***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Despite the amount of online health information , there are several barriers that limit the Internet ’s adoption as a source of health information . One of these barriers is highlighted in conceptualizations of the digital divide which include the differential possession of Internet skills , or “ eHealth literacy ” . Most measures of Internet skills among population s at large use self- assessment s. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance tests . Objective The purpose of this study was to assess how ready a sample of the general population is for eHealth . More specifically , four types of Internet skills were measured in a performance test in which subjects had to complete health-related assignments on the Internet . Methods From November 1 , 2009 , through February 28 , 2010 , 88 subjects participated in the study . Subjects were r and omly selected from a telephone directory . A selective quota sample was used divided over equal sub sample s of gender , age , and education . Each subject had to accomplish assignments on the Internet . The Internet skills accounted for were categorized as operational ( basic skills to use the Internet ) , formal ( navigation and orientation ) , information ( finding information ) , and strategic ( using the information for personal benefits ) . The tests took approximately 1.5 hours and were conducted in a University office , making the setting equally new for all . Successful completion and time spent on the assignments — the two main outcomes —were directly measured by the test leader . Results The subjects successfully completed an average of 73 % ( 5.8/8 ) of the operational Internet skill tasks and an average of 73 % ( 2.9/4 ) of the formal Internet skill tasks . Of the information Internet skills tasks , an average of 50 % ( 1.5/3 ) was completed successfully and , of the strategic Internet skills tasks , 35 % ( 0.7/2 ) . Only 28 % ( 25/88 ) of the subjects were able to successfully complete all operational skills tasks , 39 % ( 34/88 ) all formal skills tasks , 13 % ( 11/88 ) all information skills tasks , and 20 % ( 18/88 ) both the strategic skill tasks . The time spent on the assignments varied substantially . Age and education were the most important contributors to the operational and formal Internet skills . Regarding the formal Internet skills , years of Internet experience also had some influence . Educational level of attainment was the most important contributor to the information and strategic Internet skills . Conclusions Although the amount of online health-related information and services is consistently growing , it appears that the general population lacks the skills to keep up . Most problematic appear to be the lack of information and strategic Internet skills , which , in the context of health , are very important . The lack of these skills is also problematic for members of younger generations , who are often considered skilled Internet users . This primarily seems to account for the operational and formal Internet skills . The results of the study strongly call for policies to increase the level of Internet skills Background eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care . Objective The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet . The study focused on ( 1 ) traditional digital divide variables , such as sociodemographic characteristics , digital access , and digital literacy , ( 2 ) information search processes , and ( 3 ) the outcomes of Internet use for health information purpose s. Methods We used a countrywide representative r and om-digital-dial telephone household survey of the Israeli adult population ( 18 years and older , N = 4286 ) . We measured  eHealth literacy ; Internet access ; digital literacy ; sociodemographic factors ; perceived health ; presence of chronic diseases ; as well as health information sources , content , search strategies , and evaluation criteria used by consumers . Results Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts . They were also more active consumers of all types of information on the Internet , used more search strategies , and scrutinized information more carefully than did the less eHealth-literate respondents . Finally , respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive , instrumental ( self-management of health care needs , health behaviors , and better use of health insurance ) , and interpersonal ( interacting with their physician ) gains . Conclusions The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes , information consumption , and outcomes of the information search . The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences . The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information . There is a need to educate at-risk and needy groups ( eg , chronically ill ) and to design technology in a mode befitting more consumers Background Compared to females , males experience higher rates of chronic disease and mortality , yet few health promotion initiatives are specifically aim ed at men . Therefore , the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males ( aged 35–54 years ) . Method / Design The study design was a two-arm r and omised controlled trial , having an IT-based ( applying website and mobile phones ) and a print-based intervention arm , to deliver intervention material s and to promote self-monitoring of physical activity and nutrition behaviours .  Participants ( n = 317 ) were r and omised on a 2:1 ratio in favour of the IT-based intervention arm . Both intervention arms completed assessment s at baseline , 3 , and 9 months . All participants completed self-report assessment s of physical activity , sitting time , nutrition behaviours , physical activity and nutrition literacy , perceived health status and socio-demographic characteristics . A r and omly selected sub- sample in the IT-based ( n = 61 ) and print-based ( n = 30 ) intervention arms completed objective measures of height , weight , waist circumference , and physical activity as measured by accelerometer ( Actigraph GT3X ) . The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively . The majority of participants were employed in professional occupations ( IT-based 57.6 % , Print-based 54.2 % ) and were overweight or obese ( IT-based 90.8 % , Print-based 87.3 % ) . At baseline a lower proportion of participants in the IT-based ( 70.2 % ) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based ( 82.3 % ) group ( p = .026 ) . The IT-based group consumed a significantly lower number of serves of red meat in the previous week , compared