bims-librar Biomed News
on Biomedical librarianship
Issue of 2021‒10‒31
eighteen papers selected by
Thomas Krichel
Open Library Society

  1. Nature. 2021 Oct 26.
    Keywords:  Computer science; Databases; Publishing
  2. Clin Trials. 2021 Oct 24. 17407745211053803
      BACKGROUND: Addressing recruitment and retention challenges in trials is a key priority for methods research, but navigating the literature is difficult and time-consuming. In 2016, ORRCA ( launched a free, searchable database of recruitment research that has been widely accessed and used to support the update of systematic reviews and the selection of recruitment strategies for clinical trials. ORRCA2 aims to create a similar database to map the growing volume and importance of retention research.METHODS: Searches of Medline (Ovid), CINAHL, PsycINFO, Scopus, Web of Science Core Collection and the Cochrane Library, restricted to English language and publications up to the end of 2017. Hand searches of key systematic reviews were undertaken and randomised evaluations of recruitment interventions within the ORRCA database on 1 October 2020 were also reviewed for any secondary retention outcomes. Records were screened by title and abstract before obtaining the full text of potentially relevant articles. Studies reporting or evaluating strategies, methods and study designs to improve retention within healthcare research were eligible. Case reports describing retention challenges or successes and studies evaluating participant reported reasons for withdrawal or losses were also included. Studies assessing adherence to treatments, attendance at appointments outside of research and statistical analysis methods for missing data were excluded. Eligible articles were categorised into one of the following evidence types: randomised evaluations, non-randomised evaluations, application of retention strategies without evaluation and observations of factors affecting retention. Articles were also mapped against a retention domain framework. Additional data were extracted on research outcomes, methods and host study context.
    RESULTS: Of the 72,904 abstracts screened, 4,364 full texts were obtained, and 1,167 articles were eligible. Of these, 165 (14%) were randomised evaluations, 99 (8%) non-randomised evaluations, 319 (27%) strategies without evaluation and 584 (50%) observations of factors affecting retention. Eighty-four percent (n = 979) of studies assessed the numbers of participants retained, 27% (n = 317) assessed demographic differences between retained and lost participants, while only 4% (n = 44) assessed the cost of retention strategies. The most frequently reported domains within the 165 studies categorised as 'randomised evaluations of retention strategies' were participant monetary incentives (32%), participant reminders and prompts (30%), questionnaire design (30%) and data collection location and method (26%).
    CONCLUSION: ORRCA2 builds on the success of ORRCA extending the database to organise the growing volume of retention research. Less than 15% of articles were randomised evaluations of retention strategies. Mapping of the literature highlights several areas for future research such as the role of research sites, clinical staff and study design in enhancing retention. Future studies should also include cost-benefit analysis of retention strategies.
    Keywords:  Participant retention; attrition; clinical trials; literature review; trials methodology
  3. Front Digit Health. 2020 ;2 585559
      As the volume of published medical research continues to grow rapidly, staying up-to-date with the best-available research evidence regarding specific topics is becoming an increasingly challenging problem for medical experts and researchers. The current COVID19 pandemic is a good example of a topic on which research evidence is rapidly evolving. Automatic query-focused text summarization approaches may help researchers to swiftly review research evidence by presenting salient and query-relevant information from newly-published articles in a condensed manner. Typical medical text summarization approaches require domain knowledge, and the performances of such systems rely on resource-heavy medical domain-specific knowledge sources and pre-processing methods (e.g., text classification) for deriving semantic information. Consequently, these systems are often difficult to speedily customize, extend, or deploy in low-resource settings, and they are often operationally slow. In this paper, we propose a fast and simple extractive summarization approach that can be easily deployed and run, and may thus aid medical experts and researchers obtain fast access to the latest research evidence. At runtime, our system utilizes similarity measurements derived from pre-trained medical domain-specific word embeddings in addition to simple features, rather than computationally-expensive pre-processing and resource-heavy knowledge bases. Automatic evaluation using ROUGE-a summary evaluation tool-on a public dataset for evidence-based medicine shows that our system's performance, despite the simple implementation, is statistically comparable with the state-of-the-art. Extrinsic manual evaluation based on recently-released COVID19 articles demonstrates that the summarizer performance is close to human agreement, which is generally low, for extractive summarization.
