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Open Access 18-12-2024 | Digital Health | Original Research

Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany

Authors: Chen-Chia Pan, Karina Karolina De Santis, Saskia Muellmann, Stephanie Hoffmann, Jacob Spallek, Nuria Pedros Barnils, Wolfgang Ahrens, Hajo Zeeb, Benjamin Schüz

Published in: Journal of Prevention

Abstract

Background

Wearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context.

Objective

This study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator.

Methods

A cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use.

Results

Overall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1–2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18–40: 36%; 41–64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18–40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41–64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001).

Conclusions

This study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

Allen, J., Born, S., Damerow, S., Kuhnert, R., Lemcke, J., Müller, A., Weihrauch, T., & Wetzstein, M. (2021). German Health Update (GEDA 2019/2020-EHIS) - Background and methodology. Journal of health monitoring, 6(3), 66–79. https://doi.org/10.25646/8559CrossRefPubMedPubMedCentral

Brannon, E., Cushing, C., Crick, C., & Mitchell, T. (2016). The promise of wearable sensors and ecological momentary assessment measures for dynamical systems modeling in adolescents: a feasibility and acceptability study. Translational Behavioral Medicine, 6(4), 558–565. https://doi.org/10.1007/s13142-016-0442-4CrossRefPubMedPubMedCentral

Brickwood, K. J., Watson, G., O’Brien, J., & Williams, A. D. (2019). Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth, 7(4), e11819. https://doi.org/10.2196/11819CrossRefPubMedPubMedCentral

Bundesinstitut für Bau- Stadt- und Raumforschung (2021). Stadt- und Gemeindetypen in Deutschland. Bundesamt für Bauwesen und Raumordnung. https://www.bbsr.bund.de/BBSR/DE/forschung/raumbeobachtung/Raumabgrenzungen/deutschland/gemeinden/StadtGemeindetyp/StadtGemeindetyp.html#doc2779036bodyText1

Canali, S., Schiaffonati, V., & Aliverti, A. (2022). Challenges and recommendations for wearable devices in digital health: Data quality, interoperability, health equity, fairness. PLOS Digit Health, 1(10), e0000104. https://doi.org/10.1371/journal.pdig.0000104CrossRefPubMedPubMedCentral

Cheng, C., Beauchamp, A., Elsworth, G. R., & Osborne, R. H. (2020). Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. Journal Of Medical Internet Research, 22(8), e18476. https://doi.org/10.2196/18476CrossRefPubMedPubMedCentral

R Core Team (2021). R: a language and environment for statistical computing (Version 4.1) [Computer software]. https://cran.r-project.org

De Main, A. S., Xie, B., Shiroma, K., Yeh, T., Davis, N., & Han, X. (2022). Assessing the Effects of eHealth Tutorials on Older Adults’ eHealth Literacy. Journal of Applied Gerontology, 41(7), 1675–1685. https://doi.org/10.1177/07334648221088281CrossRefPubMedPubMedCentral

De Santis, K. K. M., Saskia, Haug, U., & Zeeb, H. (2022). Digitization and health in Germany: Protocol for a second cross-sectional nationwide survey. OSF. https://osf.io/phqd4/

De Santis, K. K., Muellmann, S., Pan, C. C., Hoffmann, S., Spallek, J., Haug, U., & Zeeb, H. (2024). Digitisation and health: Second nationwide survey of internet users in Germany. Digital Health, 10. https://doi.org/10.1177/20552076241301457

Dhingra, L. S., Aminorroaya, A., Oikonomou, E. K., Nargesi, A. A., Wilson, F. P., Krumholz, H. M., & Khera, R. (2023). Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020. JAMA Network Open, 6(6), e2316634–e2316634. https://doi.org/10.1001/jamanetworkopen.2023.16634CrossRefPubMedPubMedCentral

Estrela, M., Semedo, G., Roque, F., Ferreira, P. L., & Herdeiro, M. T. (2023). Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis. International Journal of Medical Informatics, 177, 105124. https://doi.org/10.1016/j.ijmedinf.2023.105124CrossRefPubMed

Eurostat (2023). Digitalisation in Europe. European Union. https://ec.europa.eu/eurostat/en/web/interactive-publications/digitalisation-2023

Fang, Z., Liu, Y., Jiang, F., & Dong, W. (2023). How does family support influence digital immigrants’ extended use of smartphones? An empirical study based on IT identity theory. Journal of the Association for Information Science and Technology, 74(12), 1463–1481. https://doi.org/10.1002/asi.24747CrossRef

Federal Ministry of Education and Research - BMBF. (2016). ISCED 2011 – International Standard Classification of Education. Federal Ministry of Education and Research - BMBF. https://www.datenportal.bmbf.de/portal/en/G294.html

Friemel, T. N. (2014). The digital divide has grown old: Determinants of a digital divide among seniors. New Media & Society, 18(2), 313–331. https://doi.org/10.1177/1461444814538648CrossRef

Hoffmann, S., Tschorn, M., Michalski, N., Hoebel, J., Förstner, B. R., Rapp, M. A., & Spallek, J. (2022). Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany. Health & Place, 75, 102794. https://doi.org/10.1016/j.healthplace.2022.102794CrossRef

Huhn, S., Axt, M., Gunga, H. C., Maggioni, M. A., Munga, S., Obor, D., Sié, A., Boudo, V., Bunker, A., Sauerborn, R., Bärnighausen, T., & Barteit, S. (2022). The Impact of Wearable Technologies in Health Research: Scoping Review. Jmir Mhealth and Uhealth. https://doi.org/10.2196/34384CrossRefPubMedPubMedCentral

Jahnel, T., Pan, C. C., Barnils, P., Muellmann, N., Freye, S., Dassow, M., & Gerhardus, H. H., A (2024). Developing and evaluating digital public health interventions using the digital public health framework DigiPHrame: a framework development study. Journal of Medical Internet Research, 26, e54269. https://www.jmir.org/2024/1/e54269/CrossRefPubMedPubMedCentral

Jang, S. H., & Je, N. (2022). The relationship between digital literacy, loneliness, quality of life, and health-promoting behaviors among the elderly in the age of COVID-19. International Journal of Advanced and Applied Sciences, 9(4), 71–79. https://doi.org/10.21833/ijaas.2022.04.009CrossRef

Kekere, V., Onyeaka, H., Fatoki, O., Olatunde, K., Enemuo, S., Asuzu, C., & Kesiena, O. (2020). Use of wearable device among adults in the US with self-reported diabetes mellitus: An analysis of the 2019 Health Information National Trends Survey. JPAR, 5, 72–78. https://doi.org/10.12691/jpar-5-2-2CrossRef

Kim, E. H., Jenness, J. L., Miller, A. B., Halabi, R., de Zambotti, M., Bagot, K. S., Baker, F. C., & Pratap, A. (2023). Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children. JAMA Network Open, 6(3), e235681–e235681. https://doi.org/10.1001/jamanetworkopen.2023.5681CrossRefPubMedPubMedCentral

Knitza, J., Simon, D., Lambrecht, A., Raab, C., Tascilar, K., Hagen, M., Kleyer, A., Bayat, S., Derungs, A., Amft, O., Schett, G., & Hueber, A. J. (2020). Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study. JMIR Mhealth Uhealth, 8(8), e19661. https://doi.org/10.2196/19661CrossRefPubMedPubMedCentral

Lee, H. Y., Kanthawala, S., Choi, E. Y., & Kim, Y. S. (2021). Rural and non-rural digital divide persists in older adults: Internet access, usage, and attitudes toward technology. Gerontechnology, 20(2). https://doi.org/10.4017/gt.2021.20.2.32-472.12

Liu, S., Zhao, H., Fu, J., Kong, D., Zhong, Z., Hong, Y., Tan, J., & Luo, Y. (2022). Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study. Bmc Public Health, 22(1), 996. https://doi.org/10.1186/s12889-022-13378-4CrossRefPubMedPubMedCentral

Lorenc, T., Petticrew, M., Welch, V., & Tugwell, P. (2013). What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health, 67(2), 190–193. https://doi.org/10.1136/jech-2012-201257CrossRefPubMed

Maaß, L., Freye, M., Pan, C. C., Dassow, H. H., Niess, J., & Jahnel, T. (2022). The definitions of health apps and medical apps from the perspective of public health and law: qualitative analysis of an interdisciplinary literature overview. JMIR mHealth and uHealth, 10(10), e37980. https://doi.org/10.2196/37980CrossRefPubMedPubMedCentral

Norman, C. D., & Skinner, H. A. (2006a). eHEALS: The eHealth Literacy Scale. Journal Of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27CrossRefPubMedPubMedCentral

Norman, C. D., & Skinner, H. A. (2006b). eHealth literacy: essential skills for consumer health in a networked world. Journal of medical Internet research, 8(2), e506. https://www.jmir.org/2006/2/e9CrossRef

Omura, J. D., Carlson, S. A., Paul, P., Watson, K. B., & Fulton, J. E. (2017). National physical activity surveillance: Users of wearable activity monitors as a potential data source. Preventive Medicine Reports, 5, 124–126. https://doi.org/10.1016/j.pmedr.2016.10.014CrossRefPubMed

Pan, C. C., Urban, M., & Schüz, B. (2024). Unintended consequences of digital behavior change interventions: A social–ecological perspective. European Journal of Health Psychology. https://doi.org/10.1027/2512-8442/a000149

Peake, J. M., Kerr, G., & Sullivan, J. P. (2018). A critical review of consumer wearables, mobile applications, and equipment for providing biofeedback, monitoring stress, and sleep in physically active populations. Frontiers in physiology, 9, 743. https://doi.org/10.3389/fphys.2018.00743CrossRefPubMedPubMedCentral

