bims-librar 2023-12-24 papers

bims-librar

Biomed News

on Biomedical librarianship

Issue of 2023–12–24
twenty-six papers selected by
Thomas Krichel, Open Library Society

Assessing the quality of services at an academic library.
Online searches to evaluate misinformation can increase its perceived veracity.
Automated data analysis of unstructured grey literature in health research: A mapping review.
Social media users' perceptions about health mis- and disinformation on social media.
Automated Credibility Assessment of Web-Based Health Information Considering Health on the Net Foundation Code of Conduct (HONcode): Model Development and Validation Study.
Accuracy and comprehensibility of chat-based artificial intelligence for patient information on atrial fibrillation and cardiac implantable electronic devices.
Is ChatGPT accurate and reliable in answering questions regarding head and neck cancer?
Evaluating text-based generative artificial intelligence models for patient information regarding cataract surgery.
Developing an Instrument to Evaluate the Quality of Dementia Websites.
Validity and reliability of artificial intelligence chatbots as public sources of information on endodontics.
The Quality of CLP-Related Information for Patients Provided by ChatGPT.
Assessing the Quality, Comprehensiveness, and Readability of Online Patient Health Resources About Psoriasis in Skin of Color.
Online information and availability of three doping substances (anabolic agents) in sports: role of pharmacies.
Evaluating the Quality of Online Patient Information for Prepectoral Breast Reconstruction Using Polyurethane-Coated Breast Implants.
Quality of Web-Based Sickle Cell Disease Resources for Health Care Transition: Website Content Analysis.
Quality Assessment of Degenerative Cervical Myelopathy Information on the Internet.
Quality, Reliability, Technical Quality, and Readability of Google Online Information on Childhood Glaucoma.
YouTube as a Patient Information Source for Gastrointestinal Reflux Disease.
An assessment of the quality of YouTube videos as a resource for adolescents experiencing abnormal uterine bleeding.
Critical Appraisal of Content Quality of YouTube Videos on the Whipple Pancreaticoduodenectomy.
Audience engagement and quality of online lumbar disc herniation-related videos in mainland China.
Third-Line Overactive Bladder Therapies on TikTok: What Does the Public Learn?
Evaluation of the quality of thyroidectomy-related posts on a video-based social media platform.
Patient-Directed Online Education for Carpal Tunnel Syndrome and Release: Analysis of What Patients Ask and Quality of Resources.
Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review.
Do Electronic Health Literacy and Online Health Information-Seeking Behavior Mediate the Effects of Socio-Demographic Factors on COVID-19- and Non-communicable Disease-Related Behaviors Among Myanmar Migrants in Southern Thailand?

Heliyon. 2023 Dec;9(12): e22449

Assessing the quality of services at an academic library.

Kwaku Anhwere Barfi, Seth Kobina Parbie, Christopher Kwame Filson, Mathias Vondee Teye, Kwame Kodua-Ntim, Eunice Ayensu.

  Customers usually have high expectations on the services they receive. The LibQUAL model was employed in this study to investigate the quality of services at an academic library. The participants were chosen from the five colleges in a university using simple random sampling. Two hundred participants were chosen from each college. In all, 1000 participants (including faculty members, postgraduate and undergraduate students) were selected for the study. The study revealed that users knew and used the library's services. The researchers delivered the questionnaires to the respondents at the library. The results showed that the library service quality (LSQ) fell short of users' expectations. There was a statistically significant difference in LSQ between gender of users. The users' expectations of the library's level of service were out of sync or mismatch. The variations could be attributed to differences in information needs of users. This requires the library to assess its services from users' perspective regularly. The use of the LibQUAL model provides useful information that library management can employ for developing service quality measurement scale and planning for service quality. The study also provides information about services that needs improvement, so that library staff could manage users' expectations and satisfaction in a better way. University authorities expect good return of investment made into the development of the library. Therefore, libraries should improve upon their services to boost the image of the Universities.

Keywords:  Academic library; Awareness; LibQUAL model; Quality of service; Usage of library services; User expectation

DOI:  https://doi.org/10.1016/j.heliyon.2023.e22449
Nature. 2023 Dec 20.

Online searches to evaluate misinformation can increase its perceived veracity.

Kevin Aslett, Zeve Sanderson, William Godel, Nathaniel Persily, Jonathan Nagler, Joshua A Tucker.

Considerable scholarly attention has been paid to understanding belief in online misinformation1,2, with a particular focus on social networks. However, the dominant role of search engines in the information environment remains underexplored, even though the use of online search to evaluate the veracity of information is a central component of media literacy interventions3-5. Although conventional wisdom suggests that searching online when evaluating misinformation would reduce belief in it, there is little empirical evidence to evaluate this claim. Here, across five experiments, we present consistent evidence that online search to evaluate the truthfulness of false news articles actually increases the probability of believing them. To shed light on this relationship, we combine survey data with digital trace data collected using a custom browser extension. We find that the search effect is concentrated among individuals for whom search engines return lower-quality information. Our results indicate that those who search online to evaluate misinformation risk falling into data voids, or informational spaces in which there is corroborating evidence from low-quality sources. We also find consistent evidence that searching online to evaluate news increases belief in true news from low-quality sources, but inconsistent evidence that it increases belief in true news from mainstream sources. Our findings highlight the need for media literacy programmes to ground their recommendations in empirically tested strategies and for search engines to invest in solutions to the challenges identified here.

DOI: https://doi.org/10.1038/s41586-023-06883-y
Res Synth Methods. 2023 Dec 19.

Automated data analysis of unstructured grey literature in health research: A mapping review.

Lena Schmidt, Saleh Mohamed, Nick Meader, Jaume Bacardit, Dawn Craig.

  The amount of grey literature and 'softer' intelligence from social media or websites is vast. Given the long lead-times of producing high-quality peer-reviewed health information, this is causing a demand for new ways to provide prompt input for secondary research. To our knowledge, this is the first review of automated data extraction methods or tools for health-related grey literature and soft data, with a focus on (semi)automating horizon scans, health technology assessments (HTA), evidence maps, or other literature reviews. We searched six databases to cover both health- and computer-science literature. After deduplication, 10% of the search results were screened by two reviewers, the remainder was single-screened up to an estimated 95% sensitivity; screening was stopped early after screening an additional 1000 results with no new includes. All full texts were retrieved, screened, and extracted by a single reviewer and 10% were checked in duplicate. We included 84 papers covering automation for health-related social media, internet fora, news, patents, government agencies and charities, or trial registers. From each paper, we extracted data about important functionalities for users of the tool or method; information about the level of support and reliability; and about practical challenges and research gaps. Poor availability of code, data, and usable tools leads to low transparency regarding performance and duplication of work. Financial implications, scalability, integration into downstream workflows, and meaningful evaluations should be carefully planned before starting to develop a tool, given the vast amounts of data and opportunities those tools offer to expedite research.

