bims-librar Biomed News
on Biomedical librarianship
Issue of 2021‒08‒08
seventeen papers selected by
Thomas Krichel
Open Library Society

  1. Health Info Libr J. 2021 Jul 31.
      BACKGROUND: The strategy lead for the National Health Service (NHS) knowledge and library services withn the NHS in England is held by Health Education England, working with 184 local NHS libraries based predominantly in hospitals OBJECTIVES: As part of the strategic framework Knowkedge for Healthcare, the objective was to increase the role NHS knowledge and library services staff play in both indirect an direct support for evidence-based information for patients and the public.METHODS: The study took an integrated multi-level approach: encouraging local staff to share their expertise through Task and Finish groups, developing tools, offering training and reviewing levers available through Health Education England's quality assurance role.
    RESULTS: Between 2014 and 2019, the percentage of services supporting patient and public information increased from 27% to 78%. Qualitative evidence demonstrates a wide range of roles played by local services, working either indirectly or directly to ensure access to evidence-based health information for patients and the public.
    DISCUSSION: The study shows the benefits of engaging people with local expertise in developing the skills and resources for system-wide change.
    CONCLUSION: Similar system-wide change programmes should also consider an integrated approach, involving people, developing tools, offering training and drawing on incentive structures such as quality assurance measures. Apologies for previous errors to Background, Objectives, Methods.
    Keywords:  National Health Service (NHS); consumer health information; health literacy; librarians, clinical; libraries, health care; libraries, hospital; patient information Please ensure that there is a ';' where you have l
  2. Soc Work. 2021 Aug 01. pii: swab032. [Epub ahead of print]
      Public libraries in the United States have begun to partner with social work to address the psychosocial needs observed in patrons that are beyond the training and education of most library staff. This is a new area of inquiry with limited research available. Of the few published studies, the majority focus on staff perceptions of patrons' needs and surveys of patrons experiencing homelessness about their use of public libraries. The present study is the first to examine and compare staff perception of patrons' needs, patrons' self-expressed needs, and the actual use of social work services by patrons within one library system. Comparisons are explored between actual service usage alongside the perception of patrons' needs as originally reported by both staff and patron groups. Implications for library-based social work practice are discussed.
    Keywords:  homelessness; poverty; psychosocial needs; public libraries
  3. Int J Med Inform. 2021 Jul 16. pii: S1386-5056(21)00156-8. [Epub ahead of print]153 104530
      INTRODUCTION: Clinicians rely on pharmacologic knowledge bases to answer medication questions and avoid potential adverse drug events. In late 2018, an artificial intelligence-based conversational agent, Watson Assistant (WA), was made available to online subscribers to the pharmacologic knowledge base, Micromedex®. WA allows users to ask medication-related questions in natural language. This study evaluated search method-dependent differences in the frequency of information accessed by traditional methods (keyword search and heading navigation) vs conversational agent search.MATERIALS AND METHODS: We compared the proportion of information types accessed through the conversational agent to the proportion of analogous information types accessed by traditional methods during the first 6 months of 2020.
    RESULTS: Addition of the conversational agent allowed early adopters to access 22 different information types contained in the 'quick answers' portion of the knowledge base. These information types were accessed 117,550 times with WA during the study period, compared to 33,649,651 times using traditional search methods. The distribution across information types differed by method employed (c2 test, P < .0001). Single drug/dosing, FDA/non-FDA uses, adverse effects, and drug administration emerged as 4 of the top 5 information types accessed by either method. Intravenous compatibility was accessed more frequently using the conversational agent (7.7% vs. 0.6% for traditional methods), whereas dose adjustments were accessed more frequently via traditional methods (4.8% vs. 1.4% for WA).
    CONCLUSION: In a widely used pharmacologic knowledge base, information accessed through conversational agents versus traditional methods differed. User-centered studies are needed to understand these differences.
