The Application and Evaluation of eHealth Literacy (eHL) Concept

Study Overview
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Brief Summary
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This study aims to explore the effectiveness of experience learning program of eHealth care to improve the chronic patients' eHL in engaging with the eHealth care system on the indicators on eHealth literacy, patient health engagement, e-Health usage status among Chronic disease patients included type 2 diabetes patients, Chronic kidney disease, and Cardiovascular Diseases.

Detailed Description
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Chronic diseases are irreversible that incurs considerable medical and economic costs. Even if the government and medical health care system make an effort to improve care and recommend e-health care, the incidence and prevalence rates of chronic diseases have not decreased but increased, and participants have even become the main cause of kidney disease. Technology and daily life has become more inseparable, which also led to the change of the traditional face to face health care model. The chronic disease care is gradually transitioning into the smart eHealth care era, patients are in need of learning how to face innovative ways of using care and resources. eHealth literacy (eHL)is the essential element that determines if patient can adapt to the rapidly changing health care system. Due to the disciplinary integration of medical and technology, eHealth care provides continuous care for patients. But, it is still necessary to return to patient-centered care thinking and improving patients' knowledge and ability to use eHealth care technology. This can be applied to disease care, and implemented for daily self-health management. Therefore, this study explores the effects of intervention and the learning process and experience of patients through an experience learning program of eHealth care.

Official Title
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Improving Patients With Chronic Disease to Engage in the eHealth Care Environment: the Application and Evaluation of eHealth Literacy Concept

Conditions
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Type 2 Diabetes Mellitus, Chronic Kidney Diseases, Cardiovascular Diseases

Intervention / Treatment
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* Behavioral: experience learning programs of eHealth care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed as a type 2 diabetes patients, Chronic kidney disease, and Cardiovascular Diseases more than three months. At least 20 years old, with clear consciousness and able to communicate in Mandarin or Taiwanese. Possess a mobile phone or tablet with internet capabilities. Consent to participate in this research and be willing to sign a consent form. Exclusion Criteria: Suffering from serious diseases, such as: general paralysis, mental disorders, cognitive function abnormalities, etc. Those who cannot communicate in Mandarin or Taiwanese. Those who refuse to participate in this research.