Keywords:  artificial intelligence; automation; grey literature; literature review; natural language processing

DOI:  https://doi.org/10.1002/jrsm.1692
Health Aff Sch. 2023 Oct;pii: qxad050. [Epub ahead of print]1(4):

Social media users' perceptions about health mis- and disinformation on social media.

Jim P Stimpson, Alexander N Ortega.

  This study used recently released nationally representative data with new measures on health information seeking to estimate the prevalence and predictors of adult social media users' perceptions of health mis- and disinformation on social media. Most adults who use social media perceive some (46%) or a lot (36%) of false or misleading health information on social media, but nearly one-fifth reported either none or a little (18%). More than two-thirds of participants reported that they were unable to assess social media information as true or false (67%). Our study identified certain population groups that might be a focus of future intervention work, such as participants who use social media to make decisions. The perception by social media users that false and misleading health information on social media is highly prevalent may lend greater urgency to mitigate the spread of false or misleading health information that harms public health.

Keywords:  United States; consumer health information; cross-sectional study; disinformation; misinformation

DOI:  https://doi.org/10.1093/haschl/qxad050
JMIR Form Res. 2023 Dec 22. 7 e52995

Automated Credibility Assessment of Web-Based Health Information Considering Health on the Net Foundation Code of Conduct (HONcode): Model Development and Validation Study.

Azadeh Bayani, Alexandre Ayotte, Jean Noel Nikiema.

   BACKGROUND: An increasing number of users are turning to web-based sources as an important source of health care guidance information. Thus, trustworthy sources of information should be automatically identifiable using objective criteria.
OBJECTIVE: The purpose of this study was to automate the assessment of the Health on the Net Foundation Code of Conduct (HONcode) criteria, enhancing our ability to pinpoint trustworthy health information sources.
METHODS: A data set of 538 web pages displaying health content was collected from 43 health-related websites. HONcode criteria have been considered as web page and website levels. For the website-level criteria (confidentiality, transparency, financial disclosure, and advertising policy), a bag of keywords has been identified to assess the criteria using a rule-based model. For the web page-level criteria (authority, complementarity, justifiability, and attribution) several machine learning (ML) approaches were used. In total, 200 web pages were manually annotated until achieving a balanced representation in terms of frequency. In total, 3 ML models-random forest, support vector machines (SVM), and Bidirectional Encoder Representations from Transformers (BERT)-were trained on the initial annotated data. A second step of training was implemented for the complementarity criterion using the BERT model for multiclass classification of the complementarity sentences obtained by annotation and data augmentation (positive, negative, and noncommittal sentences). Finally, the remaining web pages were classified using the selected model and 100 sentences were randomly selected for manual review.
RESULTS: For web page-level criteria, the random forest model showed a good performance for the attribution criterion while displaying subpar performance in the others. BERT and SVM had a stable performance across all the criteria. BERT had a better area under the curve (AUC) of 0.96, 0.98, and 1.00 for neutral sentences, justifiability, and attribution, respectively. SVM had the overall better performance for the classification of complementarity with the AUC equal to 0.98. Finally, SVM and BERT had an equal AUC of 0.98 for the authority criterion. For the website level criteria, the rule-based model was able to retrieve web pages with an accuracy of 0.97 for confidentiality, 0.82 for transparency, and 0.51 for both financial disclosure and advertising policy. The final evaluation of the sentences determined 0.88 of precision and the agreement level of reviewers was computed at 0.82.
CONCLUSIONS: Our results showed the potential power of automating the HONcode criteria assessment using ML approaches. This approach could be used with different types of pretrained models to accelerate the text annotation, and classification and to improve the performance in low-resource cases. Further work needs to be conducted to determine how to assign different weights to the criteria, as well as to identify additional characteristics that should be considered for consolidating these criteria into a comprehensive reliability score.

Keywords:  HONcode; infodemic; machine learning; natural language processing; web-based health information

DOI:  https://doi.org/10.2196/52995
Europace. 2023 Dec 21. pii: euad369. [Epub ahead of print]

Accuracy and comprehensibility of chat-based artificial intelligence for patient information on atrial fibrillation and cardiac implantable electronic devices.

Henrike A K Hillmann, Eleonora Angelini, Nizar Karfoul, Sebastian Feickert, Johanna Mueller-Leisse, David Duncker.

   BACKGROUND AND AIMS: Natural language processing chatbots (NLPC) can be used to gather information for medical content. However, these tools contain a potential risk of misinformation. This study aims to evaluate different aspects of responses given by different NLPCs on questions about atrial fibrillation (AF) and clinical implantable electronic devices (CIED).
METHODS: Questions were entered into three different NLPC interfaces. Responses were evaluated with regard to appropriateness, comprehensibility, appearance of confabulation, absence of relevant content and recommendations given for clinically relevant decisions. Moreover, readability was assessed calculating word count and Flesch Reading Ease score.
RESULTS: 52%, 60% and 84% of responses on AF and 16%, 72% and 88% on CIEDs were evaluated to be appropriate for all responses given by Google Bard, (GB) Bing Chat (BC) and ChatGPT Plus (CGP), respectively. Assessment of comprehensibility showed that 96%, 88% and 92% of responses on AF and 92% and 88% and 100% on CIEDs were comprehensible for all responses created by GB, BC and CGP, respectively. Readability varied between different NLPCs. Relevant aspects were missing in 52% (GB), 60% (BC) and 24% (CGP) for AF and in 92% (GB), 88% (BC) and 52% (CGP) for CIEDs.
CONCLUSION: Responses generated by an NLPC are mostly easy to understand with varying readability between the different NLPCs. Appropriateness of responses is limited and varies between different NLPC. Important aspects are often missed to be mentioned. Thus, chatbots should be used with caution to gather medical information about cardiac arrhythmias and devices.