    Keywords:  Artificial intelligence; Conversational agent; Information retrieval; Natural language processing; Pharmacologic knowledge base
  4. J Am Med Inform Assoc. 2021 Aug 02. pii: ocab143. [Epub ahead of print]
      OBJECTIVE: Biomedical text summarization helps biomedical information seekers avoid information overload by reducing the length of a document while preserving the contents' essence. Our systematic review investigates the most recent biomedical text summarization researches on biomedical literature and electronic health records by analyzing their techniques, areas of application, and evaluation methods. We identify gaps and propose potential directions for future research.MATERIALS AND METHODS: This review followed the PRISMA methodology and replicated the approaches adopted by the previous systematic review published on the same topic. We searched 4 databases (PubMed, ACM Digital Library, Scopus, and Web of Science) from January 1, 2013 to April 8, 2021. Two reviewers independently screened title, abstract, and full-text for all retrieved articles. The conflicts were resolved by the third reviewer. The data extraction of the included articles was in 5 dimensions: input, purpose, output, method, and evaluation.
    RESULTS: Fifty-eight out of 7235 retrieved articles met the inclusion criteria. Thirty-nine systems used single-document biomedical research literature as their input, 17 systems were explicitly designed for clinical support, 47 systems generated extractive summaries, and 53 systems adopted hybrid methods combining computational linguistics, machine learning, and statistical approaches. As for the assessment, 51 studies conducted an intrinsic evaluation using predefined metrics.
    DISCUSSION AND CONCLUSION: This study found that current biomedical text summarization systems have achieved good performance using hybrid methods. Studies on electronic health records summarization have been increasing compared to a previous survey. However, the majority of the works still focus on summarizing literature.
    Keywords:  automatic text summarization; biomedical and health sciences literature; computational linguistics; electronic health records; machine learning
  5. Int J Environ Res Public Health. 2021 Jul 30. pii: 8091. [Epub ahead of print]18(15):
      Low digital health literacy affects large percentages of populations around the world and is a direct contributor to the spread of COVID-19-related online misinformation (together with bots). The ease and 'viral' nature of social media sharing further complicate the situation. This paper provides a quick overview of the magnitude of the problem of COVID-19 misinformation on social media, its devastating effects, and its intricate relation to digital health literacy. The main strategies, methods and services that can be used to detect and prevent the spread of COVID-19 misinformation, including machine learning-based approaches, health literacy guidelines, checklists, mythbusters and fact-checkers, are then briefly reviewed. Given the complexity of the COVID-19 infodemic, it is very unlikely that any of these approaches or tools will be fully effective alone in stopping the spread of COVID-19 misinformation. Instead, a mixed, synergistic approach, combining the best of these strategies, methods, and services together, is highly recommended in tackling online health misinformation, and mitigating its negative effects in COVID-19 and future pandemics. Furthermore, techniques and tools should ideally focus on evaluating both the message (information content) and the messenger (information author/source) and not just rely on assessing the latter as a quick and easy proxy for the trustworthiness and truthfulness of the former. Surveying and improving population digital health literacy levels are also essential for future infodemic preparedness.
    Keywords:  COVID-19; digital health literacy; disinformation; health literacy; infodemic; misinformation; social media
  6. J Nurs Educ. 2021 Aug;60(8): 431-436
      BACKGROUND: Although information literacy (IL) has been valuable in nursing education, guiding documents from librarianship (e.g., Framework for Information Literacy in Higher Education) remain relatively obscure among nursing faculty. This review analyzes the intersection of IL with nursing and offers analyses for a better understanding of integrating IL into nursing education settings.METHOD: Scholarly literature was searched, and Covidence was used to track themes regarding how (and where) IL literature (n = 179) connects to nursing educational settings.
    RESULTS: Librarians are not involved consistently within nursing education. Research and discussion on IL in nursing are published in librarianship, education, and health sciences literature, and the terminology does not always align across these disciplines.
    CONCLUSION: Findings indicate an opportunity for librarians to share the Framework and its connections to the research literature with the nursing community. Researchers share suggestions for how common themes, language, and ideas can be shared between librarians and nursing faculty. [J Nurs Educ. 2021;60(8):431-436.].
  7. J Chem Inf Model. 2021 Aug 02.
      This paper describes the implementation and evaluation of a proof-of-concept Question Answering (QA) system for accessing chemical data from knowledge graphs (KGs) which offer data from chemical kinetics to the chemical and physical properties of species. We trained the question classification and named the entity recognition models that specialize in interpreting chemistry questions. The system has a novel design which applies a topic model to identify the question-to-ontology affiliation to handle ontologies with different structures. The topic model also helps the system to provide answers with a higher quality. Moreover, a new method that automatically generates training questions from ontologies is also implemented. The question set generated for training contains 432,989 questions under 11 types. Such a training set has been proven to be effective for training both the question classification model and the named entity recognition model. We evaluated the system using other KGQA systems as baselines. The system outperforms the chosen KGQA system answering chemistry-related questions. The QA system is also compared to the Google search engine and the WolframAlpha engine. It shows that the QA system can answer certain types of questions better than the search engines.
