ehealth literacy and health literacy among immigrants and their descendants compared with women of Danish origin: a cross-sectional study using a multidimensional approach among pregnant women

ObjectiveTo explore ehealth literacy, ability to actively engage with healthcare providers and health system navigation among pregnant immigrant women and their descendants compared with women of Danish origin.Design and settingA cross-sectional survey at antenatal clinics in 2016, Denmark.ParticipantsPregnant women attending antenatal care (n=405).Outcome measuresThe eHealth Literacy Questionnaire (eHLQ) and two domains from the Health Literacy Questionnaire (HLQ): ability to actively engage with healthcare providers and health system navigation. Range of response options for eHLQ (1–4) and HLQ (1–5). With mixed-effect linear regressions, eHLQ and HLQ among immigrants and their descendants compared with women of Danish origin were assessed.ResultsThe response rate was 75%. The overall trend was lower ehealth literacy and HLQ domains among immigrants and their descendants compared with women of Danish origin. For ehealth literacy, the results suggest that challenges related more to digital abilities than motivation, trust and access to technology. The mean ability to engage with digital services was 3.20 (SD 0.44) for women of Danish origin. Non-Western descendants (−0.14, 95% CI −0.31 to 0.02), non-Western (−0.20, 95% CI −0.34 to −0.06) and Western (−0.22, 95% CI −0.39 to −0.06) immigrants had lower adjusted means of this outcome. No differences in motivation to engage with digital services were found for descendants (−0.00, 95% CI −0.17 to 0.17), non-Western (0.03, 95% CI −0.11 to 0.18) or Western (−0.06, 95% CI −0.23 to 0.10) immigrants compared with the mean of the reference (2.85, SD 0.45). Lower ability to engage with healthcare providers was found for non-Western born immigrants (−0.15, CI 95% −0.30 to −0.01) compared with the mean of women with Danish origin (4.15, SD 0.47).ConclusionGenerally, descendant and immigrant women had lower levels of ehealth literacy and health literacy than women of Danish origin. These differences are potentially antecedents of adverse birth outcomes and could inform structural efforts to mitigate health inequalities.

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Health literacy responsiveness: a cross-sectional study among pregnant women in Denmark

Scandinavian Journal of Public Health ◽

10.1177/14034948211004320 ◽

2021 ◽

pp. 140349482110043

Author(s):

Eva Brorsen ◽

Trine D. Rasmussen ◽

Claus T. Ekstrøm ◽

Richard H. Osborne ◽

Sarah F. Villadsen

Keyword(s):

Health Literacy ◽

Pregnant Women ◽

Immigrant Women ◽

Healthcare Providers ◽

Active Engagement ◽

Cross Sectional Survey ◽

Asian Immigrant ◽

Cross Sectional ◽

Mixed Effect ◽

Health Literacy Responsiveness

Aims: Communication barriers in healthcare encounters contribute to ethnic inequality in health outcomes. This study aimed to examine, in a large national Danish sample of women, whether ethnicity was associated with pregnant women’s Active engagement with healthcare providers. Methods: A cross-sectional survey of 1898 pregnant women attending 19 Danish maternity wards. The key variable of interest was maternal ethnicity among ethnic Danish, European, African and Asian immigrant women and their descendants. Syrian immigrant women were studied as a subgroup. The outcome was the health literacy questionnaire domain Ability to engage actively with healthcare providers (five-item domain scored from ‘cannot do/always difficult’ (1) to ‘always easy’ (5)) which is a reflection of a respondent’s lived experiences of engaging with healthcare providers. Adjusted mixed effect multivariate linear regression was used to compare Active engagement across groups expressed as the mean difference (95% confidence interval). Results: Lower means of Active engagement were reported for immigrant women compared to ethnic Danish women in all models. When adjusting for age, parity, complications and occupation, the difference between ethnic Danish women’s Active engagement and other groups was smallest among European –0.15 (–0.26 to –0.05), slightly larger in African –0.19 (–0.40 to 0.02), and largest in Asian immigrant women –0.31 (–0.41 to –0.21). Syrian immigrant women had the largest difference –0.42 (–0.58 to –0.27). Conclusions: Pregnant immigrant women reported lower means of Active engagement than ethnic Danish women did. Increased health literacy responsiveness in maternity care is required to mitigate the potential for differential care and health inequity.

