Patrina Ha Yuen Caldwell

With more people turning to the unregulated environment of the internet for health information, digital health literacy is increasingly important to assess trustworthiness of online health information. Adolescents’ digital health literacy has long been overlooked because of the false assumption that they possess advanced skills due to being raised in a digital age. It is important that adolescents are given opportunities to develop their digital health literacy, however there is a lack of relevant educational resources, especially self-directed online resources. With adolescents, we co-designed a digital health literacy educational resource. In this study we aimed to evaluate its effectiveness at enhancing adolescents’ digital health literacy. The study utilised a pre/post mixed-method design with 12–17-year-olds. One-on-one video conference meetings were held with participants. Participants completed a digital health literacy self-assessment survey and practical search task before and after using the brief educational resource misAdventures (10–15 min), then completed an evaluation survey. Survey data were analysed using descriptive statistics; the search task was analysed using an observational checklist; inductive content analysis of qualitative data identified key themes in search and appraisal behaviours. For most of the 30 participants, there was a general increase in self-assessed digital health literacy post-intervention. Improvements in appraising the trustworthiness of online health information were seen across multiple search and appraisal skills, including choosing government or official health websites and cross-checking information. Most participants combed through search engine results listings to identify trustworthy sources rather than relying on Google suggestions or the top search result. Some skills, such as investigating bias, were not demonstrated pre- or post-intervention. Evaluation survey results indicated the app was easy to use (100% agreement), with 90% of participants reporting they could see they were learning while using the app and it would change how they use online health information. Use of the co-designed educational resource misAdventures improved adolescents’ digital health literacy and self-efficacy. Adolescents acknowledged they learnt through using the app and believed it would change the way they used online health information. A brief, self-directed digital educational resource can improve adolescents’ ability and disposition to identify trustworthy health information online and on social media.

Digital media is ubiquitous in adolescents’ lives and provides many opportunities to engage with health information. However, there is an increased risk of engaging with inaccurate or biased health information on the internet, resulting in poor health-related behaviours. As such, adolescents would benefit from improving their digital health literacy (DHL). There are limited education tools in DHL that are interactive and relatable for adolescents. A co-design approach can incorporate adolescents’ perspectives in designing an education tool to ensure its relevance. This study aimed to determine the effectiveness of the co-design approach in creating an educational resource designed to improve adolescents’ DHL. Three workshops were conducted with adolescents (12–17 years) to explore their DHL habits and education needs, evaluate an existing DHL educational app, co-design new storylines to better meet their needs and beta test the expanded resource. Data was collected through creation of storyboards, annotated posters and worksheets. Data analysis of these artefacts was undertaken through content analysis to identify themes and sub-themes. Forty-four participants attended two co-design workshops. Participants preferred using video-based social media and considered using artificial intelligence (AI) tools for extracting online health information. They designed storylines involving health topics such as dietary supplements, fitness and mental health. Storylines focused on identifying trustworthy online health information sources and dealing with concerns regarding scams, social media influencers and misinformation conveyed by parents. Eight participants who attended the beta-testing workshop positively evaluated the app as engaging and relatable. This study clarified the DHL educational needs of adolescents. In particular, it demonstrated the need to include other media literacies, the use of AI tools and interactions with family in the resource to maximise relevance to adolescents. The co-design methodology was useful for understanding adolescents’ DHL lived experiences and developing an engaging educational resource to help them navigate and appraise online health information.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).

Background: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. Objective: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents’ DHL. Methods: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. Results: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants’ relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Conclusions: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents’ DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents’ DHL.

Long outpatient waiting times pose a significant global challenge in healthcare, impacting children and families with implications for health outcomes. This paper presents the eHealth system called eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation) that is designed to address waiting list challenges for paediatricians. Initially designed for children’s incontinence, the system’s success in terms of health goals and user experience led to its adaptation for paediatric sleep problems. This paper focuses on user experiences and the development of a working alliance with the virtual doctor, alongside health outcomes based on a randomised controlled trial (N = 239) for incontinence. When reengineering eADVICE to sleep disorders, the promising results regarding the reciprocal relationship between user experience and building a working alliance encouraged a focus on the further development of the embodied conversational agent (ECA) component. This involved tailoring the ECA discussion to patient cognition (i.e., beliefs and goals) to further improve engagement and outcomes. The proposed eADVICE framework facilitates adaptation across paediatric conditions, offering a scalable model to enhance access and self-efficacy during care delays.

Children who require specialist outpatient care typically wait substantial periods during which their condition may progress, making treatment more difficult and costly. Timely and effective therapy during this period may reduce the need for lengthy specialist care. This study evaluated the cost-effectiveness of an individualized, evidence-informed, web-based program for children with urinary incontinence awaiting a specialist appointment (eADVICE) compared to usual care. eADVICE was supervised by a primary physician and delivered by an embodied conversational agent (ECA). A trial-based cost-effectiveness analysis was performed from the perspective of the healthcare funder as a sub-study of eADVICE, a multicenter waitlist-controlled randomized trial. Outcomes measures were incremental cost per incremental change in continence status and quality of life on an intention-to-treat basis. Uncertainty was examined using cost-effectiveness planes, scenarios, and 1-way sensitivity analyses. Costs were valued in 2021 Australian dollars ($). The use of eADVICE was found to be cost-saving and beneficial (dominant) over usual care, with a higher proportion of children dry over 14 days at 6 months (RD 0.13; 95%CI 0.02-0.23, P = .03) and mean healthcare costs reduced by $188 (95%CI $61-$315) per participant. An individualized, evidence-informed web-based program delivered by an ECA is likely cost-saving for children with urinary incontinence awaiting a specialist appointment. The potential economic impact of such a program is favorable and substantial and may be transferable to outpatient clinic settings for other chronic health conditions.

Children referred to specialist outpatient clinics by primary-care providers often have long waiting times before being seen. We assessed whether an individualized, web-based, evidence-informed management support for children with urinary incontinence while waiting reduced requests for specialist appointments. A multicenter, waitlisted randomized controlled trial was conducted for children (5-18 years) with urinary incontinence referred to tertiary pediatric continence clinics. Participants were randomized to web-based eHealth program 'eADVICE', which used an embodied conversational agent to engage with the child at the time of referral (intervention) or 6 months later (control). The primary outcome was the proportion of participants requesting a clinic appointment at 6 months. Secondary outcomes included persistent incontinence, and the Paediatric incontinence Questionnaire (PinQ) score. From 2018 to 2020, 239 children enrolled, with 120 randomized to eADVICE and 119 to the control arm. At baseline, participants' mean age was 8.8 years (SD 2.2), 62% were males, mean PinQ score was 5.3 (SD 2.2), 36% had daytime incontinence and 97% had nocturnal enuresis. At 6 months 78% of eADVICE participants versus 84% of controls requested a clinic visit (RR 0.92, 95% CI 0.79, 1.06, P = .3), and 23% eADVICE participants versus 10% controls were completely dry (RR 2.23. 1.10, 4.50, P = .03). The adjusted mean PinQ score was 3.5 for eADVICE and 3.9 for controls (MD -0.37. 95% CI -0.71, -0.03, P = .03). The eADVICE eHealth program for children awaiting specialist appointments doubled the proportion who were dry at 6 months and improved quality of life but did not reduce clinic appointment requests. The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001484235.