  8. Braz J Phys Ther. 2021 Jul 16. pii: S1413-3555(21)00076-9. [Epub ahead of print]
      BACKGROUND: Quality of low back pain (LBP) information offered on YouTube ™ is unclear.OBJECTIVE: To describe the current low back pain information available on YouTube ™ and determine if these videos report information that aligns with clinical guidelines. Further analysis explored whether specific features of the videos explain their popularity.
    METHODS: A cross-sectional observational study was conducted on videos related to LBP on YouTube™ with the 200 most viewed videos using the term "low back pain." The videos were independently viewed and assessed by two researchers for specific video characteristics, LBP specific content, and compliance with guidelines. The association between video characteristics or content with popularity (i.e., views, likes, dislikes, and comments) was investigated using regression models.
    RESULTS: The median number of views was 2 018 167. Only 59 (29.5%) of the videos reported at least one diagnostic recommendation from clinical guidelines, and only 100 (50%) reported a treatment recommendation that aligned with clinical guidelines. Apart from year of upload, no variables were identified that were independently associated with popularity or engagement of the videos.
    CONCLUSION: The information related to LBP offered on YouTube™ is often not evidence-based and there is the tendency to prioritize information on interventions rather than understanding the LBP process. Factors related to engagement with content about LBP on YouTube™ remains uncertain, indicating further need for knowledge translation in this field.
    Keywords:  Health information; Low back pain; YouTube
  9. JMIR Cancer. 2021 Jul 28.
      BACKGROUND: The COVID-19 pandemic created an urgent need to rapidly disseminate health information, especially to those with cancer because they face higher morbidity and mortality rates. At the same time, the disproportionate impact of the pandemic on Latinx populations underscores the need for information to reach Spanish-speakers. However, the equity of information about COVID-19 to Spanish-speaking cancer patients communicated through institutions' online media is unknown.OBJECTIVE: We conducted a multi-modal, mixed method document review study to evaluate the equity of online information about COVID-19 and cancer available to English and Spanish speaking populations from seven healthcare institutions in North Texas, where one in five adults is Spanish-speaking. Our focus is less on the "digital divide", which conveys disparities in access to computers and the Internet based on the race/ethnicity, education, and income of at-risk populations; rather, our study asks: to what extent is online content useful and culturally appropriate in meeting Spanish-speakers' information needs?
    METHODS: We reviewed 50 websites (33 English, 17 Spanish) over a period of one week in mid-May 2020. We sampled seven institutions' main oncology and COVID web pages, as well as both internal (institutional web pages) and external (non-institutional web pages) linked content. We conducted several analyses for each sampled page: (a) thematic content analysis, (b) literacy level analysis using Readability Studio software, (c) coding using the Patient Education and Materials Assessment Tool (PEMAT), and (d) descriptive analysis of video and diversity content.
    RESULTS: The themes most frequently addressed on English and Spanish websites differed somewhat. While "resources/FAQs" were frequently cited themes on both websites, English websites more frequently addressed "news/updates" and "cancer+COVID", whereas Spanish websites addressed "protection" and "COVID data". Spanish websites were on average lower literacy (11th grade) than English (13th grade), although still far above recommended guidelines of 6th-8th grade. The overall average accessibility score using the PEMAT analysis was the same for English (n=33 pages) and Spanish pages (n=17 pages) at 82%. Among the DFW organizations, the average accessibility of the Spanish pages (n=7) was slightly lower than that of the English pages (n=19) at 77% vs. 81%, respectively, due mostly to the discrepancy in English-only videos and visual aids. Twelve of the 50 websites (24%) had embedded videos in them, however 100% of videos were in English, including one that was on a Spanish website.
    CONCLUSIONS: We identified an uneven response among the seven healthcare institutions to providing equitable information to Spanish-speaking DFW residents concerned about COVID and cancer. Spanish-speakers lack equal access in both diversity of content about COVID-19 and access to other websites, leaving an already vulnerable cancer patient population at greater risk. We recommend several specific actions to enhance content and navigability for Spanish-speakers.