Keywords:  artificial intelligence; atrial fibrillation; cardiac electrophysiology; cardiac implantable devices; digital health; patient education

DOI:  https://doi.org/10.1093/europace/euad369
Front Oncol. 2023 ;13 1256459

Is ChatGPT accurate and reliable in answering questions regarding head and neck cancer?

Oğuz Kuşcu, A Erim Pamuk, Nilda Sütay Süslü, Sefik Hosal.

   Background and objective: Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI)-based language processing model using deep learning to create human-like text dialogue. It has been a popular source of information covering vast number of topics including medicine. Patient education in head and neck cancer (HNC) is crucial to enhance the understanding of patients about their medical condition, diagnosis, and treatment options. Therefore, this study aims to examine the accuracy and reliability of ChatGPT in answering questions regarding HNC.
Methods: 154 head and neck cancer-related questions were compiled from sources including professional societies, institutions, patient support groups, and social media. These questions were categorized into topics like basic knowledge, diagnosis, treatment, recovery, operative risks, complications, follow-up, and cancer prevention. ChatGPT was queried with each question, and two experienced head and neck surgeons assessed each response independently for accuracy and reproducibility. Responses were rated on a scale: (1) comprehensive/correct, (2) incomplete/partially correct, (3) a mix of accurate and inaccurate/misleading, and (4) completely inaccurate/irrelevant. Discrepancies in grading were resolved by a third reviewer. Reproducibility was evaluated by repeating questions and analyzing grading consistency.
Results: ChatGPT yielded "comprehensive/correct" responses to 133/154 (86.4%) of the questions whereas, rates of "incomplete/partially correct" and "mixed with accurate and inaccurate data/misleading" responses were 11% and 2.6%, respectively. There were no "completely inaccurate/irrelevant" responses. According to category, the model provided "comprehensive/correct" answers to 80.6% of questions regarding "basic knowledge", 92.6% related to "diagnosis", 88.9% related to "treatment", 80% related to "recovery - operative risks - complications - follow-up", 100% related to "cancer prevention" and 92.9% related to "other". There was not any significant difference between the categories regarding the grades of ChatGPT responses (p=0.88). The rate of reproducibility was 94.1% (145 of 154 questions).
Conclusion: ChatGPT generated substantially accurate and reproducible information to diverse medical queries related to HNC. Despite its limitations, it can be a useful source of information for both patients and medical professionals. With further developments in the model, ChatGPT can also play a crucial role in clinical decision support to provide the clinicians with up-to-date information.

Keywords:  ChatGPT 4; artificial intelligence; chatbot; head and neck; head and neck (H&N) cancer; information literacy; machine learning; natural language processing

DOI:  https://doi.org/10.3389/fonc.2023.1256459
J Cataract Refract Surg. 2024 Jan 01. 50(1): 95-96

Evaluating text-based generative artificial intelligence models for patient information regarding cataract surgery.

Libby Wei, Isa S K Mohammed, Sara Francomacaro, Wuqaas M Munir.

DOI: https://doi.org/10.1097/j.jcrs.0000000000001288
Healthcare (Basel). 2023 Dec 13. pii: 3163. [Epub ahead of print]11(24):

Developing an Instrument to Evaluate the Quality of Dementia Websites.

Yunshu Zhu, Ting Song, Zhenyu Zhang, Ping Yu.

  In today's digital era, health information, especially for conditions like dementia, is crucial. This study aims to develop an instrument, demenTia wEbsite measSurement insTrument (TEST), through four steps: identifying existing instruments, determining criteria, selecting and revising measurement statements, and validating the instrument from March to August 2020. Five health informatics experts used the content validity ratio (CVR) test for validation. Thirteen evaluators compared Fleiss Kappa and intraclass correlation coefficient (ICC) values across four dementia websites using TEST and another tool, DISCERN. TEST consists of seven criteria and 25 measurement statements focusing on content quality (relevance, credibility, currency) and user experience (accessibility, interactivity, attractiveness, privacy). CVR = 1 confirmed all statements as essential. The TEST demonstrated stronger consistency and assessor agreement compared to DISCERN, measured by Fleiss Kappa and ICC. Overall, it is a robust tool for reliable and user-friendly dementia resources, ensuring health holistic information accessibility.

Keywords:  Alzheimer’s disease; dementia; information quality; user experience; website; website quality measurement

DOI:  https://doi.org/10.3390/healthcare11243163
Int Endod J. 2023 Dec 20.

Validity and reliability of artificial intelligence chatbots as public sources of information on endodontics.

Hossein Mohammad-Rahimi, Seyed AmirHossein Ourang, Mohamad Amin Pourhoseingholi, Omid Dianat, Paul Michael Howell Dummer, Ali Nosrat.

   AIM: This study aimed to evaluate and compare the validity and reliability of responses provided by GPT-3.5, Google Bard, and Bing to frequently asked questions (FAQs) in the field of endodontics.
METHODOLOGY: FAQs were formulated by expert endodontists (n = 10) and collected through GPT-3.5 queries (n = 10), with every question posed to each chatbot three times. Responses (N = 180) were independently evaluated by two board-certified endodontists using a modified Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Disagreements on scoring were resolved through evidence-based discussions. The validity of responses was analysed by categorizing scores into valid or invalid at two thresholds: The low threshold was set at score ≥4 for all three responses whilst the high threshold was set at score 5 for all three responses. Fisher's exact test was conducted to compare the validity of responses between chatbots. Cronbach's alpha was calculated to assess the reliability by assessing the consistency of repeated responses for each chatbot.
RESULTS: All three chatbots provided answers to all questions. Using the low-threshold validity test (GPT-3.5: 95%; Google Bard: 85%; Bing: 75%), there was no significant difference between the platforms (p > .05). When using the high-threshold validity test, the chatbot scores were substantially lower (GPT-3.5: 60%; Google Bard: 15%; Bing: 15%). The validity of GPT-3.5 responses was significantly higher than Google Bard and Bing (p = .008). All three chatbots achieved an acceptable level of reliability (Cronbach's alpha >0.7).
CONCLUSIONS: GPT-3.5 provided more credible information on topics related to endodontics compared to Google Bard and Bing.

Keywords:  Bing; ChatGPT; Google Bard; artificial intelligence; endodontics; large language models

DOI:  https://doi.org/10.1111/iej.14014
Cleft Palate Craniofac J. 2023 Dec 21. 10556656231222387

The Quality of CLP-Related Information for Patients Provided by ChatGPT.