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Determining Health Literacy Level and Its Related Factors Among Pregnant Women Referred to Medical and Health Centers of Tehran in 2019: A Cross-sectional Study

Shiraz E-Medical Journal ◽

10.5812/semj.109592 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Safoura Taheri ◽

Mahmoud Tavousi ◽

Zohre Momenimovahed ◽

Ashraf Direkvand-Moghadam ◽

Nazanin Rezaei ◽

...

Keyword(s):

Health Literacy ◽

Pregnant Women ◽

Health Information ◽

Cross Sectional Study ◽

Health Centers ◽

Related Factors ◽

Cross Sectional ◽

Limited Health Literacy ◽

The Mean ◽

Limited Health

Background: The ability to acquire, process, and understand health information to make informed decisions about health is defined as health literacy. A low level of health literacy disrupts women’s ability to understand and use health information in order to take appropriate and timely measures during pregnancy. Objectives: Due to the importance of health literacy during pregnancy and its direct impact on fetal health, this study was conducted to determine the level of health literacy and its related items among the pregnant women referred to medical and health centers in Tehran. Methods: This descriptive-analytical study was conducted on 270 pregnant women referred to the medical and health centers of Tehran in 2019. The participants in this study were selected by the mixed sampling method (cluster and random methods to select health centers and the convenience method to select participants). Data collection tools included a questionnaire for demographic and midwifery characteristics and a specialized questionnaire for maternal health literacy in pregnancy (MHELIP). Data analysis was performed by SPSS-19 software. Results: The mean age of the participants was 28.16 ± 5.70 years, and the mean gestational age was 24.50 ± 9.25 weeks. The mean score of health literacy among pregnant women was 63.14 ± 9.63, and 48.9% of them had limited (inadequate and insufficient) health literacy. The results showed positive correlations between the total score of health literacy and the demographic variables of age (P = 0.025), education (P = 0.003), and income (0.008), but no significant relationship was found between the mean total score of health literacy and employment status (P = 0.614) or parity (P = 0.614). Conclusions: It was found that limited health literacy had a high prevalence among pregnant women. Given the importance of pregnancy, it seems necessary for healthcare policymakers to design programs to promote women’s health literacy during pregnancy.

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Exploring levels and correlates of health literacy in Arabic and Vietnamese immigrant patients with cancer and their English-speaking counterparts in Australia: a cross-sectional study protocol

BMJ Open ◽

10.1136/bmjopen-2018-021666 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021666 ◽

Cited By ~ 1

Author(s):

Martha Gerges ◽

Allan Ben Smith ◽

Ivana Durcinoska ◽

Henry Yan ◽

Afaf Girgis

Keyword(s):

Health Literacy ◽

Healthcare Providers ◽

Self Report ◽

Local Health ◽

Cross Sectional ◽

Ehealth Literacy ◽

Patients With Cancer ◽

Immigrant Populations ◽

Patient Reported ◽

English Speaking

IntroductionFor immigrants diagnosed with cancer, the stress of a cancer diagnosis and treatment can be amplified by unfamiliarity with the health system, lack of culturally and linguistically appropriate information, and inability to communicate efficiently and accurately with the treating team. Lower levels of health literacy may be one factor underlying poorer outcomes among immigrant patients with cancer, but there have been few studies exploring this issue to date. This study aims to investigate the levels and correlates of health literacy in two immigrant populations affected by cancer and their English-speaking counterparts.Methods and analysisLevels and correlates of health and eHealth literacy will be evaluated using a cross-sectional self-report questionnaire. Eligible, English, Arabic and Vietnamese patients with cancer and survivors (n=50 of each language group) will be invited to complete a questionnaire in their preferred language containing the Health Literacy Questionnaire, the eHealth Literacy Scale and study-specific questions assessing potential correlates of poor health literacy, including gender, age, education level, acculturation into Australian society and number of chronic illnesses.Multivariable logistic regression will be used to identify potential approaches to support effective communication with healthcare providers and preferred methods for assessing patient-reported outcomes (PROs) to support culturally appropriate cancer care.The outcomes of this study will be used to better meet the needs of immigrant populations, including the tailoring of interventions appropriate to different health literacy levels. Outcomes will also inform strategies for PRO assessment to inform unmet needs and to address Australian healthcare system challenges to meet the needs of immigrant populations.Ethics and disseminationThe study was reviewed and approved by the Human Research Ethics Committee of South Western Sydney Local Health District (approval number: HREC/16/LPOOL/650). Results from the study will aim to be published at international conferences and in peer-reviewed journals.

