Adolescent Ehealth Literacy in Rural and Limited Media Environments

Theoretical Background and research questions/hypothesis:  eHealth literacy refers to the ability to find, evaluate, and apply health information from electronic sources. These abilities are particularly important to develop in early adolescence because they will inform health decision-making throughout the life process. Improving these abilities may help overcome limitations in health-related resources, especially in rural areas where media environments and access to health care services are limited. Our eHealth literacy project pursues two objectives: (1) to understand the level, conditions, and topical areas of rural adolescents’ eHealth literacy; (2) to develop online training modules that improve eHealth literacy. This abstract reports findings of qualitative and quantitative formative evaluation research that informs these objectives.

Methods:  Participants are middle school students (grades 6 to 8) in a geographically isolated area of Michigan’s Upper Peninsula. First, a focus group was conducted among one group of boys, one of girls, and one of participants' parents. The purpose of this focus group study was to gain insights from both parents and their children regarding their health concerns and views of different media. Next, a baseline survey was conducted among 183 students to learn the following: their various uses for different media; level of interest in health information; level of eHealth literacy; and parental supervision of Internet use and media environments at home. For the focus group study, the transcribed data were analyzed using a grounded theory approach to allow relevant themes to emerge. For the survey study, descriptive statistics, mean difference tests, and multiple regression analysis were performed. Analysis of these data focused mainly on identifying factors associated with the level of eHealth literacy.

Results:  Focus group results indicate that both parents and children do not feel confident about their ability to find trustworthy and accurate health information online. Regarding other media at home, children from households without television agree with their parents that this feature of their media environment prevents them from "sitting there being a couch potato." Survey results indicate that, for predicting eHealth literacy, interest in learning about health plays a stronger role than Internet access at home, parental supervision, and frequency and amount of Internet use. In addition, those who use the Internet merely for entertainment seem to have a lower level of eHealth literacy than those who use it for information and communication.

Conclusions:  For our rural target audience, the major health concerns seemed to be sports activities, injuries likely to result from them, and ways to improve physical stamina. The health topics identified in the focus group research will be used for online eHealth literacy training modules. To improve adolescents’ eHealth literacy, it is important to cultivate their interest in searching for health information online and their use of the Internet for information rather than entertainment.

Implications for research and/or practice:  The online training modules we develop based on insights gained from this formative evaluation research will contribute to advancing sustainable self-help education and to overcoming the difficulty of educational intervention programs in a rural and geographically isolated area.