title: Measuring actual eHealth literacy among patients with rheumatic diseases: a qualitative analysis of problems encountered using Health 1.0 and Health 2.0 applications.
abstract: BACKGROUND
  The Internet offers diverse opportunities for disease management, through information websites (Health 1.0) and interactive applications such as peer support forums, online consults, and insight into electronic medical records (Health 2.0). However, various skills are required to benefit from Health 1.0 and Health 2.0 applications for one's own health, known as eHealth literacy.
  
  
  OBJECTIVE
  To study the eHealth literacy of patients with rheumatic diseases and the types of problems they encounter when using the Internet in relation to their disease.
  
  
  METHODS
  In two studies, patients were asked about their current disease-related Internet use and their eHealth literacy was observed during performance tests. In study 1, 15 patients (aged 39-74) performed 6 information-retrieval tasks on the Internet (Health 1.0). In study 2, 16 patients (aged 24-72) performed 3 Health 2.0 tasks on a hospital-based online Web portal and 2 Health 2.0 tasks on interactive websites. Participants were asked to think aloud while performing the assignments, and screen activities were recorded. Types and frequency of problems were identified by 2 independent researchers and coded into categories using inductive analysis.
  
  
  RESULTS
  Almost all patients in our studies had searched the Internet for information about rheumatic diseases in the past. Fewer patients had used Health 2.0 applications, but many were nevertheless enthusiastic about the possibilities from Health 2.0 applications after finishing the assignments. However, nearly all participants experienced difficulties, and a substantial number of participants were not able to complete all of the assignments. Encountered problems could be divided into 6 sequential categories: (1) operating the computer and Internet browser, (2) navigating and orientating on the Web, (3) utilizing search strategies, (4) evaluating relevance and reliability, (5) adding content to the Web, and (6) protecting and respecting privacy. Most severe difficulties occurred in levels 3 and 4-in formulating a search query, evaluating the source of the information, and in scanning a website for relevant information.
  
  
  CONCLUSIONS
  Many patients have insufficient skills to properly use Health 1.0 and Health 2.0. Formulating proper search strategies and evaluating the found information caused problems among the majority of patients. Concerning Health 2.0, use and awareness of these applications is low and patients should be guided in the use of them. Our findings may contribute to the awareness of patients' eHealth literacy problems among health professionals, and stress the importance of usability guidelines in Web design.
authors: University of Twente, Department of Psychology, Health & Technology, Enschede, Netherlands. r.vandervaart@utwente.nl
authors: Rosalie
authors: R
authors: van der Vaart
authors: Constance H C
authors: CH
authors: Drossaert
authors: Miriam
authors: M
authors: de Heus
authors: Erik
authors: E
authors: Taal
authors: Mart A F J
authors: MA
authors: van de Laar
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D009426:Netherlands; D012216:Rheumatic Diseases; D061108:Social Media; D017216:Telemedicine; D055815:Young Adult
references: Am J Health Syst Pharm. 2005 Jun 1;62(11):1184-9
references: 15984050
references: J Gen Intern Med. 2005 Aug;20(8):683-5
references: 16050874
references: Health Care Manage Rev. 2011 Apr-Jun;36(2):124-33
references: 21317657
references: J Med Internet Res. 2005 May 24;7(2):e13
references: 15914460
references: Arthritis Rheum. 2009 May 15;61(5):614-22
references: 19405002
references: J Clin Rheumatol. 2009 Oct;15(7):367-8
references: 20009977
references: J Med Internet Res. 2006 Jun 16;8(2):e9
references: 16867972
references: J Med Internet Res. 2011 Nov 03;13(4):e90
references: 22052161
references: J Med Internet Res. 2011 Dec 01;13(4):e102
references: 22155629
references: J Med Internet Res. 2008 Aug 25;10(3):e22
references: 18725354
references: J Med Internet Res. 2012 Jan 27;14(1):e19
references: 22357448
references: J R Soc Med. 2003 Feb;96(2):74-6
references: 12562977
references: J Med Internet Res. 2011 Dec 23;13(4):e125
references: 22193243
references: Diabetes Care. 2008 May;31(5):874-9
references: 18299446
references: J Med Internet Res. 2012 Apr 27;14(2):e60
references: 22543437
references: Rheumatol Int. 2013 Sep;33(9):2405-10
references: 22453527
references: J Biomed Inform. 2005 Feb;38(1):75-87
references: 15694887
references: BMJ. 2002 Mar 9;324(7337):573-7
references: 11884321
references: J Med Internet Res. 2008 May 15;10(2):e13
references: 18487137
references: J Med Internet Res. 2011 Nov 17;13(4):e94
references: 22094891
references: J Med Internet Res. 2011 Apr 29;13(2):e35
references: 21531690
references: Patient Educ Couns. 2010 Mar;78(3):329-36
references: 20202779
references: J Sch Health. 2012 Jan;82(1):28-36
references: 22142172
references: Rheumatology (Oxford). 2011 Sep;50(9):1618-26
references: 21551221
references: J Med Internet Res. 2011 Dec 05;13(4):e111
references: 22155738
references: J Am Med Inform Assoc. 2008 Jan-Feb;15(1):8-13
references: 17947617
references: Health Info Libr J. 2010 Dec;27(4):295-303
references: 21050372
references: Inform Health Soc Care. 2009 Sep;34(3):117-26
references: 19670002
references: Arthritis Rheum. 2008 Apr 15;59(4):575-82
references: 18383399
references: Cochrane Database Syst Rev. 2011 Jun 15;(6):CD007092
references: 21678364
references: Qual Health Res. 2008 Mar;18(3):405-17
references: 18235163
references: J Health Commun. 2008 Sep;13(6):583-95
references: 18726814
references: J Med Internet Res. 2006 Nov 14;8(4):e27
references: 17213046
references: Int J Med Inform. 2006 Jan;75(1):8-28
references: 16125453