Holmen Heidi, Holm Are Martin, Falk Ragnhild Sørum, Kilvær Thomas Karsten, Ljosaa Tone Marte, Ekholdt Christopher, Fosse Erik
Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway.
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
J Med Internet Res. 2025 Apr 28;27:e60343. doi: 10.2196/60343.
Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear.
This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care.
We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use.
Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, "understanding health information well enough to know what to do," between the arms at 6 months (mean difference -0.05, 95% CI -0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (-0.15, 95% CI -0.30 to -0.00; P=.048) and understanding health information well enough to know what to do (-0.17, 95% CI -0.34 to -0.00; P=.03), as well as both physical (-3.29, 95% CI -5.62 to -0.96; P=.006) and mental HRQoL (-3.08, 95% CI -5.64 to -0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm.
This study explored digital outpatient care. Although no statistical differences were observed in patients' health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care.
ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/46649.
长期有健康需求的患者通常被期望积极参与门诊护理，前提是他们具备适当的健康素养和数字健康素养。然而，参与数字门诊服务与健康素养之间的关联仍不明确。
本研究旨在评估与常规护理相比，为期6个月的数字门诊护理是否能改善健康素养、健康相关生活质量（HRQoL）、数字/电子健康素养以及医疗服务的使用情况。
我们进行了一项多中心非随机试验，设有1个干预组和1个对照组。在挪威2所大学医院的疼痛科、肺部科、神经科或肿瘤科接受门诊护理的年龄≥18岁的患者，按1:2的比例分配，倾向于干预组。干预组接受数字门诊护理，使用定制的患者报告结局测量、自我监测以及聊天功能以便与门诊及时联系。医护人员通过带有交通信号灯系统的仪表盘评估患者的回复，以提请注意最紧急的报告。对照组接受常规护理。在基线以及3个月和6个月后收集数据。主要结局是根据健康素养问卷中“对健康信息理解得足够好以知道该怎么做”这一领域，从基线到6个月健康素养的变化。两个治疗组之间变化的平均差异为效应量。次要结局是健康素养问卷的其他领域、数字/电子健康素养、HRQoL、数字干预的可接受性以及医疗服务的使用情况。
总体而言，共招募了162名患者，对照组55名（34%），干预组107名（66%），6个月后的失访率为17.3%。6个月时，两组在主要结局“对健康信息理解得足够好以知道该怎么做”方面无统计学显著差异（平均差异 -0.05，95%置信区间 -0.20至0.10；P = 0.53）。3个月后，数字门诊干预组在健康素养领域“积极管理自己的健康”（-0.15，95%置信区间 -0.30至 -0.00；P = 0.048）和“对健康信息理解得足够好以知道该怎么做”（-0.17，95%置信区间 -0.34至 -0.00；P = 0.03），以及身体HRQoL（-3.29，95%置信区间 -5.62至 -0.96；P = 0.006）和心理HRQoL（-3.08，95%置信区间 -5.64至 -0.52；P = 0.02）方面均较对照组有所改善。
本研究探索了数字门诊护理。尽管6个月后患者的健康素养未观察到统计学差异，但我们的数据表明3个月时健康素养领域和HRQoL有所改善。参与者对数字门诊护理干预的满意度较高，我们的研究结果凸显了数字干预在门诊护理中的潜力。
ClinicalTrials.gov NCT05068869；https://clinicaltrials.gov/ct2/show/NCT05068869。
国际注册报告识别码（IRRID）：RR2-10.2196/46649。