to the print-based group ( p = .017 ) . No other significant between-group differences were observed at baseline . Discussion The ManUp Study will examine the effectiveness of an IT-based approach to improve physical activity and nutrition behaviour and literacy . Study outcomes will provide much needed information on the efficacy of this approach in middle aged males , which is important due to the large proportions of males at risk , and the potential reach of IT-based interventions .Trial registration Background Baby boomers and older adults , a subset of the population at high risk for chronic disease , social isolation , and poor health outcomes , are increasingly utilizing the Internet and social media ( Web 2.0 ) to locate and evaluate health information . However , among these older population s , little is known about what factors influence their eHealth literacy and use of  Web 2.0 for health information . Objective The intent of the study was to explore the extent to which sociodemographic , social determinants , and electronic device use influences eHealth literacy and use of  Web 2.0 for health information among baby boomers and older adults . Methods A r and om sample of baby boomers and older adults ( n=283 , mean 67.46 years , SD 9.98 ) participated in a cross-sectional , telephone survey that included the  eHealth literacy scale ( eHEALS ) and items from the Health Information National Trends Survey ( HINTS ) assessing electronic device use and use of Web 2.0 for health information . An independent sample s t test compared eHealth literacy among users and non-users of Web 2.0 for health information . Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic , social determinants , and electronic device use on self-reported eHealth literacy and use of Web 2.0  for seeking and sharing health information . Results Almost 90 % of older Web 2.0 users ( 90/101 , 89.1 % ) reported using popular Web 2.0 websites , such as Facebook and Twitter , to find and share health information . Respondents reporting use of Web 2.0 reported greater eHealth literacy ( mean 30.38 , SD 5.45 , n=101 ) than those who did not use Web 2.0 ( mean 28.31 , SD 5.79 , n=182 ) , t 217.60=−2.98 , P=.003 . Younger age ( b=−0.10 ) , more education ( b=0.48 ) , and use of more electronic devices ( b=1.26 ) were significantly associated with greater eHealth literacy ( R 2 = .17 , R 2adj = .14 , F9,229=5.277 , P<.001 ) . Women were nearly three times more likely than men to use Web 2.0 for health information ( OR 2.63 , Wald= 8.09 , df=1 , P=.004 ) . Finally , more education predicted greater use of  Web 2.0 for health information , with college graduates ( OR 2.57 , Wald= 3.86 , df = 1 , P=.049 ) and post graduates ( OR 7.105 , Wald= 4.278 , df=1 , P=.04 ) nearly 2 to 7 times more likely than non-high school graduates to use  Web 2.0 for health information . Conclusions Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults . Females and those highly educated , particularly at the post graduate level , reported greater use of Web 2.0 for health information . More in-depth surveys and interviews among more diverse groups of baby boomers and older adult population s will likely yield a better underst and ing regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making BACKGROUND Little research has examined adolescent health literacy and its relationship with online health information sources . The purpose of this study is to explore health literacy among a predominantly Hispanic adolescent population and to investigate whether exposure to a credible source of online health information , Medline Plus ( ® ) , is associated with higher levels of health literacy . METHODS An online survey was administered to a cross-sectional r and om sample of high school students in South Texas . Self-reported sociodemographic characteristics and data on health-information-seeking behavior and exposure to Medline Plus ( ® ) were collected . Health literacy was assessed by eHEALS and the Newest Vital Sign ( NVS ) . Linear and binary logistic regressions were completed . RESULTS Of the 261 students who completed the survey , 56 % had heard of Medline Plus ( ® ) , 52 % had adequate levels of health literacy as measured by NVS , and the mean eHEALS score was 30.6 ( possible range 8 - 40 ) . Health literacy was positively associated with self-efficacy and seeking health information online . Exposure to Medline Plus ( ® ) was associated with higher eHealth literacy scores ( p < .001 ) and increased the likelihood of having adequate health literacy ( odds ratio : 2.1 ; 95 % CI : 1.1 , 4.1 ) . CONCLUSION Exposure to a credible source of online health information is associated with higher levels of health literacy . The incorporation of a credible online health information re source into school health education curricula is a promising approach for promoting health literacy Background Reading skills are important for accessing health information , using health care services , managing one 's health and achieving desirable health outcomes . Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener ( SILS ) to identify limited reading ability , one component of health literacy , as measured by the S-TOFHLA . Methods Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states . Participants were r and omly recruited from Primary Care practice s in the Vermont Diabetes Information System June 2003 – December 2004 . The main outcome was limited reading ability . The primary predictor was the SILS . Results Of the 999 persons screened , 169 ( 17 % ) had limited reading ability .  The sensitivity of the SILS in detecting limited reading ability was 54 % [ 95 % CI : 47 % , 61 % ] and the specificity was 83 % [ 95 % CI : 81 % , 86 % ] with an area under the Receiver Operating Characteristics Curve ( ROC ) of 0.73 [ 95 % CI : 0.69 , 0.78 ] . Seven hundred seventy ( 77 % ) screened negative on the SILS and 692 of these subjects had adequate reading skills ( negative predictive value = 0.90 [ 95 % CI : 0.88 , 0.92 ] ) . Of the 229 who scored positive on the SILS , 92 had limited reading ability ( positive predictive value = 0.4 [ 95 % CI : 0.34 , 0.47 ] ) . Conclusion The SILS is a simple instrument design ed to identify patients with limited reading ability who need help reading health-related material s. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need . Further study of the use of the SILS in clinical setting s and with more diverse 
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CONCLUSION Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services .
Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy .