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BackgroundElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. ObjectiveThis systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. MethodsA systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. ResultsA total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. ConclusionsThe findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.

Purpose: This study aimed to explore the health literacy profile of individuals attending a metropolitan community rehabilitation center in Victoria, Australia. Methods: 295 consecutive attendees of a community rehabilitation program between January and August 2015 were invited to complete the Health Literacy Questionnaire (HLQ), a 44-item questionnaire comprising nine independent scales of health literacy, and provide demographic data. Exclusion criteria were having severe dementia and inability to communicate to complete the HLQ. Participants and nonparticipants were compared using descriptive analysis. Means cores were calculated for each of the nine health literacy scales. Linear regression was used to establish associations between demographic variables and HLQ scale scores. Results: 149 individuals participated in the study (response rate 50.5%). Several demographic characteristics were associated with lower scores in one or more health literacy scales. Largest differences were observed for participants who spoke a language other than English at home. Conclusions: This study describes the health literacy profile of individuals attending a community rehabilitation program. These data can facilitate generation of ideas and opportunities to address the needs of this population.

Introduction: The relationship between obstructive sleep apnea (OSA), obesity, various metabolic variables, and psychosocial outcomes is complex. No studies have examined the association between these predictors and disease-specific distress related to heart disease (cardiac distress). We aimed to study the association between OSA and cardiac distress using a network analysis framework. Methods: This secondary analysis of an observational cross-sectional study conducted in 2021 consisted of 405 hospital- and community-sourced adults from Australia and the United States who reported an acute coronary event (such as a myocardial infarction, or procedures such as coronary artery bypass graft surgery, or percutaneous coronary intervention) in the previous 12 months. Participants were surveyed in relation to sociodemographic variables, clinical risk factors, comorbidities (including time since event, OSA, obesity, diabetes, hypertension, and hyperlipidemia), and cardiac distress (reported by the Cardiac Distress Inventory Short-Form). These data were subjected to bootstrapped exploratory graph analysis (EGA), which identifies the dimensions of variables that cluster together. Variables that contributed to the EGA dimensions were used to predict cardiac distress using multivariable logistic regression. Results: Three distinct dimensions were identified by the EGA: Dimension 1 – clinical risk factors and conditions including OSA, Dimension 2 – variables related to the heart event, and Dimension 3 – variables closely related to cardiac distress. For Dimension 1, only OSA was a significant predictor of cardiac distress in the fully adjusted model (adjusted odds ratio = 2.08, 95% confidence interval = 1.02–4.25, P = 0.044). Further analysis indicated that OSA was associated with physical challenges and changes in roles and relationships. Conclusions: This study identified that self-reported OSA is associated with cardiac distress, particularly distress that was associated with physical challenges and changes to roles and relationships. These findings imply that OSA could potentially increase stress in a relationship; however, distress was only assessed from the perspective of the participant with OSA in this study. EGA is a useful method for describing complex associations between diverse predictor variables such as OSA and cardiac distress. Owing to the self-reported aspect of the data, further investigation to confirm study outcomes is warranted. [ABSTRACT FROM AUTHOR]

Objective: This study explored young university students' (aged 18-24 years) health literacy, asthma experiences and help-seeking behaviours to inform the development of a web-based asthma education intervention relevant to this age group. Design: Exploratory mixed-methods design incorporateing a health literacy survey and interviews, plus the development of a web-based educational video. Setting: Participants were students at two universities in the state of Victoria, Australia. Method: In total, 20 asthma sufferers were interviewed by trained pairs of university students. Interpretative phenomenology underpinned the narrative analysis and enabled the description of the participants' lived experience. A branching e-simulation video was developed. Results: A number of key themes were identified: "Life with asthma", including "A life of vigilance" regarding asthma triggers, lifestyle limitations and heightened sensitivities; "Asthma management--call Mum", a lack of knowledge and support systems with substantial maternal reliance; "Health literacy: family and Dr Google", denoting low health literacy levels with passive reluctant involvement in personal health management; and "Information gathering--one size doesn't fit all"--in the form of the need for immediate gratification and resource variety. Based on interviewees' words and terminology, we designed an interactive branching educational video for YouTube portraying a young person (an actor) during an asthma flare-up. Conclusion: Young adults lacked insight into their condition and even after moving away from home, relied on Google searches and/or parents' advice. To enhance health-seeking behaviours, interactive programmes with smartphone access may be valuable. Our open access programme Help Trent Vent provides an educational resource for young people with asthma and for health education teams, to reinforce asthma knowledge.

Aims: To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. Design: A qualitative descriptive study. Data were collected via semi‐structured interviews. Methods: In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. Results: Six themes and 20 sub‐themes were identified. Non‐validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. Conclusion: Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. Impacts: The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post‐cardiac event counselling. Reporting Method: Adherence to COREQ guidelines was maintained. Patient or Public Contribution: No Patient or Public Contribution as this study explored health professionals' experiences only. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence to support the use of co‐design in developing interventions across many disciplines. This scoping review aims to examine how co‐design methodology has been used in the development of cardiovascular disease (CVD) secondary prevention interventions within health and community settings. Methods: We searched four academic databases for studies that used the co‐design approach to develop their intervention. Studies were included if consumers (adults with CVD) and key stakeholders (e.g. clinicians, service providers) were involved in the co‐design process. The review focused on methodology rather than traditional study outcomes; therefore, co‐design processes and activities were extracted and evaluated against a selected co‐design framework. Results: Twenty‐two studies were included in this review. Studies were implemented across various settings with consumers and stakeholder groups most frequently consisting of patients and healthcare professionals, respectively. Most studies specifically stated that they used a 'co‐design' approach (n = 10); others used terms such as participatory action research (n = 3), user‐centred design (n = 3) and community‐based participatory research (n = 2). Although there was variability in terminology, co‐design processes, and participants, all studies adhered to the key principles of consumer engagement. Predominant co‐design activities included semistructured interviews, focus groups, co‐design/development workshops and advisory group meetings. Intervention effectiveness was assessed in eight studies showing mixed results. Conclusions: This review provides an overview of how the co‐design approach has previously been used in the development of CVD secondary prevention interventions. These findings provide methodological considerations that can guide researchers and healthcare services when implementing co‐design to develop feasible and acceptable interventions that can improve outcomes for CVD populations. Patient or Public Contribution: No patients, service users, caregivers, people with lived experience or members of the public were involved in this scoping review. This review article was written by academics who have undertaken a significant amount of co‐design work with consumers and stakeholders. [ABSTRACT FROM AUTHOR]