    Keywords:  extractive summarization; health informatics; medical text processing; natural language processing; text mining; text summarization
  4. J Health Commun. 2021 Oct 26. 1-10
      Due to the increasing amount of new information that is emerging about COVID-19, traditional and web-based information sources are commonly used to spread and seek information. This study compared differences in information seeking, trust of information sources, and use of protective behaviors (e.g., mask wearing) among individuals in the US and China during the COVID-19 pandemic. A total of 722 valid responses in the US and 493 valid responses in China were collected via online surveys in May 2020. Pearson's Chi-square tests, independent samples t-tests, and multiple linear regressions were used to conduct the analyses. Results showed that US respondents accessed significantly fewer COVID-19 information sources, rated significantly lower levels of trust in these sources, and reported significantly lower levels of protective behaviors than the Chinese respondents. In both countries, trust in newspapers, radio/community broadcasting, and news portals were significantly positively correlated with protective behaviors. While trust of TV was significant in both populations, in China it was positively correlated, whereas in the US was negatively correlated, with protective behaviors. Findings from this study showed that coordinated and consistent messages from governmental officials, health authorities, and media platforms are important to promote and encourage protective behaviors.
  5. Front Public Health. 2021 ;9 709416
      African Americans in the United States have been disproportionately affected by the COVID-19 pandemic in infection and mortality rates. This study examined how middle-aged and older African American individuals accessed and evaluated the information about COVID-19. Semi-structured interviews with 20 individuals (age: 41-72) were conducted during the first stay-at-home advisory period in late March and early April 2020. The phronetic iterative approach was used for data analysis. We found that these individuals primarily relied on information scanning based on their routine media consumption to acquire information about COVID-19 and seldom actively searched for information outside of their regular media use. Individuals used several strategies to assess the quality of the information they received, including checking source credibility, comparing multiple sources, fact-checking, and praying. These findings could inform media and governmental agencies' future health communication efforts to disseminate information about the COVID-19 pandemic and future infectious disease outbreaks among the African American communities.
    Keywords:  African Americans; COVID-19; health disparities; information use; interview
  6. JMIR Form Res. 2021 Oct 01.
      BACKGROUND: Suicide represents a public health concern, imposing a dramatic burden. Pro-suicide websites are "virtual pathways" facilitating the insurgence of suicidal behaviors, especially among socially-isolated, susceptible individuals.OBJECTIVE: To characterize suicide-related web-pages in the Italian language.
    METHODS: The first five most commonly used search engines in Italy (namely, Bing©, Virgilio©, Yahoo©, Google©, and Libero©) were mined, searching for "suicidio" (Italian for suicide). For each search, the first 100 web-pages were considered. Web-sites resulting from each search were collected and duplicates deleted, in such a way that unique web-pages were analyzed and rated, using the HONcode© instrument.
    RESULTS: Sixty-four web-pages were included: 12.5% were anti-suicide and 6.3% explicitly pro-suicide. The majority of the included websites had a mixed/neutral attitude towards suicide (81.2%) and had an informative content and purpose (60.9%). Most web-pages targeted adolescents as age-group (59.4%), contained a reference to other psychiatric disorders/co-morbidities (65.6%), were with a medical/professional supervision/guidance (70.3%), without figures/pictures related to suicide (64.1%) and did not contain any access restraint (96.9%). The major shortcoming is the small sample size of web-pages analyzed and the search limited to the keyword "suicide".
    CONCLUSIONS: Specialized mental health professionals should try to improve their presence online and providing high-quality material.
