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Imagine that you have decided to take up running as your preferred form of exercise in a quest to get in shape. You start slowly by running a half mile and walking a half mile. You gradually build up your endurance and find yourself running nearly every day for longer distances and longer periods of time. But then you notice a nagging pain in your right hip; over a few weeks, it gradually spreads to the center of your right buttock and then down your right leg. You try rest and heat, but nothing seems to help. You visit your doctor, who indicates that you have developed piriformis syndrome and prescribes a series of stretching exercises, ice to the involved area, and rest. You are intrigued by the diagnosis. Upon your return home, you log on to the internet and begin a search for information about piriformis syndrome. When you type the words into your favorite search engine, you immediately get 2,780,000 results in response to your query.

Your use of the internet to seek health information mirrors the behavior of many consumers who are increasingly relying on the internet for health-related information. The challenge for consumers and healthcare professionals alike is the proliferation of information on the internet and the need to learn how to recognize when information is accurate and meaningful to the situation at hand.

This chapter explores consumer information and education needs and considers how patient engagement and connected health technologies, including new trends in wearable technology, may help to meet those needs yet at the same time create ever-increasing demands for health-related information. It begins with a discussion of health literacy, eHealth, and health education and information needs and explores various approaches by healthcare providers to using technology to promote health literacy. Also examined is the use of games, web quests, and simulations as a means of increasing health literacy among the school-age population. Issues associated with the credibility of web-based information and barriers to access and uses for patient engagement are discussed. Finally, future trends related to technology-supported consumer information and connectivity are explored.

This is the Knowledge Age; most people want to be in the know. People demand news and information and want immediate results and unlimited access. The same is increasingly true with health information. More and more people, in a trend known as consumer empowerment, patient engagement, and connected health, are interested in partnering with healthcare providers to take control of their health. These patients are not satisfied with being dependent on a healthcare provider to supply them with the information they need to manage their health. Instead, they are increasingly embracing electronic technologies, such as patient portals, to offer current and past health statuses, lab results, and secure messaging with providers; social media interactions; health-related games; wearable technologies for tracking health; and health management apps. Refer to Box 16-1 to review three apps and reflect on how nurses can engage with and connect their patients to their own health, whether it be diet and exercise help; medication support; or something specific to their contextual situation, such as pregnancy or monitoring their heart's function.

A national survey by the Pew Research Center's Internet and American Life Project (Fox & Duggan, 2013) indicated that 8 in 10 Americans who are online have searched for health information (these numbers are comparable to the numbers in previous surveys conducted in 2006 and 2011). The most frequent health topic searches (69%) were related to a specific disease or medical problem that the searcher or a member of the family was experiencing. Other frequent topics of health-related searches were weight, diet, and exercise (60%) and health indicators, such as blood parameters or sleep patterns (33%). The 2011 survey (n = 3,001) indicated that consumers also searched for information on food (29%) and drug safety (24%; Fox, 2011). Just over half of “online diagnosers” (i.e., those who search online for information about medical conditions) reported that they shared their internet findings with their healthcare providers, and 41% reported that their findings were confirmed by a clinician (Fox & Duggan, 2013). It is clear that patients are increasingly looking to be partners with their healthcare providers in managing their health challenges and maintaining a level of wellness. Stansberry et al. (2019) studied 530 participants. The majority of their comments surrounded their hopes and concerns over technological changes occurring in their lives; they referred to technological advances such as “brain-computer interfaces, virtual immersive experiences that will teach and entertain users, pervasive connectivity linked to artificial intelligence (AI) that helps people navigate the world and understand it better, and predictive and personalized applications that make life easier” (para. 1). Carmona et al. (2022) collected data on 2,437 users of a web-based symptom checker using AI-Buoy Health. They reported that over half of the users had pain, a lump or mass, or a gynecological issue, and many were directed to seek care within a week or to self-care. “The results of this study demonstrate the potential utility of a web-based health information tool to empower people to seek appropriate care and reduce health-related anxiety” (p. 15). Box 16-2 provides an overview of AI as a patient engagement strategy.