Gökhan Serhat Duran, Ebru Yurdakurban, Kübra Gülnur Topsakal.

   OBJECTIVE: To assess the quality, reliability, readability, and similarity of the data that a recently created NLP-based artificial intelligence model ChatGPT 4 provides to users in Cleft Lip and Palate (CLP)-related information.
DESIGN: In the evaluation of the responses provided by the OpenAI ChatGPT to the CLP-related 50 questions, several tools were utilized, including the Ensuring Quality Information for Patients (EQIP) tool, Reliability Scoring System (Adapted from DISCERN), Flesh Reading Ease Formula (FRES) and Flesch-Kinkaid Reading Grade Level (FKRGL) formulas, Global Quality Scale (GQS), and Similarity Index with plagiarism-detection tool. Jamovi (The Jamovi Project, 2022, version 2.3; Sydney, Australia) software was used for all statistical analyses.
RESULTS: Based on the reliability and GQS values, ChatGPT demonstrated high reliability and good quality attributable to CLP. Furthermore, according to the FRES results, ChatGPT's readability is difficult, and the similarity index values of this software exhibit an acceptable level of similarity ratio. There is no significant difference in EQIP, Reliability Score System, FRES, FKGRL, GQS, and Similarity Index values among the two categories.
CONCLUSION: OpenAI ChatGPT provides a highly reliable, high-quality, but challenging to read, and acceptable similarity rate in providing information related to CLP. Ensuring that information obtained through these models is verified and assessed by a qualified medical expert is crucial.

Keywords:  artificial intelligence; cleft lip and palate; natural language processing

DOI:  https://doi.org/10.1177/10556656231222387
J Clin Aesthet Dermatol. 2023 Dec;16(12): 52-54

Assessing the Quality, Comprehensiveness, and Readability of Online Patient Health Resources About Psoriasis in Skin of Color.

Danielle Yee, Kathryn Lee, Margaret Y Huang, Paige Kingston, Edwin Korouri, Hannah Peterson, April W Armstrong.

Keywords: Psoriasis; online patient health information; patient education; skin of color
Front Pharmacol. 2023 ;14 1305080

Online information and availability of three doping substances (anabolic agents) in sports: role of pharmacies.

Juan F Garcia, Jesús Seco-Calvo, Soledad Arribalzaga, Raquel Díez, Cristina Lopez, M Nelida Fernandez, Juan J Garcia, M Jose Diez, Raul de la Puente, Matilde Sierra, Ana M Sahagún.

  Background: The Internet has become an important source for easy access to doping substances, where people and athletes may acquire, outside pharmacies and without a (medical) prescription. These online websites do not always offer quality-assured products, and are outside the regular distribution channels of medicines. The aim of this study was to estimate the availability and accessible information on the Internet about the sale of three doping substances (oxandrolone, DHEA, androstenedione). Methods: Cross-sectional exploratory study, being an observation at a point in time of the online availability of these three doping substances (WADA S1 category: anabolic agents), purchased from Spain, Puerto Rico, Canada, United States, Ukraine and Russia. The characteristics of the websites, the countries the webs sold to, the pharmaceutical forms offered and the recommendations for its use were analyzed by using a computer tool designed ad hoc. Results: There were significant differences between countries in the number of webpages that sold the products (Chi-square test, p < 0.05). Oxandrolone was available for purchase mainly when buying from Spain (27.12%) and Ukraine (26.58%), in websites dedicated to sports (77.26%). For DHEA, most of the pages offered it if the search was done from Canada (23.34%) and Russia (21.44%). Products containing androstenedione or DHEA are claimed to enhance sports performance or for sports use without providing details. Compared to the total number of websites checked, the proportion of pharmacies offering these products was low, ranging from 4.86% for DHEA to 15.79% for androstenedione. Conclusion: The three substances selected are easily available without control through the Internet. Only a small number of websites offering them were online pharmacies, and requested a prescription. Most of the doping substances are purchased from the country where they are requested. Product information described benefits for sports performance, but did not do the same with their side effects. It would be advisable for these products to be sold through pharmacies, to guarantee their quality and provide evidence-based information on their safe use, benefits and risks, and only with a prescription. Athletes should be encouraged to consult health professionals about those supplements suitable for their type of training and sports objectives.

Keywords:  androstenedione; athletes; dehydroepiandrosterone (DHEA); doping substances; internet availability; internet sale; oxandrolone

DOI:  https://doi.org/10.3389/fphar.2023.1305080
JPRAS Open. 2024 Mar;39 11-17

Evaluating the Quality of Online Patient Information for Prepectoral Breast Reconstruction Using Polyurethane-Coated Breast Implants.

Edoardo Bruno, Gianluca Borea, Roberto Valeriani, Alessandro De Luca, Federico Lo Torto, Andrea Loreti, Diego Ribuffo.

   Background: An increasing number of patients are using online information regarding medical issues; however, the Internet is not subject to content ratings or filters. Unreliable information found on the web can heavily influence patients to the extent that it can lead to wrong decisions in the choice of treatment. In our daily experience we meet more informed patients and given the increasing use of polyurethane-coated implants in breast reconstruction in Europe, we wondered about the level of information available online. Our study aims to assess the quality of information available online on breast reconstruction with polyurethane-coated implants.
Materials and Methods: Assuming that the most used search engines are Google and Yahoo, we used a search strategy to identify online information regarding prepectoral breast reconstruction with polyurethane-coated implants. The selected websites were divided into 5 groups (practitioners, hospitals, healthcare portals, professional societies, and encyclopedias), and the quality of information was assessed by using an expanded version of the Ensuring Quality Information for Patients (EQIP) tool, which is a checklist applicable to all existing types of information.
Results: Fifty-six websites were selected and were categorized into 5 groups: 17 practitioners, 9 hospitals, 13 healthcare portals, 7 professional societies, 10 encyclopedias. The average score was 17 points (range: 12 - 25). We found 13 reliable websites with a score higher than 20 using the expanded version of the EQIP tool, whereas 43 were deemed unreliable, as they scored lower.
Conclusion: Proper communication between surgeon and patient is crucial in the therapeutic choice, as the available online information presently is scarce and can lead to wrong decisions if not properly verified.

Keywords:  EQIP; Online Information; Polyurethane-Coated Breast Implants; Prepectoral Breast Reconstruction

DOI:  https://doi.org/10.1016/j.jpra.2023.10.015
JMIR Pediatr Parent. 2023 Dec 13. 6 e48924

Quality of Web-Based Sickle Cell Disease Resources for Health Care Transition: Website Content Analysis.