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: experience learning programs of eHealth care<br>Patients in the experimental group received 6 sections of activities. | Behavioral: experience learning programs of eHealth care<br>* The experience learning programs of eHealth care was included six sections of activities. Six activities were conducted based on eHealth literacy framework and experience learning theory to improve patients' abilities to engage in eHealth care service. The outcome indicators were eHealth literacy, patient health engagement, the acceptance of eHealth care, eHealth usage status, and their learning experience<br>|
| No Intervention: Usual care<br>Patients in control group received usual care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Baseline of eHealth Literacy Questionnaire scores | Evaluate the patient's eHL level, including 7 dimensions (1) Using technology to process health information, (2) Understanding of health concepts and languages, (3)Ability to actively engage with digital service, (4)Feel safe and in control, (5) Motivated to engage with digital service, (6) Access to digital services that work (7)Digital services that suit individual. The higher the score, the better the eHL. | The pretest is completed when the patients agrees to join the intervention. | 
| The eHealth Literacy Questionnaire scores at the end of intervention | Evaluate the patient's eHL level, including 7 dimensions (1) Using technology to process health information, (2) Understanding of health concepts and languages, (3)Ability to actively engage with digital service, (4)Feel safe and in control, (5) Motivated to engage with digital service, (6) Access to digital services that work (7)Digital services that suit individual. The higher the score, the better the eHL. | The post-test 1 is completed at the end of the 6 weeks intervention | 
| The eHealth Literacy Questionnaire scores after intervention at 3 months | Evaluate the patient's eHL level, including 7 dimensions (1) Using technology to process health information, (2) Understanding of health concepts and languages, (3)Ability to actively engage with digital service, (4)Feel safe and in control, (5) Motivated to engage with digital service, (6) Access to digital services that work (7)Digital services that suit individual. The higher the score, the better the eHL. | The post-test 2 is completed after intervention at 3 months | 
| The eHealth Literacy Questionnaire scores after intervention at 6 months | Evaluate the patient's eHL level, including 7 dimensions (1) Using technology to process health information, (2) Understanding of health concepts and languages, (3)Ability to actively engage with digital service, (4)Feel safe and in control, (5) Motivated to engage with digital service, (6) Access to digital services that work (7)Digital services that suit individual. The higher the score, the better the eHL. | The post-test 3 is completed after intervention at 6 months | 
| Baseline of The acceptance of eHealth care scores | The scale was developed base on Technology Acceptance Model to assess patients' behaviors intention of using the eHealth device | The pretest is completed when the patients agrees to join the intervention. | 
| The acceptance of eHealth care scores at the end of intervention | The scale was developed base on Technology Acceptance Model to assess patients' behaviors intention of using the eHealth device | The post-test 1 is completed at the end of the 6 weeks intervention | 
| The acceptance of eHealth care scores after intervention at 3 months | The scale was developed base on Technology Acceptance Model to assess patients' behaviors intention of using the eHealth device | The post-test 2 is completed after intervention at 3 months | 
| The acceptance of eHealth care scores after intervention at 6 months | The scale was developed base on Technology Acceptance Model to assess patients' behaviors intention of using the eHealth device | The post-test 3 is completed after intervention at 6 months | 
| Baseline of Health Technology Usage Sore | Use self-developed structured questionnaires to investigate the types of health technology use and monitoring items. Use types include computer or network systems, mobile apps, health monitoring systems or wearable devices (such as pedometers, smart bracelets, heart rate monitors, blood pressure monitors, Blood glucose meter, blood pressure meter, blood glucose meter or weight scale, etc.) or other, monitoring items include blood pressure, blood sugar, weight, diet, sleep, heart rate, steps or other health data. The higher the number, the more items are monitored, the total score The higher the level, the better the use of health technology. | The pretest is completed when the patients agrees to join the intervention. | 
| The Health Technology Usage Sore at the end of intervention | Use self-developed structured questionnaires to investigate the types of health technology use and monitoring items. Use types include computer or network systems, mobile apps, health monitoring systems or wearable devices (such as pedometers, smart bracelets, heart rate monitors, blood pressure monitors, Blood glucose meter, blood pressure meter, blood glucose meter or weight scale, etc.) or other, monitoring items include blood pressure, blood sugar, weight, diet, sleep, heart rate, steps or other health data. The higher the number, the more items are monitored, the total score The higher the level, the better the use of health technology. | The post-test 1 is completed at the end of the 6 weeks intervention | 
| The Health Technology Usage Sore after intervention at 3 months | Use self-developed structured questionnaires to investigate the types of health technology use and monitoring items. Use types include computer or network systems, mobile apps, health monitoring systems or wearable devices (such as pedometers, smart bracelets, heart rate monitors, blood pressure monitors, Blood glucose meter, blood pressure meter, blood glucose meter or weight scale, etc.) or other, monitoring items include blood pressure, blood sugar, weight, diet, sleep, heart rate, steps or other health data. The higher the number, the more items are monitored, the total score The higher the level, the better the use of health technology. | The post-test 2 is completed after intervention at 3 months | 
| The Health Technology Usage Sore after intervention at 6 months | Use self-developed structured questionnaires to investigate the types of health technology use and monitoring items. Use types include computer or network systems, mobile apps, health monitoring systems or wearable devices (such as pedometers, smart bracelets, heart rate monitors, blood pressure monitors, Blood glucose meter, blood pressure meter, blood glucose meter or weight scale, etc.) or other, monitoring items include blood pressure, blood sugar, weight, diet, sleep, heart rate, steps or other health data. The higher the number, the more items are monitored, the total score The higher the level, the better the use of health technology. | The post-test 3 is completed after intervention at 6 months | 
| Baseline of Patient Health Engagement score | The scale is thought of as a self-administering tool by the patient in order to diagnose his/ her This scale has a total of 5 questions. The higher the number, the higher the patient engagement it is. | The pretest is completed when the patients agrees to join the intervention. | 
| The Patient Health Engagement score at the end of the intervention | The scale is thought of as a self-administering tool by the patient in order to diagnose his/ her This scale has a total of 5 questions. The higher the number, the higher the patient engagement it is. | The post-test 1 is completed at the end of the 6 weeks intervention | 
| The Patient Health Engagement score after intervention at 3 months | The scale is thought of as a self-administering tool by the patient in order to diagnose his/ her This scale has a total of 5 questions. The higher the number, the higher the patient engagement it is. | The post-test 2 is completed after intervention at 3 months | 
| The Patient Health Engagement score after intervention at 6 months | The scale is thought of as a self-administering tool by the patient in order to diagnose his/ her This scale has a total of 5 questions. The higher the number, the higher the patient engagement it is. | The post-test 3 is completed after intervention at 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in renal function level at the end of the intervention | The health outcome indicator of management of renal disease by using the estimated Glomerular filtration rate(eGRF) . | To collect two-time point data by chart review. Those were before the intervention and the end of the the 6 weeks intervention | 
| The change Trajectory of renal function level from baseline to after intervention at 6 months and 1 year | The health outcome indicator of management of renal disease by using the estimated Glomerular filtration rate(eGRF) . | To collect three-time point data by chart review. Those were before the intervention, the end of the 6 weeks intervention, and after intervention at six months and 1 year | 
| The change in HbA1C level at the end of the intervention | The health outcome indicator of management of diabetes | To collect two-time point data by chart review. Those were before the intervention and the end of the the 6 weeks intervention | 
| The change Trajectory of HbA1C level from baseline to after the intervention at 3, 6, and 12 months | The health outcome indicator of management of diabetes | To collect four-time point data by chart review. Those were before the intervention, the end of the 6 weeks intervention, after the intervention at three months, after the intervention at six months, and after the intervention at twelve months | 
| The change in Triglycerides level at the end of the intervention | The health outcome indicator of management of lipid | To collect two-time point data by chart review. Those were before the intervention and the end of the six weeks intervention | 
| The change Trajectory of Triglycerides level from baseline to after the intervention at 3 , 6 and 12 months | The health outcome indicator of management of lipid | To collect four-time point data by chart review. Those were before the intervention, the end of the 6 weeks intervention, after the intervention at three months, after the intervention at six months, and after the intervention at twelve months. | 
| The change in Cholesterol level at the end of the intervention | The health outcome indicator of management of lipid | To collect two-time point data by chart review. Those were before the intervention and the end of the 6 weeks intervention | 
| The change Trajectory of Cholesterol level from baseline to after the intervention at 3, 6 and 12 months | The health outcome indicator of management of lipid | To collect two-time point data by chart review. Those were before the intervention, the end of the 6 weeks intervention, after the intervention at three months, after the intervention at six months, and after the intervention at twelve months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic disease, eHealth literacy, patient engagement, experience learning theory, Self-management, empowerment, eHealth care