All healthcare professionals must be prepared to listen to their patients' ideas about their personal health and at the same time provide direction toward credible health information supplied by electronic provider portals on the internet. Here is some good news: In an attempt to improve the credibility of the results of online searches about health, in 2015 Google partnered with the Mayo Clinic to fact check the information in a database for 400 of the most commonly searched for health issues (Lapowsky, 2015). According to Dr. Pearl (2019), algorithms must be altered to help differentiate good sources from those providing misinformation, credible sources should accept direction and assistance from the healthcare community, and warnings should be added to websites that are sharing unsafe or dangerous health information. Healthcare is different from other industries. Dr. Pearl makes a distinction about the ability of consumers reading sales ads or information from other sites: “When most shoppers come across a Rolex watch selling for $19.99 online, they know it's a scam. But when it comes to medical information, many patients and parents don't have the scientific expertise to discern what's real from fake” (para. 13). Medical misinformation exploded on the internet during the COVID-19 pandemic. Shajahan and Pasquetto (2022) stated, “Countering misinformation requires addressing long-standing challenges that operate within social, psychological, economic, technological, and political dynamics” (p. 124). They were part of a team that developed a misinformation toolkit for providers, MisinfoRx. They suggest that when patients present inaccurate information that they found on the internet that providers acknowledge the health information-seeking behavior and then gently correct misinformation. They also caution about commenting or arguing on misinformation posts on the internet, as this boosts the post. Rather, if providers have an online presence, they should seek to post accurate information and to like or share the accurate posts of others.

It is important to note that surveys of online health behaviors are limited to those individuals who are online; therefore, they do not reflect the health information needs or demands of those persons who are not online. Digital divide is the term used to describe the gap between those who have and those who do not have access to online information. Nurses and healthcare providers must be aware of the various components of the digital divide to ensure that patients and clients are receiving the health information they need in a format that they are interested in and can comprehend. Notably, persons with chronic diseases are less likely to have internet connectivity. Fox and Purcell (2010) explained that having a chronic disease is associated with age, level of education, ethnicity, and income-all factors that are also associated with the digital divide. Persons living with a chronic disease who have internet access are likely to use the internet for blogging and online discussion forums, activities popularly referred to as peer-to-peer support. An issue brief by the Council of Economic Advisers (2015) reiterated digital divide factors as age, education, income, and geographic location. In 2021, the National Telecommunications and Information Administration released a countrywide interactive map of the digital divide (www.ntia.gov/press-release/2021/ntia-creates-first-interactive-map-help-public-see-digital-divide-across-country). By providing infrastructure investment monies, the ConnectED initiative was designed to increase broadband access for schools. A similar initiative is designed to promote competition among internet providers, thereby lowering costs and making high-speed internet connections more affordable and accessible across the country. One of Healthy People 2030's overarching goals remains “Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” (HealthyPeople.gov, n.d., para. 1). Thobias and Kiwanuka (2018) stated that there are challenges and barriers to information dissemination in low-resource settings in their study. One area was the lack of access to phones for mothers. They presented a data model that would leverage the leaders in the community who owned smartphones and others, including relatives, to assist with transmitting health education messages to the mothers. Their study has shown the feasibility of using phones to communicate with mothers who do not actually own phones. This is a great example of providing technologies that work with the constraints of the situation. Another example of addressing the digital divide is the growing number of health-related websites that support Spanish and other language formats.

The goal of health literacy for all is one that is widely embraced in many sectors of health care and remains an overarching goal for Healthy People 2030 (Health.gov, n.d.). Clinicians who have been practicing for some time recognize that informed patients have better outcomes and pay more attention to their overall health and changes in their health than those who are poorly informed. Some of the earliest formally developed patient education programs, which included postoperative teaching, diabetes education, cardiac rehabilitation, and diet education, were implemented in response to research that suggested the positive effect of patient education on health outcomes and satisfaction with care.

The Health Resources and Services Administration (2022) concluded that those persons with low health literacy have difficulty understanding what healthcare providers are telling them, lower educational skills, cultural barriers to health care, and issues managing chronic illnesses. Low health literacy affects the incidence and management of disease. “Health literacy is 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” (para. 1). For example, healthcare providers depend on a patient's ability to understand and follow directions associated with dietary restrictions or exercising at home. It is also assumed, sometimes erroneously, that people will correctly interpret symptoms of a serious illness and act appropriately. Locating and evaluating health information for credibility and quality, analyzing the various risks and benefits of treatments, and calculating dosages and interpreting test results are among the tasks that are essential for health literacy. Other important and less easily learned health literacy skills are the ability to negotiate complex healthcare environments and understand the economics of payment for services.

The National Institutes of Health (NIH; 2021) reported that numerous studies concerning health literacy demonstrate that a variety of challenges remain on both the patient and the healthcare provider sides of the equation. This is still true today, as evidenced in the Healthy People 2030 overarching goals. Health.gov (2016) created a health literacy online guide that was last updated in 2016 but that still contains valuable information, such as the Health Literacy Online Strategies Checklist. According to Health.gov (2021), “Health literacy and clear communication between health professionals and patients are key to improving health and the quality of health care” (para. 1).