Thomas Annesi, Caren Steinway, Toyosi Oluwole, Steffi Shilly, Dava Szalda, Regina Myers, Jack Chen, Sophia Jan.

   Background: Adolescents and young adults with sickle cell disease (SCD) transitioning from pediatric to adult health care face a high-risk period associated with increased use of acute health care services and mortality. Although 59% of American citizens report using the internet for health care information, the quality of web-based, patient-facing resources regarding transition in SCD care has not been evaluated.
Objective: This study aimed to evaluate the quality and readability of web-based health information on SCD, especially as it pertains to the transition to adulthood for inidividuals with SCD. The study also compared the readability and content scores of websites identified in 2018 to those from 2021 to assess any change in quality over time.
Methods: Keywords representing phrases adolescents may use while searching for information on the internet regarding transition in SCD care, including "hydroxyurea" and "SCD transition," were identified. A web-based search using the keywords was conducted in July 2021 using Google, Yahoo, and Bing. The top 20 links from each search were collected. Duplicate websites, academic journals, and websites not related to SCD health care transition were excluded. Websites were categorized based on the source: health department, hospital or private clinician, professional society, and other websites. Websites were assessed using Health On the Net Foundation code of conduct (HONcode), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FGL), Ensuring Quality Information for Patients (EQIP), and a novel SCD content checklist (SCDCC). EQIP and SCDCC scores range from 0- to 100. Each website was reviewed by 2 research assistants and assessed for interrater reliability. Descriptive statistics were calculated.
Results: Of the 900 websites collected, 67 (7.4%) met the inclusion criteria: 13 health department, 7 hospital or private clinician, 33 professional society, and 14 other websites. A total of 15 (22%) out of 67 websites had HONcode certification. Websites with HONcode certification had higher FRE and EQIP scores and lower FGL scores than those without HONcode certification, reflecting greater readability. Websites without HONcode certification had higher SCDCC scores, reflecting greater clinical content. Only 7 (10%) websites met the National Institutes of Health recommendation of a seventh-grade or lower reading level. Based on EQIP scores, 6 (9%) websites were of high quality. The mean SCDCC score was 20.60 (SD 22.14) out of 100. The interrater reliability for EQIP and SCDCC ratings was good (intraclass correlation: 0.718 and 0.897, respectively). No source of website scored significantly higher mean EQIP, FRE, FGL, or SCDCC scores than the others (all P<.05).
Conclusions: Although seeking health care information on the web is very common, the overall quality of information about transition in SCD care on the internet is poor. Changes to current web-based health care information regarding SCD care transitions would benefit transitioning youth by providing expectations, knowledge, skills, and tools to increase self-efficacy.

Keywords:   adulthood; EQIP; Ensuring Quality Information for Patients; FRE; Flesch Reading Ease; adolescent; health care information; health care service; health care transition; online information; online resource; quality; readability; sickle cell; sickle cell disease; transition; website quality

DOI:  https://doi.org/10.2196/48924
Int J Spine Surg. 2023 Dec 19. pii: 8566. [Epub ahead of print]

Quality Assessment of Degenerative Cervical Myelopathy Information on the Internet.

Leo Swee Liang Chong, Mark Zhu, Joseph Frederick Baker.

   BACKGROUND: Patient education is a key element of spinal surgery informed consent. Patients frequently access health information online, yet this information is unregulated and of variable quality. We aimed to assess the quality of information available on degenerative cervical myelopathy (DCM) websites with a focus on identifying high-quality information websites.
METHODS: We performed a Google search using keywords pertaining to DCM. The top 50 websites returned were classified based on their publication source, intended audience, and country of origin. The quality of these websites was assessed using both the DISCERN instrument and Journal of the American Medical Association (JAMA) benchmark criteria. We also utilized a novel Myelopathy Information Scoring Tool (MIST) to assess the comprehensiveness, accuracy, and detail of online DCM information.
RESULTS: The mean DISCERN score was 39.9 out of 80. Only one-quarter of these websites were rated "good" or "excellent" using DISCERN, and the remaining were rated "very poor," "poor," and "fair." The mean JAMA benchmark score was 1.6 out of 4, with 23 out of 50 websites scoring 0. Evaluation using MIST found a mean score of 25.6 out of 50. Using 30 points as a satisfactory MIST cutoff, 72% of DCM websites were deemed critically deficient and unsatisfactory for comprehensive patient education. Both DISCERN and MIST indicated poorest information pertaining to surgical risks and complications as well as treatment outcomes. Websites such as Orthoinfo.aaos.org and Myelopathy.org provided reliable, trustworthy, and comprehensive patient education.
CONCLUSIONS: Information available on almost three-quarters of DCM websites was of poor quality, with information regarding complications and treatment outcomes most deficient. Clinicians should be aware of quality sites where patients may be directed to augment patient education and surgical counseling.

Keywords:  consumer health information; internet; myelopathy; patient education; spinal cord compression

DOI:  https://doi.org/10.14444/8566
J Pediatr Ophthalmol Strabismus. 2023 Dec 19. 1-6

Quality, Reliability, Technical Quality, and Readability of Google Online Information on Childhood Glaucoma.

Abdelrahman M Elhusseiny, Amr K Hassan, Mohamed A Hassan, Taher K Eleiwa, Hossam T Ali, Salah Abdelnaem, Muhammad Z Chauhan, Omar Shaikh, Albert S Khouri, Ahmed B Sallam.