  10. Laryngoscope. 2021 Aug 07.
      OBJECTIVES/HYPOTHESIS: This study evaluated the quality and comprehensiveness of YouTube videos on hypoglossal nerve stimulation (HNS) for patients. This study also investigated the relationship between video content, video metrics, and popularity.STUDY DESIGN: Cross-sectional study.
    METHODS: We identified 150 videos using three search terms: "inspire sleep apnea," "hypoglossal nerve stimulation," and "upper airway stimulation." Videos that were unrelated to the use of HNS for obstructive sleep apnea in adults, operating room recordings, lectures for medical professionals, non-English, or non-audio were excluded. Video quality and comprehensiveness were assessed using modified DISCERN criterion (range: 5-25) and novel content criterion (range: 0-12), respectively. Secondary outcomes included video metrics (views, likes, dislikes, comments, and days since upload) and Video Power Index to measure popularity. Outcomes were stratified by video uploader source (medical institutions, medical companies, individual users, other).
    RESULTS: Users searched YouTube for "inspire sleep apnea" 2.48 times more in 2020 than in 2018. We identified 67 videos for review, with the majority coming from medical institutions (70.2%). Overall, the average-modified DISCERN (13.65 ± 4.88) and novel content (3.87 ± 2.09) scores were low and did not differ between medical institutions or other uploader sources. Higher quality and more comprehensive video content did not correlate with popularity.
    CONCLUSION: Overall quality and comprehensiveness of information of HNS YouTube videos was low. Given the high demand for information on HNS, there is opportunity for medical institutions to implement new strategies to improve both video content and visibility to patients.
    LEVEL OF EVIDENCE: N/A Laryngoscope, 2021.
    Keywords:  YouTube; hypoglossal nerve stimulation; obstructive sleep apnea
  11. J Prosthet Dent. 2021 Aug 03. pii: S0022-3913(21)00364-4. [Epub ahead of print]
      STATEMENT OF PROBLEM: Denture cleaning is indispensable to the maintenance of good oral and systemic health for denture users. Nowadays people often consult YouTube about health-related topics, including denture care. However, the quality of the information about denture care presented on YouTube is unknown.PURPOSE: The purpose of this study was to evaluate the usefulness and quality of popular videos about denture care shared by different uploaders on YouTube and to evaluate the demographic characteristics of the videos.
    MATERIAL AND METHODS: Google Trends showed that "denture cleaning" was the most searched keyword on the topic. This keyword was used to search YouTube videos. Of the 200 most-watched videos, 109 videos were selected for analysis. Included videos were analyzed for their demographic data, including number of views; number of likes, dislikes, and comments; days since upload; duration and number of subscribers; an 8-point usefulness score system, a global quality scale (GQS); video sources; target groups; and primary purposes of the videos. Statistical analyses were conducted by using the Kruskal-Wallis test, post hoc Mann-Whitney U test, Pearson chi-squared test, and Spearman correlation analysis, which was used to investigate the relationship among total content score, GQS score, and video demographics. Cohen kappa statistics was used to measure the reliability of the investigator's evaluations of the videos (α=.05).
    RESULTS: Based on the usefulness score, 59.6% of the videos were classified as poor, 32.1% as moderate, and 8.2% as good. No statistically significant differences were found among usefulness scores according to the video demographics, except lower GQS score of poor content videos (P<.001). The overall mean ±standard deviation GQS score was 1.92 ±1.0 out of 5. Videos were primarily uploaded (38.5%) from commercial companies. No statistically significant difference was found between video sources and usefulness scores (P>.05). The number of videos with poor content was significantly higher than the number with moderate and good content among the videos primarily intended for the education of health professionals (P<.001).
    CONCLUSIONS: The majority (59.6%) of YouTube videos on denture care received poor content quality ratings, independent of video demographics. Therefore, YouTube is not suitable as the only source of information on denture care. Dentists and prosthodontists should take more responsibility for enriching the content of video-sharing platforms because this content can affect the behavior of patients and their attitudes about denture care.
