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Aims: To examine the relationship among eHealth literacy, empowerment and self-management and the mediating effects of empowerment in diabetic kidney disease (DKD) patients in the eHealthcare context., Background: Self-management is an essential aspect of healthcare in delaying disease progression for DKD. In the eHealthcare era, health services providing self-management are transforming. The ability and confidence of patients to use eHealth services is a critical issue that impacts the effectiveness of self-management, but little is known about the role of eHealth literacy and empowerment in self-management., Design: A cross-sectional study guided by the STROBE., Methods: Overall, 127 Taiwanese patients were enrolled using convenience sampling. Data collection used structured questionnaires and chart reviews. Multiple regression was used to infer self-management predictors, and SPSS PROCESS macro and bootstrapping verified the mediating effects., Results: Empowerment and eHealth literacy both showed significant positive correlations with self-management. Empowerment was the main predictor of self-management and had a complete mediating effect between eHealth literacy and self-management., Conclusion: Increasing patients' eHealth literacy can improve empowerment and prevent health inequality issues. Healthcare providers should consider improving patients' eHealth literacy to enhance their self-management., Relevance to Clinical Practice: Healthcare service systems need to create user-friendly eHealthcare environments, and healthcare professionals can provide multifaceted instructions that fit patients' eHealth literacy levels to enhance their motivation and confidence in disease care, thus cultivating positive self-management behaviours., Impact: The popularity of eHealthcare services aimed at promoting self-management behaviours is increasing. However, the level of eHealth literacy is an essential factor that affects the effectiveness of self-management in the healthcare environment. In addition, empowerment is a major critical influence factor of self-management and a completely mediating variable between self-management and eHealth literacy. Consequently, healthcare providers should consider promoting patients' eHealth literacy to empower people using eHealthcare services for implementing self-management., Reporting Method: The Strengthening the Reporting of Observational Studies in cross-sectional studies (STROBE) checklist was used to ensure comprehensive reporting., Patient or Public Contribution: Patients were diagnosed with DKD in the study hospital. Physicians and case managers transferred patients to research assistants who screened them for the inclusion criteria and invited them to participate in this study if they met the requirements. After participants signed informed consent, the research nurse encouraged participants to respond to the research questionnaire face to face., (© 2023 John Wiley & Sons Ltd.)

Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users' diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users' knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties., Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures., Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty., Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7., Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users' needs., (©Yu-Chi Chen, Christina Cheng, Richard H Osborne, Lars Kayser, Chieh-Yu Liu, Li-Chun Chang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.01.2022.)

Background: Health literacy (HL) influences a patient's comprehension and judgment of health-related information. A rigorous assessment tool is needed to screen for low HL in order to improve it., Objective: The aim of this study was to develop and validate the Cancer Health Literacy Scale (C-HLS)., Methods: The framework of the C-HLS is based on the Levels of Prevention model. The scale items were developed according to Nutbeam's 3 constructs of HL. We employed several procedures to develop the C-HLS, including focus group interviews, item generation, the expert Delphi process, and face validity. Various types of analysis, including reliability and split-half reliability testing, confirmatory factor analysis, and criterion-related validity testing, were performed; receiver operating characteristic curve analysis was also performed to confirm sensitivity and specificity., Results: There were 33 items included in the C-HLS for validation; 360 newly diagnosed cancer patients completed the survey. The administration time is only 10 to 15 minutes. Results showed that C-HLS had good reliability, split-half reliability, and validity. All confirmatory factor analysis model fit indices reached acceptable thresholds. The receiver operating characteristic curve analyses suggested that the C-HLS had an adequate combination of sensitivity and specificity to distinguish between high and low HL., Conclusions: The C-HLS is a reliable, valid tool capable of discriminating levels of HL in the assessment of cancer patients and does not have an excessive administration time., Implications for Practice: This scale can aid our understanding of HL in newly diagnosed cancer patients and can serve as a basis for providing individual care interventions.

