Vazquez Christian Elias, Xie Bo, Shiroma Kristina, Charness Neil
School of Social Work, The University of Texas at Arlington, Arlington, TX, United States.
School of Nursing, The University of Texas at Austin, Austin, TX, United States.
JMIR Aging. 2023 Feb 9;6:e41809. doi: 10.2196/41809.
Older adults tend to have insufficient health literacy, which includes eHealth literacy-the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy.
The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy.
Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy.
eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases).
Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains.
老年人往往健康素养不足，这包括电子健康素养，即获取、评估和使用数字健康信息的能力。采用协作学习（CL）和个性化学习（IL）等方法进行的干预可能有助于解决老年人电子健康素养较低的问题，但关于CL与IL对老年人电子健康素养的短期和长期影响，我们所知甚少。
本研究的目的是采用3×2×3混合因子设计，研究老年人通过CL与IL学习电子健康素养的情况。
来自不同种族和族裔群体且年龄在60-96岁之间的老年人（N=466；平均年龄70.5岁，标准差7.2）被随机分配到CL组或IL组（每组233/466，各占50%）。干预为期4周，每周两次，每次2小时。我们使用方差分析和多元回归，重点关注学习条件的主效应以及学习条件与先前计算机经验之间的相互作用。学习方法（CL或IL）和先前计算机经验（有经验、新手或混合）是组间变量，测量时间（预测试、后测试和6个月随访）是组内变量。主要结局变量包括电子健康素养效能、计算机和网络知识、基本计算机和网络操作技能、信息搜索技能以及网站评估技能。控制变量包括年龄、性别、教育程度、健康状况、种族和族裔、收入、主要语言以及先前的健康素养。
从干预前到干预后，电子健康素养效能、计算机和网络知识、基本计算机和网络操作技能、信息搜索技能以及网站评估技能均有显著提高（所有情况下P<.001）。从干预后测量到6个月随访，基于一项结局指标，即计算机和网络操作技能，学习条件与先前计算机经验之间存在显著交互作用（F=3.69；P=.03）。为了在干预后6个月保持计算机和网络操作技能，对于几乎没有或没有先前计算机经验的人来说，单独学习更有效，而对于有更多先前计算机经验的人来说，协作学习更有效。从干预后测量到6个月随访，在5项结局指标中有3项出现了统计学上的显著下降：电子健康素养效能、计算机和网络知识以及基本计算机和网络操作技能（所有3种情况P<.001）。
通过有效的干预可以提高老年人的电子健康素养，IL或CL条件对短期结局可能影响不大。然而，为了保持长期收益，与具有相似先前计算机经验的人协作学习可能是最佳选择。电子健康素养是多维度的，有些组成部分随着时间的推移保留得更好。研究结果表明需要资源来提供持续培训或定期强化，以维持干预效果。