  7. Int J Radiat Oncol Biol Phys. 2021 Nov 01. pii: S0360-3016(21)01939-8. [Epub ahead of print]111(3S): e358-e359
      PURPOSE/OBJECTIVE(S): Cancer patients are increasingly using the Internet to educate themselves about COVID-19. Recent studies have shown that cancer patients are at risk of more serious outcomes of COVID-19 compared to the general population. Some cancer treatments such as chemotherapy can impact the immune system, which may make COVID-19 infection more dangerous. This study looks to systematically examine the quality of web resources available for cancer patients about COVID-19.MATERIALS/METHODS: The term "COVID-19 Risk and Cancer" was searched in Google and metasearch engines Yippy and Dogpile. URLs were recorded from each search and inclusion and exclusion criteria were applied. The results from the 3 lists were combined to come up with a final list based on overall average rank order. This list was analyzed using a previously validated structured rating tool with respect to accountability, currency, interactivity, readability, and content coverage and accuracy.
    RESULTS: 398 websites were identified prior (this includes overlap between the three search sites used), 37 websites were included for analysis. Out of 37 websites, only 43% disclosed authorship and 24% cited sources. Most websites (76%) revealed date of creation, and 32% were updated less than 3 months before the date of search. 68% of websites enabled questions to be sent to the author or webmaster regarding COVID-19 risk queries. 54% of websites had high school readability (8.0-12.0), 43% were at university level or above, and only one website demonstrated the recommended reading level for general public (below 8.0). Topics most commonly discussed were special consideration for cancer patients in COVID-19 (84%), COVID-19 risk factors (73%), and infection prevention (62%), while topics least covered were COVID-19 incidence/prevalence (5%), prognosis (8%), and treatment (16%).
    CONCLUSION: There is some COVID-19 in cancer risk information available online, but quality is variable. The total number of sites with relevant information related to COVID-19 and cancer was relatively low and many sites lacked markers for accountability. Some information may not be up to date and content may be difficult to comprehend. Healthcare professionals may direct cancer patients to the most reliable online resources about COVID-19 and cancer shown in this study. In addition, this may be helpful to consider when designing comprehensive web resources regarding COVID-19.
  8. Arthrosc Sports Med Rehabil. 2021 Oct;3(5): e1547-e1555
      Purpose: To evaluate the quality and content of internet-based information available for some of the most common orthopaedic sports medicine terms.Methods: A search of the PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was performed. All English-language literature published from 2010 to 2020 discussing information quality pertaining to orthopaedic sports medicine terms was included. Outcomes included the search engines used, number and type of websites evaluated, platform, and quality scoring metrics. Descriptive statistics are presented.
    Results: This review includes 21 studies. Of these, 3 evaluated both the upper and lower extremity. Twelve focused on either the upper or lower extremity, most commonly rotator cuff tears (3 of 12) and/or anterior cruciate ligament pathologies (7 of 12). The most common engines were Google (18 of 21), Bing (16 of 21), Yahoo (16 of 21), YouTube (3 of 21), Ask (3 of 21), and AOL (2 of 21). The average number of media files assessed per study was 87 ± 55. Website quality was assessed with DISCERN (7 of 21), Flesch-Kincaid (9 of 21), Health on the Net (7 of 21), and/or Journal of the American Medical Association Benchmark (7 of 21) scores. YouTube was evaluated with Journal of the American Medical Association Benchmark scores (1.74 ± 1.00). Image quality was reported in 2 studies and varied with search terminology.
    Conclusions: The results of this systematic review suggest that physicians should improve the quality of online information and encourage patients to access credible sources when conducting their own research.
    Clinical Relevance: Doctors can and should play an active role in closing the gap between the level of health literacy of their patients and that of most common online resources.