  12. J Gynecol Obstet Hum Reprod. 2021 Aug 02. pii: S2468-7847(21)00137-9. [Epub ahead of print] 102200
      OBJECTIVES: Women often feel embarrassed about urinary incontinence, hesitate to see a doctor and search the internet to gain information on the disease. The objective of this study was to evaluate the quality of the most viewed YouTubeTM pertaining to female urinary incontinence.MATERIAL AND METHODS: Sixty videos that met the inclusion criteria were assessed by two urologists through Quality Criteria for Consumer Health Information (DISCERN), Journal of the American Medical Association (JAMA) and Video Power Index (VPI) scoring systems. Videos' image type, video uploaders, general content, length, view counts, date of uploading, comment, like and dislike counts were also recorded and analyzed.
    RESULTS: Forty videos included real and 20 animation images. Nine videos were uploaded directly by physicians, 32 videos by health channels, 14 videos by hospital channels, 2 videos by herbalists and 3 videos by other sources. The mean comment, like and dislike counts of the videos were found as 49.4±172.9, 642.5±2,112.9 and 66.7±192.4. The mean DISCERN score was found as 38.2±11.5, JAMA score as 1.4±0.6 and VPI score as 85.1±12.1. There was no significant difference between physicians and non-physicians and between real and animated videos in terms of DISCERN and JAMA scores (p>0.05).
    CONCLUSIONS: The quality of the videos on YouTubeTM pertaining to female urinary incontinence was at an average level. Healthcare professionals should be encouraged for uploading more accurate quality health related contents. Policy makers should develop policies for supervision of the videos uploaded on the internet.
    Keywords:  Female urinary incontinence; YouTube(TM), DISCERN, JAMA, VPI, Quality
  13. J Cancer Surviv. 2021 Aug 04.
      BACKGROUND: Searching for information on the Internet, especially YouTubeTM, is gaining popularity for cancer survivors. Based on the topic of online health information, the importance of studies using YouTube data for various cancer types and treatment methods has increased. This study aims to investigate the quality, reliability, and accuracy of YouTube videos on cancer rehabilitation (CR).METHODS: YouTube search was performed on February 26th, 2021, with two keyword sets: "cancer rehabilitation" and "oncology rehabilitation." The modified DISCERN, the Journal of the American Medical Association (JAMA) scoring system, and the Global Quality Score (GQS) were used to evaluate the quality and reliability of the videos. The features of each video such as the number of likes, dislikes, and views, upload date, duration, like ratio, and the uploader profile were also collected.
    RESULTS: Fifty-three of the first 200 videos shown in the search results met the criteria. Most of the videos were low quality. The most common uploader profile was academic institute/university hospital. The three most common subjects in the videos were CR definition, physical therapy and occupational therapy, and patient experiences. The mean modified DISCERN, JAMA, and GQS scores were 2.14, 2.03, and 2.78, respectively. Higher quality videos had longer duration, greater number of views, and better reliability scores.
    CONCLUSION: The results showed that most of the rated videos were of low-quality and didn't provide sufficient information on the topic discussed. Higher-quality and more accurate YouTube videos are needed to increase awareness of CR.
    IMPLICATIONS FOR CANCER SURVIVORS: For cancer survivors, CR-related YouTube video content often provides information of low reliability. In this context, it is necessary to focus on the production of video content that includes clinical guides, references, and are based on clinical-based practices.
    Keywords:  Cancer rehabilitation; Cancer survivors; Social media; YouTubeTM
  14. Drug Alcohol Rev. 2021 Aug 03.
      INTRODUCTION: Electronic cigarette (e-cigarette) harm perceptions and information seeking behaviours are both important antecedents of e-cigarette use, yet the relationship between them has been rarely studied. We assessed how absolute (e-cigarettes are harmful to my health) and relative harm perceptions (e-cigarettes are more/less harmful than cigarettes) were associated with specific e-cigarette information seeking behaviours in a sample of current, former and never cigarette smokers.METHODS: We used data from US adults in two cycles of the Health Information National Trends Survey (HINTS-FDA 2015, n = 3738; 2017, n = 1736). Analyses controlled for socio-demographics, ever e-cigarette use and survey cycle. Data were analysed between January and August 2020.
    RESULTS: Higher relative harm perceptions were associated with lower odds of having sought any information on e-cigarettes [adjusted odds ratio 0.61, 95% confidence interval (0.48, 0.84)] and on how to use e-cigarettes to quit smoking specifically [adjusted odds ratio 0.59, 95% confidence interval (0.38, 0.91)]. Smoking status did not moderate associations between absolute or relative harm perceptions and information seeking behaviours, nor was it associated with specific information seeking behaviours after adjusting for covariates.