It is increasingly clear that better outcomes result when patients are well informed and engaged in their care. As depicted in Figure 16-1, there are a number of effective strategies to promote better health, including strategies for building sound relationships, strategies to ensure that patients are well informed about their health challenges, and strategies to build partnerships with patients.

Figure 16-1 The Health Literacy Umbrella

An umbrella under the rain symbolizes the health literacy umbrella.

The rain symbolizes health problems and risks. The umbrella encompasses key elements, including building relationships with values and preferences, and respect; ensuring understanding through plain language, clear dialogue, follow-up, technology, and easy navigation; and partnering with peer support, resources, and education. Underneath the umbrella, the concept is associated with achieving better health.

Developed by the Health Literacy in Communities Prototype Faculty: Connie Davis, Kelly McQuillen, Irv Rootman, Leona Gadsby, Lori Walker, Marina Niks, Cheryl Rivard, Shirley Sze, and Angela Hovis with Joanne Protheroe and the Ministry of Health, July 2009. IMPACT BC, with funding from the BC Ministry of Health.

The eHealth Initiative was developed to address the growing need for managing health information and promoting technology as a means of improving health information exchange, health literacy, and healthcare delivery. Visit the eHealth Initiative website (www.ehidc.org) for information. Although its scope goes beyond health literacy, a major goal continues to be empowering consumers to understand their health needs better and to act appropriately to those needs. The eHealth Initiative recently released a 2020 road map outlining a vision toward patient-centric care. Poor interoperability among healthcare systems and failure to embrace national data standards for health care continue to be identified as barriers to the eHealth Initiative. Further, concerns about privacy and security of information and the failure to invest appropriately in technology have slowed the development of this important initiative. The Centers for Disease Control and Prevention (CDC; 2023b) provides access to health literacy and eHealth initiatives by state (www.cdc.gov/healthliteracy/statedata/index.html).

Healthcare organizations (HCOs) use a wide variety of approaches and tools to engage patients and promote patient education and health literacy. Although the old standby for disseminating information is the paper-based flyer, some HCOs are recognizing that today's consumers are more attracted to a dynamic medium rather than to a static medium. In addition, the cost of designing and printing pamphlets and flyers becomes prohibitive when one considers the rapidity of changing information; the brochure may be outdated almost as soon as it is printed. One approach to deal with these issues is to have patient education information stored electronically so that changes can be made as needed or information can be better tailored to the specific patient situation and then printed out and reviewed with the patient.

Another old standby approach that is still widely used is the group education class. These classes initially were developed to help people manage chronic health problems (e.g., diabetes) and were typically scheduled while people were hospitalized. Now many HCOs also sponsor health promotion education classes as a way of marketing their facilities and showcasing their expert practitioners.

The movement from static to dynamic presentations began in many HCOs with the use of videotapes and then DVDs, which were shown in groups or broadcast on demand over dedicated channels via a television in patients' rooms. HCOs are now also taking advantage of the fact that patients and families are captive audiences in waiting rooms by promoting education via pamphlet distribution, health promotion programs broadcast on television, and health information kiosks in those locations. The kiosks are typically computer stations and often contain a variety of self-assessment tools (especially those related to risks for diabetes, heart disease, or cancer) and searchable pages of information about specific health conditions. The self-assessment tools represent yet another step forward in technological support for education; in addition to being dynamic, the kiosk is interactive. On the assessment page, the user is asked to respond to a series of questions and then the health risk is calculated by the computer program. One caution, however, is that just because the information is made available does not mean that people will participate or understand what they have experienced. Issues related to the level of health literacy, the digital divide, and the gray gap (i.e., differences in electronic connectivity by age) still exist in these situations.

Many HCOs have invested time and money in developing interactive websites and believe that web presence is a critical marketing strategy. Consider how the information in Box 16-3 might be attractive to a consumer. Most websites offer physician search capabilities, e-newsletters, and call-center tie-ins. As with all patient education materials, there must be a sincere commitment to keeping information current and easily accessible. Web designers must pay particular attention to the aesthetics of the site, the ease of use, and the literacy level of those in the intended audience.

The aim of the review conducted by Reen et al. (2019) was “to synthesize the usability of specific health information websites” (para. 2). They provided insights into how to assess website usability. It is important to collect information on user site preferences and user satisfaction with websites. “Preferred website features were interactive content such as games and quizzes, as well as videos, images, audio clips, and animations” (para. 4). When considering the adolescent population, it was important for them to be able to communicate or interact with other like adolescents, and they wanted to learn about their situation by hearing true stories in other adolescents' own words.

