Implementing eHealth literacy interventions in diverse communities: Challenges and opportunities

Abstract

Purpose: eHealth literacy interventions can significantly increase eHealth literacy among older adults 1,2. However, implementing interventions in communities with diverse social, economic, racial, and ethnic populations can create challenges. We designed an interactive, web-based multimedia tutorial for the NIH-funded Electronic Health Information for Lifelong Learners (eHiLL) intervention involving eight 2-hour-long computer instruction sessions. After pilot testing of the tutorial at two public libraries in Prince George's County, Maryland, with test groups that consisted of primarily African Americans, the intervention expanded to six new locations in Austin, Texas with test groups having 35% Hispanics 3. These locations included new class settings, such as senior centers, recreation centers, and assisted living (Figure 1), and participants with different demographics. We report challenges encountered in implementing the tutorial in diverse settings, along with opportunities to improve the intervention. Method: After each intervention session, nine intervention facilitators submitted written field reports describing challenges encountered during their sessions, along with recommendations for overcoming the challenges. Results: Major challenges identified include: (i) tutorial incompatibility with different computer systems; (ii) environmental distractions, such as a noisy kitchenette in a computer lab; and (iii) varying levels of English language proficiency among participants. Discussion: Identifying challenges helped to identify opportunities for improving tutorial implementation in different settings. First, we improved the tutorial's compatibility by publishing it in multiple formats compatible with different operating systems, internet browsers, and internet speeds. For example, we pre-loaded the tutorial on flash drives to ensure that it performed with offline computers. This improvement enabled us to expand classes to settings with older computer equipment and poor internet connectivity. Second, environmental distractions included loud, non-participant conversations and non-participants seeking to use participant computers during class. At senior centers or assisted living facilities, asking non-participants to limit noise provides an opportunity to recruit new participants. For example, we provide flyers with class information to the non-participants. Last, participants with lower proficiency in English may require assistance with tutorial content. Collaborative learning, where students work together on common pedagogical goals 4, can pair participants with diverse levels of proficiency. As the participants work together, they assist each other with comprehending tutorial content.