JMIR Publications

ABSTRACT

Background:

Older adults tend to have insufficient health literacy, which includes eHealth literacy—the ability to access, assess, and use digital health information. Interventions based on lifelong learning methods like collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults’ low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults’ eHealth literacy in informal settings.

Objective:

The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults’ learning with CL versus IL for eHealth literacy.

Methods:

Older adults (N = 466; age range, 60–96 years; M = 70.5; SD = 7.2) from diverse racial/ethnic groups were randomly assigned to either the CL or the IL group (n = 233 in each). The instructional task consisted of 4 weeks of training in 2-hour sessions held twice a week. Using analysis of variance and multiple regression, we focused primarily on the main effects of learning condition and the interaction of learning condition and prior computer experience. Learning method (CL, LL) and prior computer experience (experienced, new, mixed) were between-subjects variables; time of measurement (pretest, posttest, 6 months follow-up) was the within-subjects variable. Primary outcome variables were eHealth literacy efficacy, computer/web knowledge, basic computer/web operation skills, information-seeking skills, and website evaluation skills; control variables were age, gender, education, health status, race/ethnicity, income, primary language, and prior health literacy.

Results:

From pre- to postintervention, eHealth literacy efficacy, computer/web knowledge, basic computer/web operation skills, information-seeking skills, and website evaluation skills improved significantly (P < .001 in all cases). From postintervention to 6 months follow-up, there was a significant interaction between learning condition and prior computer experience based on one outcome measure, computer/web operation skills (F2,55 = 3.69, P = .03). To maintain computer/web operation skills 6 months postintervention, it was more effective for people with little to no prior computer experience to learn individually, whereas for people with more prior computer experience, it was more effective to learn collaboratively. From postintervention to 6 months follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer/web knowledge, and basic computer/web operation skills (P < .001 for all 3 cases). Decreases for information-seeking skills and website evaluation skills were not statistically significant.

Conclusions:

Older adults’ eHealth literacy can be improved regardless of CL or IL method. Prior computer experience is an important factor to consider when choosing a learning method. eHealth literacy may be multidimensional, with some components retained better than others over time. These findings suggest a need for resources to provide continuous training or periodic retraining.