Effectiveness of Intensive Tutoring vs. Flexible Self-Learning on Digital Health Literacy and Self-Efficacy for "My Health Bank" App Use Among Adults Over 50

Tri-Service General Hospital235 enrolled

Overview

The purpose of this study is to evaluate the effectiveness of two different educational models in improving the use of the "My Health Bank" App (a Personal Health Record system in Taiwan) among adults aged 50 and older. As Taiwan's population ages, digital health management has become essential, yet older adults often face a "digital divide." Participants will be randomly assigned to either a "Intensive Guided Learning group" (receiving one-on-one human instruction) or a "Flexible Self-study group" (using self-learning materials co-created with Generative AI). The study aims to compare the outcomes of these two groups in terms of enhancing digital health literacy, self-efficacy, and actual App usage behavior to identify more effective and scalable digital health education strategies.

This study is conducted over a period of 18 months (from March 1, 2026, to August 31, 2027) and is divided into three strategic phases: Phase 1 (Months 1-6): Focuses on the development of AI-collaborative educational materials, expert validity review, and a questionnaire pre-test (n=15). A Pilot Randomized Controlled Trial (Pilot RCT, n=60) will be executed to verify the feasibility and readability of the intervention materials. Phase 2 (Months 7-15): The formal enrollment and intervention phase. A full-scale Randomized Controlled Trial (Full-scale RCT, n=160) will be conducted using a single-blind, two-arm design. Participants will be randomly assigned to either the "Intensive Guided Learning group" or the "Flexible Self-study group," with longitudinal data collection and tracking at three time points. Phase 3 (Months 16-18): Data processing, advanced statistical analysis (including SEM to verify empowerment mechanisms), and final manuscript preparation. The study aims to provide empirical evidence for scalable digital health education strategies to reduce the "digital divide" among adults over 50.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Interventions

AI-Collaborative eHealth EducationBEHAVIORAL

This behavioral intervention consists of a structured eHealth literacy curriculum using AI-collaborative educational materials. The program focuses on teaching participants how to utilize the "My Health Bank" platform for personal health management. The intervention is delivered in two formats depending on group assignment: The experimental group receives intensive instructor-led guidance and hands-on practice. The control group engages in flexible self-study using the same AI-generated materials. The curriculum aims to enhance digital health literacy, self-efficacy, and active engagement (measured by frequency of use) with digital health tools among older adults.

Eligibility

Sex: ALLMin age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Participants aged 50 years and older. * Possession of a smartphone with basic operational skills (e.g., unlocking the phone, making calls, and using LINE). * Self-reported lack of familiarity with the "My Health Bank" App (used less than 3 times or never used in the past year). * Proficiency in listening, speaking, reading, and understanding Mandarin Chinese. Exclusion Criteria: * Regular users of the "My Health Bank" App (used 3 times or more in the past year). * Severe cognitive impairment identified through brief cognitive screening, the participant unable to follow instructions or complete questionnaires. * Smartphone operating system is too outdated to support the installation of the "NHI App" (National Health Insurance App). * Inability to complete the App download and installation process independently or with family assistance (e.g., lost App Store/Google Play password, insufficient storage space).

Outcomes

Primary Outcomes

Change in eHealth Literacy Scale (eHEALS) Score

The eHealth Literacy Scale (eHEALS) is used to measure participants' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The scale contains 8 items, each scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 8 to 40, with higher scores indicating higher perceived eHealth literacy.

Time frame: Baseline (T0), 1-week post-intervention (T1), and 4-weeks post-intervention (T2)

Secondary Outcomes

Change in General Self-Efficacy Scale (GSES) Score

This scale is used to assess participants' self-efficacy in managing their health and using digital tools. It consists of 5 items, with each item scored on a 10-point scale ranging from 1 (not confident at all) to 10 (completely confident). The total score ranges from 5 to 50. A higher score indicates a stronger sense of self-efficacy in health management and digital tool proficiency.

Time frame: Baseline (T0), 1-week post-intervention (T1), and 4-weeks post-intervention (T2)

Post-Intervention Digital Health Management Behavior

This measures the frequency and proficiency of participants' actual use of digital health tools, specifically the "My Health Bank" platform. Depending on the questionnaire used (e.g., a self-reported health behavior frequency scale), each item is typically scored on a Likert scale. Total scores reflect the active engagement level in digital health self-management. Higher scores indicate more frequent and positive health-promoting behaviors.

Time frame: 4-weeks post-intervention (T2)