Role of ehealth literacy, learning styles, and patterns of web-based e-content access for seeking health information among dental university students in Vadodara, India

Abstract

BACKGROUND:

Individual’s learning style, ehealth literacy, and preferred web-based e-content and channel to access information determines how one makes sense of health information on the Internet. Understanding these dynamics will help design suitable e-contents and choose appropriate channels for effective health communication. To assess the relationship between ehealth literacy, learning styles, and web-based e-content accessed for receiving health information among dental college students in Vadodara, India.

MATERIALS AND METHODS:

A cross-sectional questionnaire study was conducted among all consenting Undergraduate Students (UGs), interns, and Postgraduate Students (PGs) of a dental college in Vadodara, India, from July to August 2022. The questionnaire used to collect data included questions on general information, eHealth literacy scale (eHEALS), Visual Auditory Reading/Writing Kinaesthetic (VARK) Questionnaire, and preferences of web-based e-content for receiving health information. Completely filled questionnaires were subject to statistical analysis: descriptive (means and percentages) and inferential (analysis of variance tests and odds ratio).

RESULTS:

285 out of 380 students filled out the questionnaires completely (75% response rate). All reported using Internet for receiving health information. Majority preferred textual ehealth message (71%) and access websites (80%). Students were quadmodal (98.%) and trimodal (2%) learners who learned predominantly through kinaesthetic methods (46%). Mean eHEALS score of the group was 30.27 ± 3.41. There was a statistically significant association between preference for sharing channels and being a kinaesthetic learner (OR = 1.6; P = 0.04).

CONCLUSIONS:

Participants were multi-modal, predominantly kinaesthetic learners. The association between the preference for video-sharing channels and being kinaesthetic learner suggests the need and scope for demonstrative and interactive video-based health educational tools, with the endorsement of health authorities based on health policy.

Introduction

For effective health communication, health educators must be aware of individuals’ health information-seeking behavior and the methods that influence them the most to bring about a behavior change.[1] Successful percolation of health information depends on the person’s learning styles, whereas comprehension of health information received depends on health literacy.[2]

According to the VARK learning styles model, learning styles are categorized into visual, auditory, reading/writing, and kinaesthetic. Visual learners understand best by seeing information presented in a visual rather than written form. Auditory learners process new information by hearing and repeating the explanation for validation. Reading/writing learners understand information by writing it down as words and text. Kinesthetic learners absorb information by touching and by active participation through demonstration.[3]

Determining learning styles can help frame health education strategies. However, accurate health literacy assessment is pivotal for self and guided learning through comprehension of health information.[4] The Department of Health and Human Services defines personal health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”[5]

In today’s context, with the boom in digital information, ehealth literacy has become more relevant, especially among adolescents and young adults. eHealth literacy is defined as “the ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” eHealth literacy has six core skills that take into consideration traditional literacy, health literacy, information literacy, scientific literacy, media literacy, and computer literacy. Among various scales used for the assessment of ehealth Literacy, eHEALS is the most widely used scale. The tool has been used in various populations and settings, exhibiting considerable validity and reliability of items.[6,7]

According to a report by the Institute of Governance, Policies and Politics, Social Media Matters and Youth Online Learning Organization, 86% of adolescents and youth aged 18-25 years consume Internet/social media through their mobile phones. Growing numbers of mobile Internet users have been the reason that dissemination of public health and healthcare-related content gained popularity via Web 2.0-based channels.[8] Web 2.0, also known as “participative Internet” has risen in popularity due to the advent of social-networking, which facilitates multi-way conversations about health. Examples of Web 2.0-based applications are Google Docs, Flickr, video-sharing sites (YouTube), Blogs, Podcasts, Slide Share, Wikis, MedWorm, Micro-blogging (Twitter), Social Networking (Facebook, Whatsapp, etc.), content hosting sites, etc.

