Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Jul 8, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Role of eHealth Literacy in an Online Self-Management Program for Canadians with Spinal Cord Injury: A Mixed-Methods Sequential Explanatory Study
ABSTRACT
Background:
People with a spinal cord injury (SCI) have significant and diverse needs for information to manage many aspects of their health. Unfortunately, people with SCI may leave inpatient stays still lacking necessary health information. Many turn to the internet to fill the gaps. However, locating, validating and applying electronically sourced health information requires significant digital health (or “eHealth”) literacy skills. Competence in such literacy is shaped by broad social, economic, and accessibility related factors, as well as personal knowledge and experience. The research presented here aims to identify and characterize eHealth literacy (EHL) skills among people living in Canada with SCI in a peer-led health coaching study.
Objective:
We aim to 1) quantitatively assess the impact of a peer-led health coaching program for Canadian residents with SCI on digital health literacy, and 2) qualitatively explore processes associated with change in eHealth literacy among a subset of individuals enrolled in the study.
Methods:
A mixed-methods sequential explanatory study consisting of a 1) multivariate (ANCOVA) analysis of self-reported measures of EHL, health-related self-efficacy and associated demographic variables among individuals enrolled in a peer health coaching study and 2) in-depth interviews of selected participants, purposively chosen to capture variation in baseline eHealth Literacy scores.
Results:
A positive and significant effect on EHL was found to be present after 12 months as reflected in a mean post-intervention increase in score of 2.55 points among participants. Qualitative results helped investigators clarify participants’ understanding of digital health literacy, capture changes in digital information use resulting from the COVID-19 pandemic and identify relational and structural factors influencing participants’ engagement with online health information. Participants described the importance of trusted peer support in navigating overwhelming, complex, or conflicting health information online.
Conclusions:
Participation in a peer led self-management program for people living with SCI in Canada was associated with positive and significant changes in EHL. Trained peer health coaches (PHCs) served as trusted information navigators who promoted active, critical engagement with online information, something which was particularly valued during the COVID-19 pandemic. Clinical Trial: ClinicalTrials.gov NCT04474171
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