PURPOSE: To evaluate the quality, reliability, technical quality, and readability of online information related to childhood glaucoma.
METHODS: In this cross-sectional study, no human subjects were studied. Analysis was done for online websites on childhood glaucoma. The terms "childhood glaucoma," "pediatric glaucoma," "congenital glaucoma," "buphthalmos," and "big eyes" were entered into the Google search engine and the first 100 search results were assessed for quality, reliability, technical quality, and readability. Peer-reviewed articles, patient forum posts, dictionary definitions, and websites that appeared as targeted ads, were not in English, or were not focused on humans were excluded. Each website was evaluated for (1) quality and reliability using the DISCERN, HONcode, and JAMA criteria; (2) technical quality assessing 11 technical aspects; and (3) readability using six separate criteria (Flesch-Kincaid Reading Ease Score and Grade Level, Gunning Fog Index score, the Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index).
RESULTS: The median scores for the DISCERN, HONcode, and JAMA criteria were 2.6 (range = 1 to 4.75; 1 = worst, 5 = best), 10 (range = 0 to 16; 0 = worst, 16 = best), and 2 (range = 0 to 4; 0 = worst, 4 = best), respectively. The median technical quality score was 0.7. Readability was poor among most websites, with a median Flesch-Kincaid grade Grade Level Score of 9.3. The median Gunning Fog Index score was 9.8. There was a statistically significantly higher JAMA score and Gunning Fog Index score among the private websites compared to the institutional websites. However, institutional websites had higher technical quality.
CONCLUSIONS: Online information on childhood glaucoma had poor to moderate quality and reliability. The technical quality is good; however, most websites' readability was above the recommended 5th to 6th grade reading level. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

DOI: https://doi.org/10.3928/01913913-20231114-01
Cureus. 2023 Nov;15(11): e49118

YouTube as a Patient Information Source for Gastrointestinal Reflux Disease.

Veeramachaneni Naga Nyshita, Mahima Kuruvila, Swathi Galidevara, Akshay Sundaram, Shreya Sirohi, Mayank Singh.

  Introduction Gastroesophageal reflux disease (GERD) affects a substantial portion of the global population, resulting in significant morbidity and impacting the quality of life. YouTube (YouTube, San Bruno, California) serves as a platform where medical professionals, individuals with personal experiences, and educational channels share their insights on GERD. However, with the vast amount of information available on YouTube, the question of credibility and reliability is a concern and, thus, is crucial to evaluate. This research paper aims to explore the impact of YouTube as a source of information on GERD. The aim of this study is to assess the quality and reliability of the information on YouTube about GERD. Methodology This cross-sectional observational study was conducted in June 2023. A questionnaire was designed using Google Forms (Google, Mountain View, California) with predetermined criteria such as characteristics of YouTube videos (time since uploaded, uploader, number of likes and comments); information about GERD (symptoms, investigations, treatment); and quality and reliability of information on YouTube about GERD using Global Quality Scale (GQS) and Reliability score. The Kruskal-Wallis Test was used to evaluate the difference in quality and reliability of information about GERD on YouTube based on the type of uploader. Results Out of 90 videos analyzed, 68 YouTube videos on GERD that met inclusion criteria were included in the study. The number of videos uploaded by hospitals was 28 (41.2%), those by doctors was 12 (17.6%), and the remaining by others (like pharmacists, patients, and non-medical personnel) was 28 (41.2%). A significant proportion of videos (88.24%) shared information pertaining to disease symptoms and cause/etiology. The videos uploaded by "others" had significantly higher (p<0.05) reach as assessed by the Video Power Index (VPI) compared to those uploaded by doctors and hospitals. However, there was no significant difference (>0.05) in the quality and reliability of videos uploaded by doctors, hospitals, and other sources. Conclusion Although the YouTube videos uploaded by doctors and hospitals had less reach among viewers compared to other uploaders (patients, news agencies, pharmaceutical companies, and others unrelated to healthcare), the quality and reliability of videos uploaded by doctors, hospitals, and other uploaders were of good quality and reliability and with no significant difference based on type of uploader. Healthcare organizations and government agencies should ensure that viewers have access to accurate and reliable information from social media like YouTube, which is crucial in their health decision-making.

Keywords:  etiology; gastroesophageal reflux disease; gerd; patient information source; youtube

DOI:  https://doi.org/10.7759/cureus.49118
J Pediatr Adolesc Gynecol. 2023 Dec 18. pii: S1083-3188(23)00460-6. [Epub ahead of print]

An assessment of the quality of YouTube videos as a resource for adolescents experiencing abnormal uterine bleeding.

Ayşe Gül Güven, Melis Pehlivantürk Kızılkan, Medine Ayşin Taşar, Sinem Akgül.

   STUDY OBJECTIVE: YouTube, the largest accessible media-sharing platform, has become an important tool for pursuing health-related information. Adolescents may find it challenging to seek counseling or access adolescent-friendly services for menstruation-related problems, so YouTube may be a useful resource. This study aimed to examine the reliability, quality, and accuracy of YouTube videos concerning abnormal uterine bleeding (AUB) in adolescents.
METHODS: A YouTube search using the keywords ''adolescent, teens, heavy period, abnormal uterine bleeding, heavy menstrual bleeding'' yielded 109 videos. Video features (duration, time since upload, likes, views, comments), sources of upload, and content were recorded. All the videos were reviewed by two adolescent medicine specialists and scored using the Journal of the American Medical Association (JAMA), the five-point modified DISCERN, and the Global Quality Score (GQS).
RESULTS: Fifty-eight videos met the inclusion criteria. The majority (62.1%) were created by non-professionals, and a significant portion (81%) contained general descriptions. Based on the DISCERN classification, 50% exhibited poor quality. Similarly, the JAMA assessment indicated that only 36.2% satisfied the requirements for good quality. The videos uploaded by professionals exhibited notably superior quality in comparison to those uploaded by non-professionals. Additionally, higher-quality videos were longer (p=0.040) and more recent (p=0.011).
CONCLUSION: The majority of YouTube videos about adolescent AUB provide low-quality information. We believe that increasing the number of videos tailored by health care providers specializing in adolescent gynecology to address the specific physical and psychosocial needs of adolescents with menstrual problems would be beneficial.

Keywords:  Abnormal uterine bleeding; Adolescent; DISCERN; GQS; JAMA; YouTube

DOI:  https://doi.org/10.1016/j.jpag.2023.12.001
J Surg Res. 2023 Dec 21. pii: S0022-4804(23)00638-8. [Epub ahead of print]295 690-698

Critical Appraisal of Content Quality of YouTube Videos on the Whipple Pancreaticoduodenectomy.

Raja R Narayan, Haaris Kadri, Huda A Muhammad, Motaz Qadan.