The rapid growth of electronic communication through increased use of computers and access to the internet, particularly for medical purposes, empowers the clinician as well as the consumer of healthcare information. The integration of information and communication technologies and the growing trend of consumer empowerment have reshaped the delivery of health care. As a result of meaningful use initiatives, many HCOs have developed secure patient portals that allow patients to access their health records, including tracking laboratory results and reviewing the records. Most HCOs, however, do not allow patients to edit these records. In addition, patients are occasionally interested in interacting with others who have the same or similar conditions, and some HCOs are providing the information necessary to help them connect. This peer-to-peer support is especially popular with patients who have cancer diagnoses, diabetes, and other chronic and debilitating conditions (Lober & Flowers, 2011).

Some HCOs are using social media for health education to promote actual engagement of audiences rather than as a means of one-way messaging. Neiger et al. (2013) suggested “that the use of social media in health promotion must lead to engagement between the health promotion organization and its audience members, that engagement must provide mutual benefit, and that an engagement hierarchy culminates in program involvement with audience members in the form of partnership or participation (as recipients of program services)” (p. 158). The CDC (2011) has an excellent social media tool kit that can be used by health educators to guide the planning and implementation of social media strategies for health promotion: www.cdc.gov/healthcommunication/ToolsTemplates/SocialMediaToolkit_BM.pdf. The CDC (2023a) also has a social media overview page at www.cdc.gov/healthcommunication/toolstemplates/socialmediatoolkit_bm.pdf. The CDC (2023a) also has a digital and social media page at www.cdc.gov/digital-social-media-tools/index.html.

Promoting health literacy in school-age children presents special challenges to health educators. There is wide agreement that childhood obesity is a serious and growing issue, which is related not only to poor choice of foods but also to the sedentary lifestyles promoted by video games and television. In addition, the time once devoted to health and physical education programs in schools has given way to more time spent on core subjects, such as math and science. Auld et al. (2020) recommended strategies to support health-enriching behaviors, such as customizing and personalizing information and engaging students using age and developmentally suitable information, materials, teaching techniques, and learning approaches. The eHealth programs are developed specifically to appeal to the generational (i.e., highly connected and computer literate) and cultural needs of this group.

Although sedentary lifestyles promoted by video game engagement may contribute to obesity, gaming may be an effective way to promote health literacy. Here are a few examples and an overview of very early games. As early as 2005, Donovan described an interdisciplinary web quest designed to appeal to older school-age children. The quest is interdisciplinary in that it requires reading comprehension, critical thinking, presentation, and writing; thus, core skills and health literacy skills are learned in a single assignment. Students are directed to the web to search for information on the pros and cons of low-carbohydrate diets and obesity prevention. Students learn along the way as they search for information, collect and interpret it, and then develop a presentation and final paper.

The Cancer Game (Oda & Kristula, n.d.) was developed by a young man taking a college class on Macromedia software who had previously undergone a bone marrow transplant. Subsequently, he and a professor collaborated and expanded the project to its present form. The game is designed as an arcade-style video game for cancer patients to relieve stress by visualizing the fighting of cancer cells. Although cancer victims of any age can access and play the game, it has a special appeal to children and adolescents. Similarly, Ben's Game (https://archive.org/details/bensgame) is a video game designed to help relieve the stress of cancer treatment for children (Anderson & Klemm, 2008). According to Cullen et al. (2016), Squires Quest II is a serious video game designed to increase fruit and vegetable consumption in fourth and fifth graders; these authors found an increase in fruit intake at breakfast and increased vegetable intake at dinner. This is a great example of a health education program designed to appeal to this connected generation of learners and their intuitive ability to use interactive technologies.

You can access newer games on the internet by typing “health games” into a search engine. Be sure to review the information presented in the game for accuracy before you recommend it to parents and children. The National Library of Medicine maintains a site dedicated to health learning games for both children and adults (https://medlineplus.gov/games.html). You can feel confident in recommending games from this trusted website because it has been vetted for accuracy and credibility.

Winkelman et al. (2016) reported that only 12% of adults in the United States are proficient in health literacy, or the ability to successfully navigate and function in the healthcare system. This is cause for grave concern because health literacy is one of the strongest predictors of health; it is more prognostic than gender, age, income, or educational status (Leiditch, 2021). Low health literacy is linked with poor child health outcomes, increased healthcare costs, and higher mortality rates (Schools for Health in Europe, n.d.; Winkelman et al., 2016). It is easy to understand why the CDC (2022) has a website on health literacy to support schools (www.cdc.gov/healthliteracy/education-support/schools.html) and why health literacy was included in Healthy People 2010 and Healthy People 2020 and continues as a goal in Healthy People 2030.