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PERIODONTAL DISEASE STATUS, KNOWLEDGE, ATTITUDE, PRACTICE AND TREATMENT NEEDS OF PREGNANT WOMEN

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.18 ◽

2018 ◽

Vol 8 (6) ◽

pp. 138-144

Author(s):

Thien Nguyen Duc ◽

Tai Tran Tan

Keyword(s):

Periodontal Disease ◽

Pregnant Women ◽

Oral Hygiene ◽

Disease Status ◽

Incidence Rates ◽

Gestation Period ◽

Treatment Needs ◽

Cross Sectional ◽

Mean Values ◽

The Mean

Background: Periodontal disease is a prominent and important issue of public health, especially in pregnant women. The objective of this study is to describe the clinical characteristics; learn knowledge, attitudes, practice oral hygiene and assess the need for treatment of periodontal disease in pregnant women. Subjects and Methods: A cross-sectional study of 210 pregnant women who visited the Department of Obstetrics and Gynecology at the Hue University of Medicine and Pharmacy Hospital. Clinical examination and interview questions on knowledge, attitudes and practice of oral care for all subjects. Results: The incidence of gingivitis was 100%, with mild gingivitis of 4,3% and moderate gingivitis of 95.7%. There was a difference in incidence rates of gingivitis in the gestational period (p<0.001). The incidence of periodontitis is 17.6% and there is no difference in gestational age (p>0.05). The mean values of GI and BOP indices differed by gestation period (p<0.05) and PD, OHI-S, PlI have statistically significant relationship with gestation period (p>0.05). The incidence of periodontal disease is 80.5%; The percentage of pregnant women who abstain from brushing their teeth after birth is 61.4%. Prevalence of brushing once a day: 7.1%; Twice a day: 70.5% and 3 times daily: 22.4%; The mean values of GI, PD, BOP, OHI-S and PlI were inversely proportional to the number of brushing (p<0.001). The rate of dental hygiene is just 3.3%; The rate of oral hygiene, dental plaque and plaque removal was 94,3%; The proportion of subjects required for intensive treatment is 2.4%. Conclusion: Periodontal disease, especially for pregnant women, is high. It is necessary to educate the knowledge, attitudes and practice of proper oral hygiene and to better meet the demand for periodontal disease treatment for pregnant women. Key words: Periodontal disease, pregnant women, knowledge, attitude, practice for oral hygiene, treatment needs

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Is it time to administer acellular pertussis vaccine to childbearing age/pregnant women in all areas using whole-cell pertussis vaccination schedule?

Therapeutic Advances in Vaccines and Immunotherapy ◽

10.1177/25151355211015842 ◽

2021 ◽

Vol 9 ◽

pp. 251513552110158

Author(s):

Abdoulreza Esteghamati ◽

Shirin Sayyahfar ◽

Yousef Alimohamadi ◽

Sarvenaz Salahi ◽

Mahmood Faramarzi

Keyword(s):

Pregnant Women ◽

Age Groups ◽

Vaccination Schedule ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Childbearing Age ◽

