Effectiveness of Theory-Based Interventions in E-health Literacy Improvement: Protocol for a Systematic Review

Abstract

Abstract
Abstract
Background: Internet and electronic health (e-health) literacy is a very important skill for the adoption and use of electronic health services, especially for older adults when they are suffering from numerous diseases or health problems. This is a protocol for a systematic review of interventional studies to evaluate the applied theory-based strategies and manipulations on e-health literacy improvement programs for older adults.
Methods: A comprehensive literature search of MEDLINE®, Cochrane Library, ProQuest, and EMBASE will be conducted for studies that included old people, described a theory-based intervention study, aimed improving e-health literacy, described an outcome measure related to improving e-health literacy and was written in English for the timeframe 2008–2018. The authors will screen the papers first by title and abstract, and then by full-text, and independently assess studies for inclusion and extracting data. The primary outcome will be theory-based interventions that have somehow helped improve older adults' e-health literacy. Results will be submitted for publication in a peer-reviewed journal.
Discussion: This systematic review will summarize the evidence for the effectiveness of theory-based interventions for improving older adults' e-health literacy. This knowledge is important for healthcare providers and researchers in designing effective interventions aimed at e-health literacy improvement.

Methods: A comprehensive literature search of MEDLINE®, Cochrane Library, ProQuest, and EMBASE will be conducted for studies that included old people, described a theory-based intervention study, aimed improving e-health literacy, described an outcome measure related to improving e-health literacy and was written in English for the timeframe 2008–2018. The authors will screen the papers first by title and abstract, and then by full-text, and independently assess studies for inclusion and extracting data. The primary outcome will be theory-based interventions that have somehow helped improve older adults' e-health literacy. Results will be submitted for publication in a peer-reviewed journal.
Discussion: This systematic review will summarize the evidence for the effectiveness of theory-based interventions for improving older adults' e-health literacy. This knowledge is important for healthcare providers and researchers in designing effective interventions aimed at e-health literacy improvement.

Full text

This is an unpublished work about the protocol of a systematic review
Effectiveness of Theory-Based Interventions in E-health Literacy Improvement: Protocol
for a Systematic Review
Sara Pourrazavi
PhD candidate of Health Education & Promotion Department, Tabriz University of Medical Sciences,
Tabriz, Iran
Abstract
Background: Internet and electronic health (e-health) literacy is a very important skill for the
adoption and use of electronic health services, especially for older adults when they are suffering
from numerous diseases or health problems. This is a protocol for a systematic review of
interventional studies to evaluate the applied theory-based strategies and manipulations on e-health
literacy improvement programs for older adults.
Methods: A comprehensive literature search of MEDLINE®, Cochrane Library, ProQuest, and
EMBASE will be conducted for studies that included old people, described a theory-based
intervention study, aimed improving e-health literacy, described an outcome measure related to
improving e-health literacy and was written in English for the timeframe 2008–2018. The authors
will screen the papers first by title and abstract, and then by full-text, and independently assess
studies for inclusion and extracting data. The primary outcome will be theory-based interventions
that have somehow helped improve older adults' e-health literacy. Results will be submitted for
publication in a peer-reviewed journal.

This is an unpublished work about the protocol of a systematic review
Discussion: This systematic review will summarize the evidence for the effectiveness of theory-
based interventions for improving older adults' e-health literacy. This knowledge is important for
healthcare providers and researchers in designing effective interventions aimed at e-health literacy
improvement.
Introduction
Nowadays, the Internet is an influential element in our lives and it has changed our lifestyle
and learning procedures (Sadiku, Shadare, & Musa, 2016). The Internet can be an important source
of information for its users (A. E. Anker, A. M. Reinhart, & T. H. Feeley, 2011; Chew & Yuqian,
2015a; Sadiku et al., 2016). Accessing the Internet plays a significant role in people’s health-
seeking behavior, interaction, and communication with healthcare providers, treatment
compliance, self-care, and healthcare decision-making (Dutta-Bergman, 2004; Fox & Duggan,
2013; Kivits, 2009).
Computer skill and internet literacy are main skills for e-health literacy (C. Norman & H.
Skinner, 2006) and e-health literacy is known as an essential issue in the health related fields (Pohl,
Griebe, & Trill, 2015). In health education, these skills are important for the prevention,
maintenance, and promotion of health, especially for older adults (Xie, 2012b). E-health literacy
interventions have shown encouraging results in increasing the ability of the elderly to manage
their health and daily activities (Korda & Itani, 2013 ; Segal et al., 2012). However, they are under-
utilized in health promotion and disease prevention programs, which are designed for the elderly
population (Fox & Madden, 2005).