Prensky, M. (2001). Digital Natives, Digital Immigrants Part 1. On the Horizon, 9(5), 1–6. https://doi.org/10.1108/10748120110424816CrossRef

Ranganathan, C., Katthula, V., & Moustakas, E. (2020). Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights From a National Survey. Journal of medical Internet research. https://doi.org/10.2196/22443CrossRef

Ranganathan, C., Katthula, V., & Moustakas, E. (2021). Too Old for Technology? Use of Wearable Healthcare Devices by Older Adults and Their Willingness to Share Health Data With Providers. Health Informatics Journal. https://doi.org/10.1177/14604582211058073CrossRef

Richardson, S., Lawrence, K., Schoenthaler, A. M., & Mann, D. (2022). A framework for digital health equity. npj Digital Medicine, 5(1), 119. https://doi.org/10.1038/s41746-022-00663-0CrossRefPubMedPubMedCentral

Rosli, M. S., Saleh, N. S., Aris, B., Ahmad, M. H., & Md. Salleh, S. (2016). Ubiquitous Hub for Digital Natives. International Journal of Emerging Technologies in Learning (iJET), 11(02), 29–34. https://doi.org/10.3991/ijet.v11i02.4993CrossRef

Schaeffer, D., Gille, S., Berens, E. M., Griese, L., Klinger, J., Vogt, D., & Hurrelmann, K. (2023). Digitale Gesundheitskompetenz der Bevölkerung in Deutschland: Ergebnisse des HLS-GER 2. Das Gesundheitswesen, 85(04), 323–331. https://doi.org/10.1055/a-1670-7636CrossRefPubMed

Scheerder, A., Van Deursen, A., & Van Dijk, J. (2017). Determinants of Internet skills, uses and outcomes. A systematic review of the second-and third-level digital divide. Telematics and informatics, 34(8), 1607–1624. https://doi.org/10.1016/j.tele.2017.07.007CrossRef

Soellner, R., Huber, S., & Reder, M. (2014). The Concept of eHealth Literacy and Its Measurement. Journal of Media Psychology, 26(1), 29–38. https://doi.org/10.1027/1864-1105/a000104CrossRef

Statistisches Bundesamt (Destatis) (2023). Federal Statistical Office of Germany. https://www.destatis.de/

The jamovi project (2022). jamovi (Version 2.3) [Computer Software]. https://www.jamovi.org

van der Vaart, R., & Drossaert, C. (2017). Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills. Journal of medical Internet research, 19(1), e27. https://doi.org/10.2196/jmir.6709CrossRefPubMedPubMedCentral

van der Vaart, R., van Driel, D., Pronk, K., Paulussen, S., te Boekhorst, S., Rosmalen, J. G. M., & Evers, A. W. M. (2019). The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study. JMIR Form Res, 3(4), e12883. https://doi.org/10.2196/12883CrossRefPubMedPubMedCentral

van Kessel, R., Wong, B. L. H., Clemens, T., & Brand, H. (2022). Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interv, 27, 100500. https://doi.org/10.1016/j.invent.2022.100500CrossRefPubMedPubMedCentral

Vetrovsky, T., Borowiec, A., Juřík, R., Wahlich, C., Śmigielski, W., Steffl, M., Tufano, J. J., Drygas, W., Stastny, P., Harris, T., & Małek, Ł. (2022). Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis. British Journal Of Sports Medicine, 56(23), 1366–1374. https://doi.org/10.1136/bjsports-2021-105198CrossRefPubMed

Wang, E., Abrahamson, K., Liu, P. J., & Ahmed, A. (2020). Can Mobile Technology Improve Weight Loss in Overweight Adults? A Systematic Review. Western Journal of Nursing Research, 42(9), 747–759. https://doi.org/10.1177/0193945919888224CrossRefPubMed

Wójcik-Czerniawska, A. (2024). Silver generation, digitalization, cashless payment and the phenomenon of social and financial exclusion in the era of Covid-19. Eurasian Business and Economics Perspectives. https://doi.org/10.1007/978-3-031-51212-4_20

Title: Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany
Authors: Chen-Chia Pan
Karina Karolina De Santis
Saskia Muellmann
Stephanie Hoffmann
Jacob Spallek
Nuria Pedros Barnils
Wolfgang Ahrens
Hajo Zeeb
Benjamin Schüz
Publication date: 18-12-2024
Publisher: Springer US
Keyword: Digital Health
Published in: Journal of Prevention
Print ISSN: 2731-5533
Electronic ISSN: 2731-5541
DOI: https://doi.org/10.1007/s10935-024-00821-y

Podcast | Sexual health in older age

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Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany

Abstract

Background

Objective

Methods

Results

Conclusions

Podcast | Sexual health in older age

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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