    DISCUSSION AND CONCLUSIONS: The risks of e-cigarettes relative to combusted cigarettes (as opposed to the absolute risks of e-cigarettes) appear to be more important in individuals' information seeking behaviours about e-cigarettes. Public health messages could ensure that all individuals understand how one's health risk would change if they exclusively used e-cigarettes, switched to e-cigarettes completely or used both products.
    Keywords:  absolute harm perception; electronic cigarette; information seeking; relative harm perception; smoking
  15. Public Health Nutr. 2021 Aug 05. 1-26
      OBJECTIVE: During COVID-19, the internet was a prime source for getting relevant updates on guidelines and desirable information. The objective of the present study was to determine the nutritional immunity information seeking behaviour during COVID-19 in India.DESIGN: Google Trends (GTs) data on relevant COVID-19 and nutritional topics were systematically selected and retrieved. Data on newly reported COVID-19 cases were also examined on a daily basis. The cross-correlation method was used to determine the correlation coefficient between the selected terms and daily new COVID-19 cases, and the joint point regression models were utilised to measure monthly percent change in relative search volumes.
    SETTING: Online.
    PARTICIPANTS: People using google search during period 01-01-2020 to 31-08-2020 in India.
    RESULTS: The date of peak searches can be attributed to the COVID-19 guidelines announcement dates. All the nutritional terms showed a significant increase in average monthly percentage change. The higher than the average daily rise in COVID-19 cases leads to a higher than average increase in RSVs of nutritional terms with the greatest association after 14 to 27 days. The highest mean relative search volume for nutritional terms was from Southern India (49.34±7.43), and the lowest was from Western India (31.10±6.30).
    CONCLUSION: There was a significant rise in the google searches of nutritional immunity topics during COVID-19 in India. The local/regional terms can be considered for better outreach of public health guidelines or recommendations. Further automation of Google Trends using programming languages can help in real-time monitoring and planning various health/nutritional events.
    Keywords:  Behaviour; COVID-19; Google Trends; Immunity; Nutrition
  16. Am J Health Behav. 2021 07 26. 45(4): 665-676
      Objectives: The purpose of this study was to understand COVID-19 information seeking among Korean immigrant women in comparison to their flu/cold information seeking. In particular, the study aimed to examine: (1) the levels of information sought regarding both COVID-19 and the flu/cold, and (2) the content of information discussed at each level. Methods: We analyzed the posts on Missy USA--one of the largest Korean online communities for married Korean immigrant women. Two sets of data, one for COVID-19 (n=726) and the other for the flu/cold (n=50), were analyzed with codes at different levels, which were adapted from the social-ecological model. Results: Applying the social-ecological model, we found that about 80% of information regarding the flu/cold and about 60% of COVID-19 information was concentrated at individual, interpersonal, and organizational levels. Information seeking at the community level was more frequent for COVID-19 than for the flu/cold. Conclusions: Our finding that Korean immigrant women primarily sought information regarding COVID-19 serves as a theoretical contribution at the transnational level, which might be relevant for immigrant women during the unprecedented COVID-19 pandemic.
  17. Int J Environ Res Public Health. 2021 Jul 31. pii: 8121. [Epub ahead of print]18(15):
      The Internet and social media are crucial platforms for health information. Factors such as the efficiency of online health information, the outcomes of seeking online health information and the awareness of reliable sources have become increasingly important for the elderly during the COVID-19 pandemic. This study aimed to examine differences between elderly individuals' income above and below the average monthly wage in relation to their online health information efficiency and the outcomes of seeking online health information; to evaluate types of online information sources with online health information efficiency and the outcomes of seeking online health information; and to explore online health information efficiency as a mediator between health status and awareness of online sources. A cross-sectional study design was conducted with 336 elderly participants age 65 or older. The participants volunteered to complete a questionnaire. No differences were found between the two groups regarding efficiency in retrieving health information from official online health sites and Google. Perceived efficiency mediated health status and awareness of online sources. In these challenging times, it is important to provide a tailor-made education strategy plan for reliable sources of online health information for the elderly, in order to enhance their technology safety skills. It is also important to explore other mediating variables between health status and awareness of online sources.
    Keywords:  COVID-19; awareness of online sources; elderly; online health information; perceived efficiency