This is an unpublished work about the protocol of a systematic review
It is postulated that applying theory-based manipulations can increase the effectiveness of
interventional programs for better implementation of health promotion programs (Glanz , Rimer ,
& Viswanath 2008). However, little is known about the application, function, and effectiveness of
theory-based interventions focusing on improving e-health literacy in elderly population.
In accordance with the above-mentioned background, it would be useful to evaluate and
criticize the interventions that were conducted using the theoretical framework and examine their
applied methodology for designing effective programs of elderly e-health literacy improvement.
This is a protocol for a systematic review aimed at evaluating theory-based interventions on e-
health literacy of older adults done over the past ten years.
Methods/design
The objective of this article is to describe the protocol for this systematic review according
to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P)
(Moher et al., 2015).
Eligibility criteria
Studies will be selected according to the criteria described as follows.
Types of studies
Randomized and non-Randomized intervention study will be included.
Types of participants
Only studies that have involved the elderly (60 years and older) as the intervention group's
subjects will be included.
Types of interventions

This is an unpublished work about the protocol of a systematic review
The studies were delimited to those in which the theoretical framework had been explicitly
named, referenced, and used. The theory was defined as a set of analytical principles or statements,
including defined variables, a domain to which the theory applies, and a set of relationships
between the variables and specific predictions (Nilsen, 2015). Theory-informed frameworks or
models will also be considered.
Comparisons
We will not consider any other intervention for comparison.
Outcome
Outcomes will be any reported impact of the theory-based interventions on the improvement
of e-health literacy. In addition to the studies that have directly addressed e-health literacy
improvement, we will also include studies that have attempted to improve information literacy,
media literacy, and computer literacy as components of e-health literacy (C. D. Norman & H. A.
Skinner, 2006).
Time
All articles published between 2008 and 2018 will be considered.
Setting
There will be no restrictions based on the type of setting.
Search strategies
A comprehensive search for relevant randomized and non-randomized interventions will be
performed between October and November 2018 in the following electronic bibliographic
databases: Medline via PubMed, Cochrane Library, ProQuest, and EMBASE. A research librarian

This is an unpublished work about the protocol of a systematic review
with expertise in search strategies for systematic reviews will further help develop the search based
on the following domains using Medical Subject Headings (MeSH) where possible "e-Health
literacy" OR "internet-based health information" OR "telehealth literacy" OR mobile health
literacy" OR "electronic health literacy" OR "internet health information " OR "computer literacy"
OR "online health information literacy" OR "online health information seeking" OR "web-based
health information" AND "old* adult*" OR "old people" OR "senior*" OR "elder*" OR "aging"
OR "ageing" OR "babyboomer*" OR "retiree*" OR "aged" OR "pensioner" AND "theory" OR
"theories" OR "theoretical framework" OR "model" OR "theory-driven approach" OR "theoretical
study" OR "theoretical model".
Reference lists of previous reviews and included papers will be searched to check for any
further trials. The flow of results generated and reasons for exclusion will be presented in the
PRISMA flow chart (Liberati et al., 2009).
Data collection and analysis
Relevant records will be screened through a two-stage process. In the first stage, titles and
abstracts will be screened by two investigators. Irrelevant studies (according to the eligibility
criteria listed above) will be excluded. In the second stage, two investigators will examine the
remaining full-text reports for concordance with the inclusion criteria.
Data extraction and management
Two authors will independently extract the data using a structured form. Any discrepancies
in the data extraction or inclusion/exclusion of trials will be resolved by referring to the original
papers. The authors will not be blinded to article results, authors, or institutions. In addition to
outcomes, data extraction will include information about the author(s), year of publication, country

This is an unpublished work about the protocol of a systematic review
of origin, number of participants, demographic information of participants (age and sex),
intervention (design, theoretical framework, materials), and outcome measure. The results will be
presented in a detailed summary of findings table.
Discussion
Computer-based e-health literacy has the potential to remove barriers to accessing and
delivery of care services (Xie, 2012a). Electronic content within the scope of health sciences could
provide an overwhelming supply of indispensable knowledge for those who are in pursuit of
information for better decision making alternatives (A. E Anker, A. M Reinhart, & T. H Feeley,
2011; Chew & Yuqian, 2015b). The innate facet of e-health literacy for older adults, especially
those with multiple chronic conditions, physical limitations, and those who live alone, could be
impressive in daily life (Christmann, 2005; Taha, Sharit, & Czaja, 2009; Tse, Choi, & Leung,
2008). Older adults, generally due to physical limitations and constraints in attending face to face
educational meetings, not only benefit directly from the competence but the positive consequence
can even be incremental for their families and the whole community (Tse et al., 2008). However,
diversity of e-health literacy level across the countries and even inside geographical regions
created major challenges for healthcare providers and e-content developers (Ruggeri, Farrington,
& Brayne, 2013).
An appropriate and effective exploration of e-health content requires some basic computer
skills including how to operate and maintain a computer, i.e., computer literacy (Norman &
Skinner, 2006). However, given the variety of e-health information for different types of users,
ability of searching, finding and understanding these types of information are considered
preliminary skills for becoming self-reliant (Childs, 2005). Hence, those individuals who have not
adequate amount of the basic skills will face dilemma in managing their healthcare needs compared

This is an unpublished work about the protocol of a systematic review
to their computer savvy counterparts (Campbell & Nolfi, 2005; Korda & Itani, 2013; Segal et al.,
2012).
During the last three decades, theory-based interventions have moved health promotion field
toward achieving successful and efficacious results (Glanz, Rimer, & Viswanath, 2008; Michie,
Johnston, Francis, Hardeman, & Eccles, 2008). However, little is known about the application and
outcomes of theory-based e-health literacy interventions in the adult populations. In this systematic
review, it is expected that we will be able to identify those theoretical constructs which can help
to design effective programs to e-health literacy improvement.
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