mar 12;7:46. doi: 10.3389/fpubh.2019.00046. eCollection 2019.
Our decision aid on mammography screening developed according to the criteria of the International Patient Decision Aids Standards Collaboration increases knowledge compared to usual care. However, it remains unclear whether this decision aid is more effective in women with higher eHealth literacy. Our objective was to test whether the positive effect of the decision aid on knowledge is moderated by eHealth literacy. A total of 1,206 women aged 50 from Westphalia-Lippe, Germany, participated (response rate of 16.3%) in our study and were randomized to usual care (i.e., the standard information brochure sent with the programme's invitation letter) or the decision aid. eHealth literacy was assessed at baseline with the Electronic Health Literacy Scale (eHEALS); knowledge was assessed at baseline and post-intervention. First, we compared the 2-factor model of the German eHEALS (information-seeking and information-appraisal) found in previous research and the 3-factor model we hypothesized for decision aid use to the originally proposed 1-factor model. Second, we modeled the measurement model according to the superior factor model found in step one and tested whether the eHEALS moderated the effect of the decision aid on knowledge. The 3-factor model of the eHEALS had a better model fit than the 1-factor or 2-factor model. Both information-seeking, information-appraisal, and information-use had no effect on knowledge post-intervention. All three interactions of the decision aid with information-seeking, information-appraisal, and information-use were not significant. Equally, neither education nor its interaction with the decision aid had an effect on knowledge post-intervention. The decision aid developed in this project increases knowledge irrespective of level of eHealth literacy. This means that not only women with high eHealth literacy profit from the decision aid but that the decision aid has been successfully conceptualized as a comprehensible information tool that can be used by women of varying eHealth literacy levels. : German Clinical Trials Register DRKS00005176 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005176).
我们依据国际患者决策辅助工具标准协作组织的标准开发的乳腺钼靶筛查决策辅助工具，与常规护理相比能增加知识量。然而，尚不清楚该决策辅助工具对具备较高电子健康素养的女性是否更有效。我们的目标是检验决策辅助工具对知识的积极影响是否会因电子健康素养而有所不同。来自德国威斯特法伦 - 利珀的1206名50岁女性参与了我们的研究（应答率为16.3%），她们被随机分为接受常规护理组（即随项目邀请函一同发送的标准信息手册）或决策辅助工具组。在基线时使用电子健康素养量表（eHEALS）评估电子健康素养；在基线和干预后评估知识水平。首先，我们将先前研究中发现的德国eHEALS的二因素模型（信息寻求和信息评估）以及我们为决策辅助工具使用所假设的三因素模型，与最初提出的单因素模型进行比较。其次，我们根据第一步中发现的更优因素模型构建测量模型，并检验eHEALS是否调节了决策辅助工具对知识的影响。eHEALS的三因素模型比单因素或二因素模型具有更好的模型拟合度。信息寻求、信息评估和信息使用对干预后的知识均无影响。决策辅助工具与信息寻求、信息评估和信息使用的所有三种交互作用均不显著。同样，教育程度及其与决策辅助工具的交互作用对干预后的知识也均无影响。本项目开发的决策辅助工具无论电子健康素养水平如何都能增加知识量。这意味着不仅具备高电子健康素养的女性能从决策辅助工具中获益，而且该决策辅助工具已成功被概念化为一种可供不同电子健康素养水平女性使用的易于理解的信息工具。德国临床试验注册编号：DRKS00005176（https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005176）