The majority of Internet users are university students compared to general population.[9,10] In a systematic review by Stellefson et al. (2011),[11] it was reported that although college students were highly connected to, and felt comfortable with, using the Internet to find health information, their eHealth literacy skills were generally subpar. In this context, it is imperative to assess the skills of the majority of individuals/end-users, if the power of information technology is to be leveraged to promote health and deliver health information effectively. Assessment of students’ learning styles has become more important and relevant in this digital era. The high use of Internet and addiction to Internet use among college/University students[12] and the pervasive nature of health information e-content types warrant assessment of ehealth literacy of college students.

Although students of health and medical professions may be assumed to be well trained owing to the concerned health field-related knowledge that probably is expected to improve their eHealth literacy, recent studies have shown that there is a need to pay attention to the ehealth literacy of the medical and dental students.[13,14] There is a need to assess the ehealth literacy of students of health sciences fields, such as dentistry, to determine scope to empower and prepare a task force that can steer an ehealth literacy movement on a larger arena for the general population. Furthermore, there is a dearth of information on the dental students’ preferred choice of e-content on electronic channels or social media platforms and pattern of use, access to health information, to design appealing e-content types through popular platforms.

Hence, the present study was conducted with the aim of assessing the relationship between ehealth literacy, learning styles, and web-based e-content access for receiving health information among dental university students in Vadodara, Gujarat, through a cross-sectional questionnaire study. This study is unique as it attempts to study the combined effects of learning style, ehealth literacy, and preferred e-content type for receiving health information. The study’s novelty also lies in the intended exploration of the learning styles of students in the context of imbibing health information, rather than in the usual context of academics.

The objectives of the study were: (i) to assess ehealth literacy of dental students using ehealth Literacy Scale (eHEALS)[6]; (ii) to assess learning styles of dental students using Visual Aural Read/Write Kinaesthetic VARK Questionnaire Version 8.01 (updated 2019)[15]; (iii) to assess dental students’ use of web-based e-content for receiving health information through a set of validated questions adopted from a previous questionnaire study[16]; (iv) to study the relationship (if any) between dental students’ ehealth literacy, learning styles, and web-based e-content used for receiving health information.

Materials and Methods

Study design and setting

An institution-based cross-sectional questionnaire study was conducted to address the abovementioned aim and objectives. All students (undergraduate and postgraduate) and interns of KM Shah Dental College and Hospital, Vadodara, as per the official list of the institute, were considered eligible to participate in the study. The study was conducted from July to August 2022.

Study participants and sampling

The assessment of students was through enrollment in the survey on a complete enumeration sample of all students on the roll during the study period. Hence, the sample size was 380, which included the total number of undergraduate students, interns, and postgraduate students on roll during the study period. Students who were not willing to take part in the study were excluded. Students who remained absent on three consecutive attempt days since the commencement of data collection were not included.

Data collection and technique

The questionnaire used in the study was a self-administered questionnaire in English. The data recording proforma included four sections—General Information, eHEALS scale items (10 items), VARK Questionnaire (Version 8.01;16 items), and a set of items (6 items) for assessment of the pattern of use and preferences of web-based e-content for receiving health information adopted from the previously published validated questionnaire by Masilamani et al.[16]

Printed questionnaires (in hard copies) were distributed to all the students: UG, interns, and PGs on roll during the study period. The questionnaires were self-administered. The filled-out questionnaires were collected by the principal investigator on the next day. Three attempts were made to contact the participant if unavailable on the first day of questionnaire distribution; the participant was excluded from the study on all three consecutive attempt days. Only completely filled questionnaires were considered for analysis.

Ethical consideration

The study was carried out after receiving clearance from the Institutional Ethics Committee (IEC) [Approval Letter Ref. SVIEC/ON/Dent/RP/22030; July 20, 2022]. Participants were informed about the study, its purpose, and that their data would be utilized for analysis and dissemination, without disclosure of identity, were provided, and informed consent was obtained from the subjects before data collection.

