Effects of two-week e-learning on eHealth literacy: a randomized controlled trial of Japanese Internet users

BACKGROUND: The Internet is widely used as a source of information by people searching for medical or healthcare information. However, information found on the Internet has several drawbacks, and the ability to consume accurate health information on the Internet (eHealth literacy) is increasingly important. This study’s goal was to clarify the extent to which eHealth literacy is improved after e-learning in a randomized controlled trial. METHODS: Data were collected on 301 Japanese adults through an online survey. Participants were assigned to the intervention (e-learning about eHealth literacy) group or the control group in a 1:1 ratio. The intervention group included 148 participants, and 153 participants were in the control group. The participants provided information at baseline on demographic characteristics, self-rated health, and frequency of Internet searching. The eHealth Literacy Scale (eHEALS), which was the main measure of eHealth literacy, and data on secondary outcomes (the Healthy Eating Literacy Scale and skill for evaluating retrieved search results) were obtained at baseline and at follow-up. The score difference was calculated by subtracting the score at baseline from the score at follow-up. Linear regression analysis and multinomial regression analysis were performed using the differences in score as the dependent variables and the intervention as the explanatory variable. Intention-to-treat analysis was employed. RESULTS: The results from participants who responded to all of the questions both times were analyzed (134 in the intervention group and 148 in the control group). eHEALS increased 1.57 points due to the intervention effect (Δ score change = 1.57; 95% CI [0.09–3.05]; p = 0.037). Skills for evaluating retrieved search results improved more in the intervention group than in the control group (relative risk ratio = 2.47; 95% Confidence Interval: 1.33, 4.59; p = 0.004). There were no large differences at baseline between the intervention and control groups in the eHEALS, Healthy Eating Literacy scale, or skill for evaluating retrieved search results. However, at follow-up, the intervention group had improved more than the control group on both the eHEALS and skill for evaluating retrieved search results. DISCUSSION: eHealth literacy improved after the e-learning, as evidenced by the change to the eHEALS scores and increased skill for evaluating retrieved search results. There was no significant effect of e-learning, which did not include content on healthy eating, on the Healthy Eating Literacy Scale scores. This indicates that scores did not increase much due to effects other than e-learning, as is sometimes seen with the Hawthorne effect. Although it was statistically significant, the effect size was small. Therefore, future research is necessary to verify the clinical implications. In sum, this study suggests that e-learning is an effective way to improve eHealth literacy.