  9. Cureus. 2021 Sep;13(9): e18188
      Introduction Distal radius fractures (DRFs) are among the most common upper limb fractures reviewed in the emergency and orthopaedic departments. Approximately 40% of these fractures are unstable and require fixation to improve limb function. Confronted with an impending operation, many patients will access the internet, looking for information and reassurance. Previous studies have suggested that orthopaedic healthcare websites are beyond the comprehension of their target audience. Objective To assess the readability of healthcare websites regarding DRFs. Methods The terms distal radius fracture, broken wrist and wrist fracture were searched on Google and Bing. Of 101 websites initially considered, 52 unique websites underwent evaluation using readability software. Websites were assessed using two common methods for assessing readabilty; the Reading Grade Level (RGL) and the Flesch Reading Ease Score (FRES). In line with recommended guidelines and previous studies, an RGL of sixth grade and under and a FRES score above 65 was considered acceptable. Results The mean score for the FRES index was 56.67 (SD: ± 19.6), which resulted in the majority of pieces assessed being classified as 'fairly difficult to read'. The mean RGL was 8.61 (SD: ± 2.86); 17.3% of the websites assessed fulfilled the criteria of having an RGL of six or less. One way T-tests comparing the FRES and RGL mean scores against the acceptable standards showed that they failed to meet the acceptable indexes (FRES: P<0.004; 95% CI: -13.8 to -2.8; RGL: P<0.0001; CI: 1.8-3.4). ANOVA testing showed no significant difference based on category (FRES: P=0.791; RGL: P=0.101). Conclusion The level of comprehension required for online healthcare education materials related to distal radius fractures exceeds the recommended guidelines. Improving the readability content of these websites would enhance the internet's usability as an educational tool as well as improve patient post-operative outcomes.
    Keywords:  accessibility; distal radius fractures; healthcare education; internet access; internet technologies; online medical education; orthopaedics surgery
  10. Sports Med Open. 2021 Oct 30. 7(1): 80
      BACKGROUND: Preventing sports injuries is at the forefront of sports medicine. Although effective preventive strategies in scientific literature exist, their implementation is lagging behind. The Internet could support the translation of knowledge from the literature to end-users, but the quality of the online resources would have to be assured. This online-based systematic review is to assess availability, readability, quality, and content of the websites presenting exercise-based sports injury risk reduction (prevention) programmes. Moreover, the quality of reporting and contents of the exercise programmes were assessed.METHODS: Google, Yahoo, and Bing were searched on 2 September 2018. We used 'sports injury prevention program*' and 'sports injury prevention warm-up' as search phrases. The owners/authors of the included websites were asked for further recommendations on online resources. Search updates were run in DuckDuckGo on 15 May 2020 and 22 August 2021. Eligible websites were active, in English, and contained instructions for the exercise/s aiming at sports injury prevention. Two reviewers independently screened the links and previews and performed an in-depth appraisal of included websites. The website quality was assessed using JAMA framework criteria and Health on the Net Foundation Code of Conduct (HONcode) certification. The readability of websites was assessed using the Flesch-Kincaid Reading Ease score. The reporting appraisal of exercise programmes was done using the modified Consensus on Exercise Reporting Template (CERT).
    RESULTS: Among 480 websites screened, 16 were eligible with an additional four recommended and nine found in search updates (29 in total). None of the websites was certified by HONcode. The overall quality of websites was low 2.1 ± 1.0/4, but overall readability was high 67 ± 17/100. The average quality of reporting of exercise programmes was low 5.79 ± 3.1/12. Websites with community input had the lowest readability, but the highest quality, and vice versa websites run by businesses had the highest readability, but the lowest quality. Eight websites presented programmes tested for effectiveness.
    CONCLUSIONS: Overall, the quality of the websites was low, but their readability was high. Improvements required are relatively easy to implement (i.e. including the date when the website was updated, applying for HONcode certification) and extremely important (e.g. providing resources on which the website's content is based). There are some sports injury risk reduction programmes reported with high quality and effectiveness-tested available online for team sports, but none for individual sports. Trial Registration This review has been registered in the PROSPERO (CRD42019107104).
    Keywords:  Exercise programme; Online health resources; Sports injuries; Sports injury prevention; Sports injury risk reduction
  11. Orbit. 2021 Oct 29. 1-7
      PURPOSE: To evaluate the educational content, quality, and reliability of YouTube videos addressing anterior approach ptosis surgery.METHODS: A search on YouTube using the term "ptosis surgery" was performed between March 20 and March 26 2021. The quality, reliability, and accuracy of the contents of 38 videos meeting the inclusion criteria were evaluated by two independent ophthalmologists using the DISCERN questionnaire and the Journal of the American Medical Association (JAMA) benchmark criteria. The Global Quality Score (GQS) and a surgical scoring system were used to assess the educational value of the content.