Analysis

Raw data was entered in Microsoft Excel Spreadsheet and was exported to SPSS software Version 20 (IBM SPSS Statistics Inc. Chicago, Illinois, USA). Descriptive Statistics included computation of means, standard deviation, and percentages. Chi-square test, ANOVA, correlation statistics (Karl Pearson’s correlation test), and odds ratio were applied to draw inferences.

Results

Out of 380 eligible participants, 285 returned completely filled-out questionnaires, yielding a response rate of 75%. Among the respondents, 79% were females and 21% were males. The mean age of respondents was 21.89 ± 2.299 years (age range: 18-29 years). All the participants reported accessing Internet for seeking health-related information, with the majority (65.6%) searching for information related to healthy lifestyles [Figure 1]. 70.9% of the participants chose textual content type for gathering health information as opposed to picture and slide content (58.6%), video content (48.4%), and audio (11.2%). Majority of the participants (80%) were found to rely on health information available at websites as their preferred web-based sites/channels/platforms/media [Figure 2].

Figure 1.

Study Participants’ Reasons for Searching For Health Information on Internet

Figure 2.

Study Participants’ Preferred Web-Based Channels/Platforms/Media for Accessing Health Information

It was observed that all participants were multi-modal learners, predominantly quadmodal (98%). The distribution of participants by VARK learning style is illustrated in Figure 3. Majority of the participants in the present study were kinesthetic learners (46%).

Figure 3.

Distribution of Participants by Vark Learning Style

The ehealth Literacy Score (eHEALS) in the present study is 30.2 ± 3.41 (Range: 21-40). There was no statistically significant difference in eHEALS between predominantly visual, predominantly auditory, predominantly reading/writing, and predominantly kinesthetic learners [Table 1].

Table 1.

Comparison of mean eHEALS score among participants with respective predominant learning styles

eHEALS Score	Type of Learner	Mean	Std. Deviation	Inference
eHEALS Score	Visual Learner	30.347	3.4032	F statistic:
	Auditory Learner	29.924	3.4775	3.23
	Read/write Learner	30.320	3.1000	df: 3
	Kinaesthetic Learner	30.338	2.8626	P: 0.58 (NS)

NS: Not Statistically Significant (P>0.05)

Correlation Statistics for eHEALS score and percentage scores of individual components of VARK among predominantly visual, auditory, reading/writing, and kinaesthetic learners, respectively were analyzed [Figure 4].

Figure 4.

Correlation Statistics for eHEALS score and Percentage Scores of Individual Components of VARK among participants with predominantly various learning styles

There was a statistically significant association between the preferred use of video demonstration e-content and being a kinaesthetic learner for receiving health information [Table 2]. There was also a statistically significant association between the preferred use of web-based video-sharing sites viz. YouTube channels for learning techniques, developing skills, and initiating positive health actions through interactive videos and being a kinaesthetic learner for accessing health information [Table 3]. Kinaesthetic learners are those who need to be actively engaged through practical experience rather than theoretical concepts. The same is translated to health information-seeking behavior among the kinesthic learners in the present study.

Table 2.

Association between preferred use of video demonstration e-content and being a kinaesthetic learner for receiving health information

	Video Demonstration Content		Total
	No	Yes
Kinaesthetic learner
No	88	66	154
Yes	59	72	131
Total	147	138	285

OR=1.62 (95% CI=1.01-2.602); P=0.04 (S). S: Statistically Significant (P<0.05)

Table 3.

Association between preferred use of video demonstration e-content and being a kinaesthetic learner for receiving health information

	Video-Sharing sites viz. YouTube Channels		Total
	No	Yes
Kinaesthetic learner
No	83	71	154
Yes	55	76	131
Total	138	147	285

OR=1.61 (95% CI=1.01-2.58); P=0.04 (S). S: Statistically Significant (P<0.05)

Discussion

Understanding different learning styles to identify how students learn the best, their ehealth literacy skills, and preferred web-based e-content types can help devise appropriate innovative ways and channels to provide health education on topics concerning health, disease, prevention, and treatment modalities.