   INTRODUCTION: The coronavirus pandemic has demonstrated profound issues with using the Internet to research health information. For patients recommended a complex operation, such as the Whipple pancreaticoduodenectomy, the quality of health information online has not been appraised. The objective of this study was to define the readability and content quality of YouTube search results for the Whipple pancreaticoduodenectomy.
METHODS: The first 100 search results for "whipple procedure" less than 10 min long in English with audio and or text were transcribed. The Flesch-Kincaid Grade defined the reading grade level. High content quality videos were accredited by YouTube in accordance with principles specified by the National Academy of Medicine or mentioned the standard components for a surgical consent. The Anderson-Lau score is a composite of these consent criteria out of a maximum of 8/8. The simplicity of videos for patient education was defined by the DISCERN tool.
RESULTS: The reading level of 23% of the top 100 search results met the American average (8th grade). Accreditation was present for 45% and associated with an earlier median search ranking (36 versus 68, P = 0.002) and more 5th-8th grade level material (70% versus 38%, P = 0.014). The median Anderson-Lau score was 3/8 (range = 0/8-7/8) with only 5% achieving 7/8. Only 4% were high quality per DISCERN.
CONCLUSIONS: Although accredited videos were more readable, most videos, especially those targeting patients, were beyond the comprehension of the average American. Simpler and higher quality educational materials are needed to inform patients on Whipple pancreaticoduodenectomy beyond their date of clinical diagnosis or surgical consenting.

Keywords:  Patient education; Surgical consent; Whipple pancreaticoduodenectomy

DOI:  https://doi.org/10.1016/j.jss.2023.11.066
Asian J Surg. 2023 Dec 19. pii: S1015-9584(23)01926-7. [Epub ahead of print]

Audience engagement and quality of online lumbar disc herniation-related videos in mainland China.

Chang Chen, Ge Chen, Yiran Yin, Xiao Zhong.

DOI: https://doi.org/10.1016/j.asjsur.2023.11.130
Urogynecology (Phila). 2023 Dec 20.

Third-Line Overactive Bladder Therapies on TikTok: What Does the Public Learn?

Alexandra L Tabakin, Sharon Choi, Arshia Sandozi, Kelli Aibel, Michael A Weintraub, Harvey A Winkler, Dara F Shalom, Justina Tam, Wai Lee.

IMPORTANCE: Millions of people rely on social media platforms, including TikTok, for health-related information. TikTok has not yet been evaluated as an information source for overactive bladder (OAB) third-line therapies.
OBJECTIVES: Our aim was to assess TikTok videos on third-line therapies for OAB for misinformation and quality.
STUDY DESIGN: In this cross-sectional analysis, we abstracted the top 50 TikTok videos for keywords: "Axonics," "sacral neuromodulation," "Interstim," "PTNS," "posterior tibial nerve stimulation," and "bladder Botox." Videos were scored for quality by 3 independent reviewers using the Medical Quality Video Evaluation Tool (MQ-VET). Two reviewers determined if videos contained misinformation.
RESULTS: Of 300 videos screened, 119 videos were included. Twenty-four (21%) were created by medical professionals (MPs). Medical professional videos were more frequently shared (5 vs 1, P < 0.01) but had similar views, likes, comments, and length. Although MP videos had significantly higher MQ-VET scores (43 vs 27, P < 0.01), there was no difference in the rate of misinformation between MP and non-MP videos (21% vs 18%). Twenty-two videos (18.4%) contained misinformation, which were 3 times longer (50.5 vs 15 seconds, P < 0.01) and had higher MQ-VET scores (34.5 vs 27, P = 0.03) than those without misinformation. Common themes of misinformation pertained to therapy indication, mechanism of action, and patient limitations after undergoing therapy.
CONCLUSIONS: Many TikTok videos on OAB third-line therapies contain misinformation. Most of these videos were not of high quality and created by the public. Medical professionals should be aware of misinformation permeating TikTok, given its large audience, and aim to promote or offer educational material of better accuracy and quality.

DOI: https://doi.org/10.1097/SPV.0000000000001431
Laryngoscope Investig Otolaryngol. 2023 Dec;8(6): 1685-1691

Evaluation of the quality of thyroidectomy-related posts on a video-based social media platform.

Yun J Kim, Matthew Lin, Ryan J Davis, Oluwatobiloba Ayo-Ajibola, Daniel Kwon, Kevin Hur.

   Objective: To evaluate the quality of thyroidectomy-related posts on TikTok, the fastest-growing social media platform worldwide.
Methods: Videos posted from April 2020 to September 2022 were queried on TikTok using the search terms "thyroidsurgery," "thyroidectomy," and "thyroidremoval." Two reviewers recorded thematic, demographic, and performance data of these posts. The DISCERN instrument was used to evaluate the quality and reliability of the information contained in the videos. Descriptive statistics were used to characterize post-submitter demographics and video content. Simple and multiple linear regression analyses were used to evaluate the association between DISCERN scores and video characteristics. Univariate analysis of variance was performed to compare DISCERN scores between author types.
Results: In this study, 228 TikTok videos were included which totaled over 23 million views. On average, each video accumulated more than 6000 "likes," 300 comments, and 70 shares. The average total DISCERN score was 27.46, which is deemed to be of poor overall quality. Upon multiple linear regression, video duration (β = 4.66, p < .001) and educational subject type (β = 3.97, p < .001) significantly positively predicted aggregate DISCERN scores, while journey subject type (β = -3.19, p = .006), and reassurance subject type (β = -2.52, p = .035) significantly negatively predicted aggregate DISCERN scores. Aggregate DISCERN scores varied significantly (p < .05) between author types.
Conclusion: Social media posts on TikTok about thyroidectomy are mostly of poor quality and reliability but vary by authorship, subject type, and video characteristics. Given its widespread popularity, TikTok videos may have an increasing role in shaping patient perception of thyroidectomy and may represent an opportunity to provide education.
Lay summary: TikTok posts about thyroidectomy are mostly of poor quality but vary by authorship, subject, and video characteristics. Given its popularity, TikTok videos may have a role in shaping the patient perception of thyroidectomy and may represent an opportunity to provide education.
Level of evidence: Level 4.

Keywords:  DISCERN; TikTok; social media; thyroidectomy

DOI:  https://doi.org/10.1002/lio2.1174
J Hand Surg Glob Online. 2023 Nov;5(6): 818-822

Patient-Directed Online Education for Carpal Tunnel Syndrome and Release: Analysis of What Patients Ask and Quality of Resources.

Shelby R Smith, Alexander Hodakowski, Johnathon R McCormick, Jonathan Spaan, John Streepy, Colton Mowers, Xavier Simcock.