Aims: To investigate the relationships among social support, health literacy, and self-management, and the factors influencing self-management of chronic kidney disease (CKD)., Design: Cross-sectional study., Methods: A random sample of 410 patients was recruited from nephrology clinics. Data were collected using structured questionnaires and chart reviews from January 2013 to February 2014. Hierarchical regression analysis was used to determine the predictive factors of self-management behaviors and ∆R 2 to determine each variable's explanatory power., Findings: Health literacy and social support were positively correlated with self-management behaviors. Furthermore, social support, health literacy, and marital status were significant predictors of self-management behaviors. Social support had a relatively greater explanatory power for self-management behaviors than did health literacy. Particularly, healthcare provider support had the greatest influence on patients' self-management behaviors., Conclusions: Health literacy and social support play independent positive roles in self-management behaviors of patients with CKD, with social support having a particularly dominant role. Further research using a systems approach to improving self-management behaviors is necessary to clarify the role of social support., Clinical Relevance: Health literacy and social support are independently and positively related to self-management. Social support, which is a system-level factor, is a relatively stronger and crucial predictor than is health literacy. Nurses have to refine self-management programs to focus on families and adopt a systems approach to help CKD patients improve their self-management behaviors., (© 2018 Sigma Theta Tau International.)

The study aimed to illustrate the constructs and test the psychometric properties of an instrument of health literacy competencies (IOHLC) for health professionals. A multi-phase questionnaire development method was used to develop the scale. The categorization of the knowledge and practice domains achieved consensus through a modified Delphi process. To reduce the number of items, the 92-item IOHLC was psychometrically evaluated through internal consistency, Rasch modeling, and two-stage factor analysis. In total, 736 practitioners, including nurses, nurse practitioners, health educators, case managers, and dieticians completed the 92-item IOHLC online from May 2012 to January 2013. The final version of the IOHLC covered 9 knowledge items and 40 skill items containing 9 dimensions, with good model fit, and explaining 72% of total variance. All domains had acceptable internal consistency and discriminant validity. The tool in this study is the first to verify health literacy competencies rigorously. Moreover, through psychometric testing, the 49-item IOHLC demonstrates adequate reliability and validity. The IOHLC may serve as a reference for the theoretical and in-service training of Chinese-speaking individuals' health literacy competencies.

Objectives: To achieve consensus on a set of competencies in health literacy practice based on a literature review and expert consultation., Setting: Hospitals and community health centres in Taiwan., Method: A 2-stage modified Delphi study involving a literature review was conducted, followed by qualitative interviews and 3 rounds of email-based data collection over a 3-month period in 2011., Participants: 15 Chinese healthcare practitioners with more than 6 months' experience in patient education were interviewed to collect data on health literacy practice. 24 experts (12 academic scholars in health literacy and 12 professionals with training related to health literacy practice) were invited to participate in the Delphi process., Results: Qualitative data from the interviews were analysed and summarised to form 99 competency items for health literacy practice, which were categorised into 5 domains of health literacy practice including those pertaining to knowledge and skills. Consensus was reached on 92 of 99 competencies, using a modified Delphi technique., Conclusions: The 92 competencies in health literacy practice embraced core components of patient education in the Chinese healthcare profession., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Aim: This study aims to explore the change process among chronic kidney disease patients in shared decision‐making. Design: Qualitative research is the design applied. Method: Original transcripts from an earlier study involving a purposive sample of 31 patients with chronic kidney disease provided a source of information. The data collection was conducted from August 2017–January 2018. Data analysis applied the thematic analysis method. Results: Three themes were identified: from avoidance to being forced to accept, decision‐making process of action and facilitating factors. After making the psychological adjustments necessary for undergoing dialysis treatment, participants experience the process of decision‐making action. The improvement of knowledge and ability increases the patient's self‐determination consciousness and strengthens confidence in decision‐making. The nurse and the patient's family are both important facilitating factors, and they assist through the entire SDM process. [ABSTRACT FROM AUTHOR]