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eHealth literacy and its association with demographic-, disease-specific factors and well-being among adults with type 1 diabetes: a cross-sectional survey study.
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-6116-3848
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-8709-342X
Department of Health Promoting Science, Sophiahemmet University.ORCID iD: 0000-0003-3309-136X
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-6245-1788
2025 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 10, article id e66117Article in journal (Refereed) Published
Abstract [en]

Background: The use of digital health technology in diabetes self-care is increasing, making eHealth literacy an importantfactor to consider among people with type 1 diabetes. There are very few studies investigating eHealth literacy among adultswith type 1 diabetes, highlighting the need to explore this area further.Objective: The aim of this study was to explore associations between eHealth literacy and demographic factors, disease-specific factors, and well-being among adults with type 1 diabetes.Methods: The study used data from a larger cross-sectional survey conducted among adults with type 1 diabetes in Sweden(N=301). Participants were recruited using a convenience sampling method primarily through advertisements on social media.Data were collected between September and November 2022 primarily through a web-based survey, although participantscould opt to answer a paper-based survey. Screening questions at the beginning of the survey determined eligibility toparticipate. In this study, eHealth literacy was assessed using the Swedish version of the eHealth Literacy Scale (Sw-eHEALS).The predictor variables, well-being was assessed using the World Health Organization-5 Well-Being Index and psychosocialself-efficacy using the Swedish version of the Diabetes Empowerment Scale. The survey also included research group–developed questions on demographic and disease-specific variables as well as digital health technology use. Data wereanalyzed using multiple linear regression presented as nested models. A sample size of 270 participants was required in orderto detect an association between the dependent and predictor variables using a regression model based on an F test. The finalsample size included in the nested regression model was 285.Results: The mean Sw-eHEALS score was 33.42 (SD 5.32; range 8‐40). The model involving both demographic anddisease-specific variables explained 31.5% of the total variation in eHealth literacy and was deemed the best-fitting model.Younger age (P=.01; B=–0.07, SE=0.03;95% CI –0.12 to –0.02), lower self-reported glycated hemoglobin levels (P=.04; B=–0.06, SE=0.03; 95% CI –0.12 to 0.00), and higher psychosocial self-efficacy (P<.001; B=3.72, SE=0.53; 95% CI 2.68-4.75)were found associated with higher Sw-eHEALS scores when adjusted for demographic and disease-specific variables in thismodel. Well-being was not associated with eHealth literacy in this study.Conclusions: The demographic and disease-specific factors explained the variation in eHealth literacy in this sample. Furtherstudies in this area using newer eHealth literacy tools are important to validate our findings. The study highlights theimportance of development and testing of interventions to improve eHealth literacy in this population for better glucosecontrol. These eHealth literacy interventions should be tailored to meet the needs of people in varying age groups and withdiffering levels of psychosocial self-efficacy.

Place, publisher, year, edition, pages
JMIR Publications, 2025. Vol. 10, article id e66117
Keywords [en]
cross-sectional studies; diabetes mellitus, type 1; digital technology; eHealth literacy; health literacy
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-103299DOI: 10.2196/66117ISI: 001464117300001Scopus ID: 2-s2.0-105001963172OAI: oai:DiVA.org:kau-103299DiVA, id: diva2:1939159
Projects
DHINO - Digital hälsoinnovationDWA - DigitalWell Arena
Funder
Karlstad UniversityRegion VärmlandSophiahemmet University
Note

This paper was included as a manuscript in the doctoral thesis entitled "cross-sectional studies; diabetes mellitus, type 1; digital technology; eHealth literacy; health literacy", KUS 2025:13. 

Available from: 2025-02-20 Created: 2025-02-20 Last updated: 2025-11-07Bibliographically approved
In thesis
1. Digital health technology for supporting diabetes self-care: Perspectives among adults with type 1 diabetes
Open this publication in new window or tab >>Digital health technology for supporting diabetes self-care: Perspectives among adults with type 1 diabetes
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to examine currently available evidence on selected digital health technology (DHT) for diabetes self-care support, explore people's experiences with their use for diabetes self-care, and identify relationships between DHT use and psychosocial self-efficacy, eHealth literacy, and other selected variables among adults with type 1 diabetes (T1D).

Methods: In this thesis, an integrative review methodology, along with cross-sectional and qualitative designs, was used to explore perspectives on DHT support for diabetes self-care. The population in focus in all four studies was adults (≥ 18years) with T1D. Outcome measures examined features of mobile health applications (mHealth apps) that promote diabetes self-care, factors affecting mHealth app use in diabetes self-care, reported changes in PROMs in literature, psychosocial self-efficacy, eHealth literacy, and experiences with using DHT for diabetes self-care. 

Main results: The integrative review was inconclusive due to the limited number and heterogeneity of studies reporting on perceptions of mHealth apps. Higher psychosocial self-efficacy was associated with higher well-being and lower HbA1c. Higher eHealth literacy was associated with younger age, higher psychosocial self-efficacy, and lower HbA1c. Using DHTs in diabetes self-care was experienced as empowering yet exasperating.

Conclusion: This thesis showed the importance of measuring psychosocial self-efficacy and eHealth literacy among adults with T1D using DHTs. People described feeling empowered by DHTs. However, there is a need for measures to support people facing exasperating experiences while using DHTs. This is important in improving DHT use and glucose control in this population. This thesis indicates a need for further research in this area.

Abstract [en]

Type 1 diabetes is a chronic illness, and diabetes self-care measures play a crucial role in disease management. Well-designed digital health technologies (DHTs) can support diabetes self-care, however, their use can be challenging. This thesis explores perspectives on DHT support for diabetes self-care among adults with type 1 diabetes. 

In this thesis, higher psychosocial self-efficacy has been associated with higher well-being scores and better glucose control. In addition, younger age, higher psychosocial self-efficacy, and better glucose control have been associated with higher eHealth literacy. Participants experienced DHTs in diabetes self-care as empowering yet exasperating. The exasperating experiences may contribute to digital health inequities and are therefore important to address. This thesis showed the importance of measuring psychosocial self-efficacy and eHealth literacy among adults with type 1 diabetes using DHTs. More studies in this area among adults with type 1 diabetes is required.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2025. p. 85
Series
Karlstad University Studies, ISSN 1403-8099 ; 2025:13
Keywords
Diabetes type 1, Digital technology, eHealth literacy, Experiences, Patient reported outcome measures, Self efficacy, Self-care, Self-management
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-103303 (URN)10.59217/opqb6593 (DOI)978-91-7867-558-6 (ISBN)978-91-7867-559-3 (ISBN)
Public defence
2025-04-11, Frödingsalen, 1B364, karlstads Universitet, Karlstad, 09:00 (English)
Opponent
Supervisors
Available from: 2025-03-21 Created: 2025-02-21 Last updated: 2025-10-16Bibliographically approved

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Stephen, Divya AnnaNordin, AnnaNilsson, Jan

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