Developing an eHealth Tutorial for Older Adults to Use Online Health Resources

摘要 65岁以上的老年人在美国所有成年人年龄组中的健康素养水平最低： 3%的美国老年人拥有熟练的健康知识。1由于信息和通信技术 越来越多地用于医疗保健，2，3在医疗保健方面使用技术的能力已经开始 4 -10老年人的健康知识普及率是老年人的两倍， 在电子健康时代的危险，因为他们往往不仅有低健康素养，而且低技术 11，12如果没有有效的干预措施，老年人可能无法充分利用这项技术。 在这项R21研究中，我们建议开发、完善和试点测试一种创新的 改善老年人的电子健康素养。这种干预的关键是一个综合的电子健康教程 其特点是在一个实际的健康信息网站上添加了一个教学覆盖层。电子健康的发展 教程是由在线叠加演示器（OnTOP），一个新颖的计算机程序，建立在 视觉识别技术的最新发展，并使教程的发展，可以减少 对学习者认知能力的要求。这个项目扩展了我们以前在老年人学习方面的工作， 使用技术，17-36设计高级友好技术，37-41新颖的机器视觉算法，使 计算机识别用户界面呈现的视觉图像，42-45我们对老年人的试点研究 使用OnTOP，38，46和我们最近开发的一个简短的电子健康教程的设计功能的偏好 对老年人电子卫生知识干预文献进行了系统回顾，发现缺乏 以理论为基础的干预措施，很少有研究采用高质量的研究设计。 ·目标1：为老年人开发一个友好的、理论驱动的交互式多媒体电子健康教程， 访问、评估和使用互联网上的可靠健康信息; 目标2：确定老年人使用本教程提高其电子健康素养的可行性。 为了实现具体目标1，我们将招募8-10名老年人参加咨询委员会， 在整个设计过程中，每月与他们会面，收集设计想法，以指导我们的设计 电子健康教程。为了解决具体目标2，我们将使用随机对照进行可行性研究 分组设计，包括前后测。我们将招募100名老年人（65岁以上）参加这一部分， 该研究确保有足够的统计把握度（.80）在.05水平检测0.25的效应量，即使在 考虑到15%的流失率。参与者将被随机分配到一个干预组， 一组通过我们的电子健康教程学习，或一个对照组通过现有的NIA学习 51 R21项目意义重大，因为它解决了电子卫生文盲的重要问题。 老年人口。这个项目是创新的，因为我们的干预功能使用国家的最先进的视觉 识别技术，以便为老年人开发综合电子健康教程。

Abstract Older adults age 65+ have the lowest health literacy levels of all adult age groups in the United States: only 3% of older Americans have proficient health literacy.1 As information and communication technologies are increasingly used in health care,2,3 the ability to use technology in the health care context has begun to be integrated into recent conceptualization and measurement of health literacy.4-10 Older adults are in double jeopardy in the eHealth era because they tend to have not only low health literacy but also low technology literacy.11,12 Without effective interventions, older adults are likely unable to make use of the technology's full potential to improve health.13,14 In this R21 study, we propose to develop, refine, and pilot test an innovative intervention for improving older adults' eHealth literacy. Key to this intervention is an integrated eHealth tutorial featuring an instructional overlay added onto an actual health information website. Development of this eHealth tutorial is enabled by the Online Tutorial Overlay Presenter (OnTOP), a novel computer program that builds on recent developments in visual recognition technology and enables the development of tutorials that can reduce the demand on learners' cognitive abilities. This project expands our prior work on older adults' learning and use of technology,17-36 design of senior-friendly technology,37-41 novel machine vision algorithms that enable computers to recognize the visual images presented by user interfaces,42-45 our pilot studies on older adults' preferences for design features of a brief eHealth tutorial developed using OnTOP,38, 46 and our recent systematic review of the literature on eHealth literacy interventions for older adults, which found a lack of theory-based interventions with few studies applying high-quality research design.47 Specific Aims are: · Aim 1: To develop a senior-friendly, theory-driven interactive multimedia eHealth tutorial for accessing, assessing, and using reliable health information on the Internet; · Aim 2: To determine the feasibility of older adults using this tutorial to improve their eHealth literacy. To address Specific Aim 1, we will recruit 8-10 older adults to participate in an Advisory Committee and will meet with them monthly throughout the design process to gather design ideas to guide the design of our eHealth tutorial. To address Specific Aim 2, we will conduct a feasibility study using a randomized control group design involving pre- and posttest. We will recruit 100 older adults (age 65+) to participate in this part of the study to ensure sufficient statistical power (.80) to detect an effect size of 0.25 at the .05 level, even after taking into account an attrition rate of 15%. Participants will be randomly assigned to either an intervention group featuring learning with our eHealth tutorial, or a control group featuring learning with an existing NIA tutorial.51 This R21 project is significant because it addresses the important problem of eHealth illiteracy in the older population. This project is innovative because our intervention features the use of state-of-the-art visual recognition technology to enable the development of an integrated eHealth tutorial for older adults.