The present study uncovered several important aspects related to receiver attributes in health communication process relevant to the present-day context.

The fact that the majority of students accessed websites for health information in the present study reveals that websites are not only conventional platforms but also are perceived to be reliable sources. This places onus on government and non-governmental health organizations to provide credible, updated health information on their websites. This can also be seen as an opportunity for health and allied institutions to build websites that can publish health education messages. Medical institutions in India have harnessed the potential of institutional websites for patient empowerment through provision of authentic health information and messages.[17]

Khajouei et al.(2019)[18] reported that 65% of medical students in Iran used Internet for health information, while in the present study, all students reported to have used Internet for accessing health information. This could be ascribed to the surge in Internet use for online learning and seeking health information during the COVID-19 pandemic time.[19]

The most common reason for searching for health information on the Internet, as found in this study, was to know about lifestyle interventions, similar to the findings reported by Masilamani et al. (2020).[16] Parija et al. (2020)[20] in their investigation on online health-seeking behavior of urban people of Delhi also had reported that the most commonly searched reason for health information was ‘fitness and exercise’ in 65% of the subjects, followed by ‘diet and nutrition’ in 60% of the subjects.

The students in the present study were predominantly kinaesthetic learners, and the least favored learning style was reading/writing, similar to the study conducted by Hashem (2022)[21] among dental students of a University in Saudi Arabia. The most common learning style overall was the quadmodal (VARK) style, which was similar to the findings of Aldosari et al. (2018)[22] and was contradictory to the study by Deshpande et al.[23] who reported a greater number of unimodal learners.

The mean ehealth literacy of subjects in the present study (30.27 ± 3.41) was greater than that of nursing students (25.23 ± 7.29) Ethiopia reported by Shiferaw et al. (2020).[24] As no other similar study has investigated the relationship between ehealth literacy, learning style, and use and preference of web-based e-content and channels for receiving health information, comparisons for the same could not be performed.

The statistically significant association between the preference for video-sharing channels and video demonstration content type and being kinaesthetic learner, in the present study, suggests the need and scope for developing demonstrative and interactive video-based health educational tools.

The present study provided insights useful for devising appropriate health communication strategies and methods suitable for late adolescents and young adult groups based on prevalent learning styles for mass approach and making tailor-made interventions wherever necessary. This is the first study that intended to understand the interplay of learning styles, ehealth literacy, and the use and preferences of web-based content for accessing health information. In this study, the VARK learning style questionnaire has been used for the first time ever in the context of health information assimilation rather than academic learning. The use of validated scales is the major strength of this research.

The study, however, has certain limitations. First, as this is a single institution-based study, the results have limited generalizability. Second, the study suffers from inherent biases of self-reported questionnaire study such as sequential bias, recall bias, and social desirability bias. However, the responses obtained to the various items of the questionnaire correlate with the respondents’ narratives in a qualitative study reported by Pattath (2021),[25] which substantiates the validity of the results of the present study.

Despite the limitations mentioned above, this study determined gaps and scope for improvement in dental students’ ehealth literacy and to conduct need-based programs beneficial to the same end.

Conclusion

The research helped identify the most popular web-based e-content type, as assessed through the preferred choice of students, to suitably channelize health information to the young target groups.

Based on the salient findings of the study, it is concluded that participants in the study were multi-modal, predominantly kinaesthetic learners. No statistically significant difference was observed in the ehealth literacy of students with different learning styles. There is a need to develop and make available e-content types and channels for the dissemination of health information based on predominant learning type in case of mass approach or tailor-made interventions in case of an individual approach. Future research should focus on the effectiveness of the various new-age health information content types and channels for dissemination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.