Cross Sectional ◽

Whole Cell ◽

Childbearing Age Women ◽

The Mean

Background: Whole-cell pertussis (wP) vaccine administration is still advocated for children under 7 years of age in Iran. However, there is no recommendation for the administration of a dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to childbearing age/pregnant women in the Iranian vaccination program and it has increased the risk of infection through waning immunity during women’s childbearing age life. The study aimed to assess the levels of anti- Bordetella pertussis antibodies in childbearing age women of different ages in Iran. Methods: A cross-sectional study was conducted on a total number of 360 childbearing age women divided into six age groups, with 5-year intervals from 15 to 45 years old, in 2018–2019. Then, the levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) antibodies against B. pertussis were evaluated using enzyme-linked immunosorbent assay (ELISA). The IBM SPSS Statistics software (version 16.0) (SPSS Inc., Chicago, IL, USA) was used for data analysis. Results: The mean age of the participants was 30.01 ± 8.35 years (range 14–45 years). All the cases were IgM negative, but two IgA-positive individuals (in the age groups of 14–19 and 30–34 years) were reported. Overall, 239 (66.4%) cases were IgG positive. The mean age of IgG-positive cases was 30.37 ± 8.37 years. The IgG-positive cases were mostly in the age groups of 30–34 and 35–39 years [43 (71.1%)]. The odds of IgG positivity were 1.97. The highest odds of IgG positivity were seen in 30–34 and 35–39 years groups (2.52) and the lowest odds were seen in the 20–24 and 25–29 years groups (1.60). Using the Jonckheere–Terpstra test, the increasing trend of IgG changes in different age groups was not statistically significant (Tπ=5.78, p = 0.09). Conclusion: The infants of women of childbearing age might be prone to pertussis in countries using the wP vaccination schedule. It is suggested to administer a dose of Tdap to women before or during pregnancy to increase the immunity of their infants against this disease during early infancy.

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Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude

Nutrients ◽

10.3390/nu10070916 ◽

2018 ◽

Vol 10 (7) ◽

pp. 916 ◽

Cited By ~ 3

Author(s):

Andrea Hemmingway ◽

Karen O’Callaghan ◽

Áine Hennessy ◽

George Hull ◽

Kevin Cashman ◽

...

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Pregnant Women ◽

Calcium Intake ◽

Geometric Mean ◽

Vitamin D Status ◽

Metabolic System ◽

Cross Sectional ◽

The Mean ◽

In Pregnancy

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks’ gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = −0.311, p < 0.001), but not with calcium intake or serum calcium (r = −0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800–1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.

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Factors influencing the dental caries in pregnant women: a cross-sectional study

Research Society and Development ◽

10.33448/rsd-v10i1.12226 ◽

2021 ◽

Vol 10 (1) ◽

pp. e32810111226

Author(s):

Gabriela Bohrer Bolsson ◽

Jessica Klöckner Knorst ◽

Marília Cunha Maroneze ◽

Maísa Casarin ◽

Patrícia Pasquali Dotto ◽

...

Keyword(s):

Dental Caries ◽

Pregnant Women ◽

Basic Research ◽

Cross Sectional Study ◽

Mean Value ◽

Sectional Study ◽

Cross Sectional ◽

The Mean ◽

The City ◽

Santa Maria

Objective: To assess factors associated with the average number of dental caries in pregnant women. Method: Basic research design: This cross-sectional study was performed between January 2017 and December 2018 in Santa Maria, Brazil. Clinical setting and participants: Multistage random sampling resulted in the recruitment of 256 pregnant women from public health centers across the city. Clinical exams and semi-structured questionnaires including demographic, socioeconomic and behavioral questions were performed by trained interviewers. Main outcome measure: The experience of dental caries was evaluated through the mean value of the Decay, Missing, and Filled Surface Index (DMFS) by 4 trained and calibrated examiners. Multilevel Poisson regression models were used to evaluate the influence of different variables on the average number of dental caries. Rate ratio (RR) and respective 95% confidence intervals were calculated (CI 95%). Results: The prevalence of untreated dental caries was 62.7% in the sample, while the mean DMFS index was 10.27 (± 10.92). Women who smoked during pregnancy had a higher mean DMFS (RR 1.41; 95% CI 1.25-1.57). Furthermore, pregnant women who had poor self-ratings of oral health had a higher average DMFS (RR 1.21; 95% CI 1.10-1.32). Conclusions: The results showed that older age, ethnicity, fewer years in education and the presence of dental plaque resulted in higher means of DMFS.

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Determinants of anemia among pregnant women: A hospital based cross sectional study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193783 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3609

Author(s):

P. Kalpana ◽

A. Kavitha

Keyword(s):

Pregnant Women ◽

Demographic Data ◽

Cross Sectional Study ◽

Hemoglobin Level ◽

Sectional Study ◽

Cross Sectional ◽

Lower Segment Cesarean Section ◽

Menstrual History ◽

History Of ◽

The Mean

Background: The objective was to study the determinants of anemia among pregnant women. There is a negative effect on the health of the mother and as well as that of the child due to anemia in women with pregnancy. Death rate is more in women who are pregnant and having anemia. The objective of this study was to study the determinants of anemia among pregnant women.Methods: A hospital based cross sectional study was carried out among 40 pregnant women over a period of six months. Demographic data like age, residence, occupation etc was recorded. Obstetric data like gravida, parity, previous LSCS was also recorded. The data was presented as means and student’s t test was applied.Results: The mean age was 23.43±3.4 years. Majority were young between the ages of 19-22 years. Majority belonged to urban residents i.e. 57.5%. 20% of the subjects were found to be illiterate. Majority of the mothers were housewives i.e. 82.5%. Majority were multi-gravida i.e. 60%. Majority had no history of abortions in the past i.e. 75%. Out of total 19 repeat pregnancies, majority i.e. 84.2% had lower segment cesarean section. Majority reported that they had normal menstrual history. The mean hemoglobin level was found out to be 7.94 gm/dl. It was found that the mean hemoglobin level did not differ significantly across age, residence, education, occupation, gravidity, history of abortions, type of delivery but differed significantly by abnormal menstrual cycle.Conclusions: Mean hemoglobin level was more in women with normal menstrual history compared to those women with abnormal menstrual history and this difference was found out to be statistically significant. Hence abnormal menses should be promptly treated, hemoglobin assessed.

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INTENSITAS NYERI PINGGANG DAN PINGGUL PADA IBU HAMIL YANG MELAKSANAKAN YOGA PRENATAL DI KOTA DENPASAR

Jurnal Midwifery Update (MU) ◽

10.32807/jmu.v2i2.90 ◽

2020 ◽

Vol 2 (2) ◽

pp. 69

Author(s):

Ni Made Dwi Purnamayanti ◽

Gusti Ayu Eka Utarini

Keyword(s):

Pregnant Women ◽

Pain Intensity ◽

Descriptive Study ◽

Effective Strategy ◽

Third Trimester ◽

Cross Sectional ◽

Mild Pain ◽

The Mean ◽

Observational Descriptive Study

Nyeri pinggang dan panggul merupakan keluhan yang umum dirasakan oleh wanita hamil terutama pada akhir kehamilan. Olah raga termasuk yoga prenatal merupakan strategi yang efektif dan disarankan untuk mengatasi nyeri pinggang dan panggul. Penelitian ini bertujuan untuk mendapatkan gambaran intensitas nyeri pinggang dan panggul pada ibu hamil trimester III yang melaksanakan yoga prenatal di Kota Denpasar. Penelitian ini merupakan penelitian deskriptif observasional dengan pendekatan cross sectional terhadap 96 ibu hamil trimester III yang melaksanakan yoga prenatal di kota Denpasar. Didapatkan hasil rerata intensitas nyeri pinggang dan panggul yang dirasakan adalah 1.88 (SD ±2.202). Sebagian besar responden (41.7%) merasakan nyeri pada area tulang belakang disekitar lumbal hingga diatas sacrum.Intensitas nyeri pinggang dan pelvis pada ibu hamil trimester III di Kota Denpasar yang melaksanakan yoga prenatal tergolong nyeri intensitas ringan.Lumbopelvic pain are common complaints felt by pregnant women. Exercise, including prenatal yoga, is an effective strategy and is recommended for treating pregnancy-related lumbopelvic pain. The purpose of the syudi is to know the intensity of pregnancy-related lumbopelvic painamong woman who performe prenatal yoga in Denpasar. This study was an observational descriptive study with a cross sectional approach. The subjeck study was 96 third trimester pregnant women who performed prenatal yoga in Denpasar. The mean pain intensity was 1.88 (SD ± 2.202). Most respondents (41.7%) felt pain in the spinal area around the lumbar to above the sacrum. The intensity of pregnancy-related lumbopelvic pain among third trimester pregnant women in Denpasar who performe prenatal yoga is mild pain.

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Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

BMJ Open ◽

10.1136/bmjopen-2017-019192 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019192 ◽

Cited By ~ 24

Author(s):

Sharon Parker ◽

Amy Prince ◽

Louise Thomas ◽

Hyun Song ◽

Diana Milosevic ◽

...

Keyword(s):

Chronic Disease ◽

Health Literacy ◽

Healthcare Providers ◽

Chronic Health Condition ◽

Vulnerable Groups ◽

Self Management ◽

Future Research ◽

Ehealth Literacy ◽

Health Technologies ◽

Vulnerable Patients

ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

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