    RESULTS: The mean DISCERN score was 32.8 ± 10, and the mean JAMA score was 1.3 ± 0.5, indicating poor quality; the mean global quality score was 3.1 ± 1.1, indicating moderate quality; and the mean surgical score was 7.5 ± 2.7, indicating moderate to good quality. The surgical, DISCERN, and GQS scores of the videos uploaded by physicians were significantly higher than those of the videos uploaded by private clinics (p = .015, p= .049, and p= .01, respectively). There was a significant positive correlation between the surgical, DISCERN, JAMA, and GQS scores (p< .001). A significant positive correlation was found between video duration and surgical score (p= .013), DISCERN score (p ˂0.001), and GQS score (p ˂0.001).
    CONCLUSION: Videos with known sources, uploaded by physicians, and supported by audio narration may be useful in obtaining educational information. However, the available videos are not a reliable source of educational information about ptosis surgery.
    Keywords:  Education; YouTube; eyelid ptosis; ptosis surgery; surgical video
  12. Int J Radiat Oncol Biol Phys. 2021 Nov 01. pii: S0360-3016(21)01494-2. [Epub ahead of print]111(3S): e157-e158
      PURPOSE/OBJECTIVE(S): The internet has become a mainstay source of health information for cancer patients. Online patient education videos are common, however, there has been no studies examining the quality of publicly available videos on radiotherapy for lung cancer (one of the most common forms of cancer). To fill this gap in knowledge, we aim to systematically map and objectively assess videos discussing radiotherapy for lung cancer on YouTube.MATERIALS/METHODS: The terms "radiotherapy for lung cancer," "radiation for lung cancer," "radiation therapy for lung cancer," and "radiation treatment for lung cancer" were searched on YouTube using a clear-cache browser. Results were sorted by "Relevance" and the top 50 English-language results for each search were recorded. After removing duplicates, each video was assessed for length, Video Power Index (VPI, which is the product of a video's average daily views and like: dislike ratio), source, content, comment moderation, and misinformation. Two raters were used to ensure consistency. Results were evaluated using descriptive and inferential statistics.
    RESULTS: 88 unique videos resulted from the search. The median video length was 4 minutes and 5 seconds. The average VPI was 10.9 (95% CI: 1.5-20.4) and the median number of views was 954.5. All videos were published between July 8, 2009 and November 18, 2020. 44% were published within the past two years. 61% of the videos were from the USA, 14% were from the UK, 6% from Australia, 5% each from Canada and India, and other countries make up the remaining 8%. Most of the videos were published by healthcare facilities (39%) and non-profit organizations (31%). Content-wise, 95% of videos contain information specific for lung cancer. 46 videos (52%) were targeted towards patient education. Of which, 37 covered radiotherapies for lung cancer, 12 covered side effects for radiotherapy, and 11 covered both. The other 42 videos (48%) were designed for a professional audience. SBRT/SABR was the most commonly described radiotherapy modality (42%), and the physician interview was the most common format, being used in 59% of videos. Out of the 38 videos with at least one comment, only 2 (5%) were moderated by the host channel. None of the videos featured misleading information.
    CONCLUSION: This study comprehensively surveyed YouTube videos pertaining to radiotherapy for lung cancer to provide a high-level overview of the information that patients may find online. Although nearly half of the videos describe lung cancer radiotherapy for patients, only a small proportion comprehensively cover both radiotherapy and its side effects. The results of our study can help guide development of patient education tools and encourage healthcare providers to recognize limitations of online health information and proactively address patient questions regarding radiotherapy. Future research could examine videos on other lung cancer treatment options or radiotherapy for other cancers.
  13. Int J Dent Hyg. 2021 Oct 23.
      INTRODUCTION: The present study aims to assess the quality, reliability and content of the information provided by the YouTubeTM videos on oral hygiene during orthodontic treatment, to reveal the efficacy of the videos for patients and to help dentists who use this platform as a source to guide their patients accurately.METHOD: In the beginning, it was found that the most common search term on oral hygiene during orthodontic treatment in Google Trends was 'how to clean braces'. A total of 150 videos containing keywords were reviewed, and 56 videos were assessed within the scope of the study. Videos were analysed for reliability score, content analysis and GQS criteria.