   Purpose: This study classifies common questions searched by patients from the Google search engine and categorizes the types and quality of online education resources used by patients regarding carpal tunnel syndrome (CTS) and carpal tunnel release (CTR).
Methods: Google's results were extracted and compiled using the "People also ask" function for frequent questions and associated web pages for CTS and CTR. Questions were categorized using Rothwell's classification with further topic subcategorization. Web pages were evaluated by using Journal of the American Medical Association Benchmark Criteria for source quality.
Results: Of the 600 questions evaluated, "How do I know if I have carpal tunnel or tendonitis?" and "What causes carpal tunnel to flare up?" were the most commonly investigated questions for CTS. For CTR, frequent questions investigated included "How long after hand surgery can I drive" and "How do you wipe after carpal tunnel surgery." The most common questions for CTS by Rothwell classification were policy (51%), fact (41%), and value (8%) with the highest subcategories being indications/management (46%) and technical details (27%). For CTR, the most common questions entailed fact (54%), policy (34%), and value (11%) with the highest subcategories as technical details (31%) and indications/management (26%). The most common web pages were academic and medical practice. The mean Journal of the American Medical Association score for all 600 web pages was 1.43, with journals (mean = 3.91) having the highest score and legal (mean = 0.52) and single surgeon practice websites (mean = 0.28) having the lowest scores.
Conclusions: Patients frequently inquire online about etiology, precipitating factors, diagnostic criteria, and activity restrictions regarding CTS/CTR. Overall, the quality of online resources for this topic was poor, especially from single surgeon practices and legal websites.
Clinical relevance: Understanding the type and quality of information patients are accessing assists physicians in tailoring counseling to patient concerns and facilitates informed decision-making regarding CTS/CTR as well as guiding patients to high-quality online searches.

Keywords:  Carpal tunnel release; Carpal tunnel syndrome; Common questions; Education; Google; Online

DOI:  https://doi.org/10.1016/j.jhsg.2023.07.015
Digit Health. 2023 Jan-Dec;9:9 20552076231210663

Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review.

Giulia Ferraris, Dario Monzani, Veronica Coppini, Lorenzo Conti, Silvia Francesca Maria Pizzoli, Roberto Grasso, Gabriella Pravettoni.

  Objective: Disparities in cancer care contribute to higher rates of cancer mortality. Online health information would be a resource for cancer patients to obtain knowledge and make health decisions. However, factors that hinder or facilitate online searching behaviours among patients remain unexplored. The current systematic review aims to identify and synthesise evidence of cancer patients' barriers to and facilitators of online health information-seeking behaviours. Methods: Electronic databases (PubMed, EMBASE, Scopus) were systematically searched, and a total of 123 full-text studies were reviewed of which 24 met the inclusion criteria. Results: Thematic analysis was performed to identify barriers and facilitators of online health information-seeking behaviours. Seven key themes were identified: (1) socio-demographic characteristics (age, gender, education, income, ethnicity and language), (2) psychosocial aspects (psychological wellbeing, need for a face to face contact, motivation, support), (3) accessibility (Internet access, residence), (4) quality and quantity of information (amount, reliability), (5) cancer stage and symptoms (time since diagnosis, experiencing symptoms), (6) aspects related to healthcare professionals (relationship with the patients and opinions on online health information) and (7) digital literacy (computer skills and literacy). Conclusions: Findings underscore the significance of recognising the multifaceted nature of barriers and facilitators affecting cancer patients' online health information-seeking behaviours. A strong link between these factors and cancer patients' ability to make informed decisions and cope effectively with their diagnosis emerged. Consequently, addressing these barriers and leveraging the identified facilitators could lead to improvements in patient-centred care, ultimately contributing to better healthcare services and informed decision-making for cancer patients. Future research should prioritise exploring strategies for enhancing cancer care accessibility across all stakeholders involved.
Registration: CRD42023408091.

Keywords:  Internet; Online health information-seeking behaviours; barrier; cancer; digital divide; facilitator

DOI:  https://doi.org/10.1177/20552076231210663
Cureus. 2023 Nov;15(11): e49090

Do Electronic Health Literacy and Online Health Information-Seeking Behavior Mediate the Effects of Socio-Demographic Factors on COVID-19- and Non-communicable Disease-Related Behaviors Among Myanmar Migrants in Southern Thailand?

Hein Htet, Wit Wichaidit, Hutcha Sriplung, Kyaw Ko Ko Htet, Aungkana Chuaychai, Tida Sottiyotin, Virasakdi Chongsuvivatwong.

  Introduction Myanmar migrants in Thailand are vulnerable to COVID-19 and non-communicable disease (NCD) risk behaviors, influenced by socio-demographic factors. In the digital age, migrants can seek extensive health information online, and their ability to understand and use electronic health information, which is known as electronic health literacy (e-Health literacy), becomes critical in making decisions about their health behaviors. This study aims to investigate the potential mediating roles of online health information-seeking and e-Health literacy in the associations between socio-demographic factors and COVID-19- and NCD-related behaviors. Methods Our study was conducted in 2022, involving 1,050 Myanmar migrants in two southern Thai cities. Data on socio-demographic factors, e-Health literacy, online health information seeking, COVID-19-related behaviors (adherence to COVID-19 protective behavior (CPB), vaccination), and NCD risk behaviors (smoking, betel chewing, alcohol consumption, substance abuse) were collected. Structural equation modeling (SEM) was employed to analyze the hypothesized relationships. Results Nearly all migrants received the COVID-19 vaccination in two doses and above, with reasonable good adherence to CPB. Migrants exhibited risky NCD-related behaviors, including current smoking (26.8%), alcohol consumption (17.5%), and betel chewing (25.8%). Approximately three-quarters (73.4%) had a limited e-Health literacy level, and the vast majority did not search for online health information. Their COVID-19- and NCD-related behaviors were directly influenced by socio-demographic factors without the significant mediation roles of e-Health literacy and online health information seeking. Conclusions Myanmar migrant workers in Southern Thailand had reasonably good practices in COVID-19-related behaviors despite engaging in risky NCD-related behaviors. These outcome behaviors were directly influenced by their socio-demographic factors, without the significant mediation roles of e-Health literacy and online health information seeking. The findings suggest that diverse interventions beyond e-Health strategies for future pandemic mitigation and enhancement of their health behaviors are needed.

Keywords:  covid-19; electronic health literacy; myanmar migrants; non-communicable disease; online health information-seeking; socio-demographic factors

DOI:  https://doi.org/10.7759/cureus.49090