    RESULTS: According to the results, the mean video length was statistically significantly greater in rich-content videos than in poor-content videos (p = 0.024). In addition, the reliability score of rich-content videos was statistically significantly higher than that of poor-content videos (p = 0.026). Likewise, the GQS of rich-content videos was statistically significantly higher than that of poor-content videos (p < 0.001). However, the number of views, the number of likes, the number of dislikes, the number of comments, the number of days since upload, the interaction index and the view rate did not statistically significantly differ by content categories (p > 0.05).
    CONCLUSION: The present study concluded that the YouTubeTM videos providing oral hygiene education for patients receiving or scheduled for orthodontic treatment had poor content and overall medium quality. The instantaneous data collection was one of the study's limitations.
    Keywords:  oral health; oral hygiene; orthodontics
  14. J Obstet Gynaecol. 2021 Oct 27. 1-6
      With increasing numbers of laparoscopic hysterectomies, surgical trainees are compelled to learn more about endoscopy. Owing to coronavirus disease-related social distancing requirements, online education has gained prominence. Here, we aimed to investigate the laparoscopic hysterectomy video quality on YouTube using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). YouTube was searched on June 7, 2020 using 'laparoscopic hysterectomy'. Three examiners evaluated videos using Global Operative Assessment of Laparoscopic Skills (GOALS). Subsequently, videos were assessed for their conformity to the LAP-VEGaS and LAP-VEGaS Video Assessment Tool. Interobserver reliability was estimated using intraclass coefficients and Cronbach's alpha. Cochran's Q test was used to determine correlations among quantitative data. The median GOALS score was 21.50. The observers' GOALS scores were significantly correlated. The results showed low conformity to the LAP-VEGaS. YouTube is the most used platform among trainees. The low YouTube video educational quality highlights the necessity for peer review, as trainees increasingly seek such resources during the pandemic.IMPACT STATEMENTWhat is already known on this subject? YouTube is the most commonly used online resource for educational material among surgical trainees. Online videos usually do not undergo a peer-review process. The LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) may be used to assess the educational quality of surgical videos.What do the results of this study add? To our knowledge, this is the first study on the quality of laparoscopic hysterectomy videos available on YouTube and the first study to evaluate YouTube laparoscopic surgery videos using the LAP-VEGaS Video Assessment Tool (VAT). Our study revealed the low educational quality of YouTube laparoscopic hysterectomy videos. The LAP-VEGaS VAT seems to be a valid and practical tool for assessing online laparoscopic hysterectomy videos.What are the implications of these findings for clinical practice and/or further research? Medical communities, especially tertiary care or academic centres, may upload educational peer-reviewed videos for trainees seeking this type of resource, especially during the coronavirus disease pandemic, as surgical education alternatives are limited.
    Keywords:  LAP-VEGaS; Laparoscopic hysterectomy; YouTube; educational videos; endoscopic surgery; video quality
  15. J Med Internet Res. 2021 Oct 29. 23(10): e29155
      BACKGROUND: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information.OBJECTIVE: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet.
    METHODS: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy-focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women's internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use.
    RESULTS: Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24).
    CONCLUSIONS: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans.
    Keywords:  English proficiency; Korean American; health disparities; health literacy; immigrant; internet; mobile phone; technology use; text messaging; women
  16. JMIR Form Res. 2021 Oct 27. 5(10): e22809
      BACKGROUND: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing.OBJECTIVE: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web.
    METHODS: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it.
    RESULTS: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test.
    CONCLUSIONS: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web.
    Keywords:  Hispanic breast cancer survivors; health literacy; low literacy; online searches
  17. Front Digit Health. 2021 ;3 739476
      Introduction: Digital health literacy (DHL) has recently been proposed as a means of enabling healthy decisions for protective behavior, preventive measures, and adherence with COVID-19 policies and recommendations especially in the era of the "infodemic". This study aimed to (1) identify COVID-19 related DHL and its association with online information seeking; (2) to elucidate COVID-19 related DHL as a mediator predictor between the importance of online information search and its association with subjective well-being among Vietnamese university students. Methods: A cross-sectional web-based survey was used to elicit the responses of Vietnamese students over 2 consecutive weeks (from April 25 to May 9, 2020, n = 1,003, 70.1% female students, mean age 21.4 ± 3.1). The online survey questionnaire collected data on the sociodemographic characteristics of participants, DHL about COVID-19, information seeking behavior, and subjective well-being. Mediation analysis was conducted using the importance of searching COVID-19 related information as independent variables, subjective well-being as a dependent variable, and DHL as a mediator variable. Results: Among 1,003 students, the mean (SD) of DHL related to COVID-19 was 2.87 ± 0.32. In the survey, 87.2% of the students reported sufficient well-being, while almost 13% reported low or very low well-being. The findings also indicated that search engines were the most popular platform for information seeking by Vietnamese students (95.3%) and 92.8% of participants had searched for information related to the current spread of COVID-19. Not searching for hygiene regulation as part of infection control and an average level of information satisfaction were associated with limited DHL (p < 0.05). The importance of online information searching related to COVID-19 increased the subjective well-being of students significantly and limited DHL (p < 0.05). DHL was found to mediate the relationship between the importance of online information searching and the subjective well-being of students. Conclusion: The finding provides insight into DHL about COVID-19 among university students, and their ability to find, understand, appraise, and use online health related information during lockdown throughout the first COVID-19 pandemic wave. DHL should be highlighted as a mediating factor that enhances the positive effect of the importance of information seeking on psychological well-being. However, further studies are needed to better define the mediating role of DHL across other factors.
    Keywords:  COVID-19; Vietnamese students; digital health literacy; mediator; subjective well-being
  18. Int J Radiat Oncol Biol Phys. 2021 Nov 01. pii: S0360-3016(21)01855-1. [Epub ahead of print]111(3S): e319-e320
      PURPOSE/OBJECTIVE(S): Accessible, patient-centered educational resources improve health literacy and patient outcomes. Readability standards help create educational resources that are effective and comprehensible for most patients. However, many United States (US) professional societies fail to meet these standards. Language access is also an important consideration in treating an increasingly diverse and multilingual patient population. This study assesses the availability and readability of radiotherapy patient education resources, available in non-English languages, from three major US professional societies. We hypothesized that there would be limited available non-English resources, and that these resources would fail to meet recommended national readability levels.MATERIALS/METHODS: Patient education resources in non-English languages were collected from the American Society for Radiation Oncology (ASTRO), the American Cancer Society (ACS), and a collaboration between the American College of Radiology and Radiological Society of North America (ACR/RSNA). Number of English resources were tabulated. The text from each non-English resource was extracted and analyzed using 4 previously validated Spanish readability indices that provide grade level equivalents: Gilliam-Peña-Mountain (GPM), Läsbarhetsindex (Lix), Rate Index (Rix), and Spanish Simple Measure of Gobbledygook (SOL). One-sided t-test was used for comparisons to national standards. Fisher's exact test was used to assess for differences in proportions.
    RESULTS: Of 51 identified English resources, 35 (69%) had a Spanish counterpart. English materials from ACR/RSNA were more likely than ACS and ASTRO materials to have a provided Spanish counterpart (100% vs 75% vs 24%, respectively; P < 0.01) There were no resources available in other languages. Mean readability levels for all resources in Spanish ranged from 10.0 to 12.0 grade levels, depending on the index, and were at a high school level: ACS (GPM, Lix, Rix, SOL) 9.0, 11.0, 11.2, 10.5; ASTRO 10.0, 11.0, 10.3, 9.6; and ACR/RSNA 10.0, 12.0, 11.8, 11.2. Using the most permissive scores for each resource, ACS had the only resources at or below the 8th grade level (50%, P < 0.01). The most permissive mean scores of all organizations significantly exceeded 6th grade levels (P < 0.01) and only ACS did not exceed an 8th grade level (P = 0.05).
    CONCLUSION: Limited resources are available in non-English languages for patients undergoing radiotherapy in the US. Spanish was the only language with available translations. Available Spanish resources did not meet readability standards from the American Medical Association (6th grade) and National Institutes of Health (8th grade). These findings demonstrate a paucity of non-English language resources, and the need to improve readability levels in Spanish radiotherapy patient education resources.