Nurses and other healthcare providers must embrace the internet as a source of health information for patient education and health literacy. Patients are increasingly turning there for instant information about their health maladies. Health-related blogs (short for weblogs, or online journals) and electronic patient and parent support groups are also proliferating at an astounding rate. Clinicians need to be prepared to arm patients with the skills required to identify credible websites. They also need to participate in the development of well-designed, easy-to-use health education tools. Finally, they need to convince payers of the necessity of health education and the powerful effect education has on promoting and maintaining health. Box 16-4 provides more information about patient education.

Box 16-4 Considerations for Patient Education

Julie A. Kenney  IdaAndrowich  Nurses need to consider many things when teaching patients. They need to assess patients' willingness to learn and reading ability, the means by which they learn best, and their existing knowledge about the subject. These important considerations for patient education are depicted in Figure 16-2. Figure 16-2 Choosing an Education Strategy A cyclic diagram depicts the considerations in choosing an education strategy. Elements include willingness to learn, reading ability, culture and language, existing knowledge, and preferred method. Photo: © ERproductions Ltd/Blend Images/Getty Images Nurses also need to consider cultural, language, and generational differences when teaching their patients. If the nurse chooses to use an electronic method to educate the patient, digital natives (i.e., patients who have grown up with technology) need to be taught differently from digital immigrants (i.e., those who are late adopters of technology; “Educational Strategies,” 2006). Digital natives are typically born after 1982 and may also be referred to as Millennials. This generation prefers to learn using technology and learns quite well if information is presented in a format to which they are accustomed, such as an interactive video game to introduce them to a topic. This group is also comfortable using information that they can access via their handheld devices, such as smartphones and tablets, as well as wearable devices, such as smartwatches. Those born before 1982 have learning styles that range from preferring to learn in a classroom setting to reading a book about the topic to learning using a hands-on, interactive approach (“Educational Strategies,” 2006). A systematic review of the literature related to teaching methods (Friedman et al., 2011) suggested that all the various modalities ranging from computer technologies to demonstrations and reviews of written materials can be effective as long as they are structured and specifically designed for and congruent with the patient's culture. More recently, Sawyer et al. (2016) tested a tablet-based education program for patients with heart failure. They sought to demonstrate the value of the tablet-based education approach to staff and at the same time find ways to minimize the disruptiveness of the technology-based education on clinical workflow, ensure patent safety by establishing specific procedures for device cleaning, and suggest strategies for maintaining the security of the devices. They conclude that technology-based learning tools may be effective in helping patients manage their disease after discharge. They also emphasize the need to consider clinician workflow and device security to ensure a successful implementation. The next generation, Generation Z, are those born between 1996 and 2010 (Spitznagel, 2020). This generation is growing up in a highly sophisticated and complex digital environment and spending more time with digital devices and the internet than the previous Generation Y. They are also the most ethnically and racially diverse. These individuals are active problem solvers and comfortable and familiar with getting information on demand. They do not like lectures and expect to be able to customize their educational episodes. The teaching strategies should fit with the patient's culture and include using up-to-date instructional technologies, including communication and feedback incorporating social media and smart devices. References Educational strategies in generational designs. (2006). Progress in Transplantation, 16(1), 8-9. https://journals.sagepub.com/doi/pdf/10.1177/152692480601600101 Friedman  A., Cosby  R., Boyko  S., Hatton-Bauer  J., & Turnbull  G. (2011). Effective teaching strategies and methods of delivery for patient education: A systematic review and practice guideline recommendations. Journal of Cancer Education, 26, 12-21. https://doi.org/10.1007/s13187-010-0183-x Sawyer  T., Nelson  M. J., McKee  V., Bowers  M. T., Meggitt  C., Baxt  S. K., Washington  D., Saladino  L., Lehman  E. P., & Brewer  C. (2016). Implementing electronic tabletbased education of acute care patients. Critical Care Nurse, 36(1), 60-70. https://doi.org/10.4037/ccn2016541 Spitznagel  E. (2020). Generation Z is bigger than millennials-And they're out to change the world. New York Post. https://nypost.com/2020/01/25/generation-z-is-bigger-than-millennials-and-theyre-out-to-change-the-world/

The HONcode and TRUSTe accreditation symbols are two of the most common symbols that indicate trustworthy and secure websites. Internet users can also look at the domain name of the website as a clue to trustworthiness. Many users gravitate toward university sites (.edu), government sites (.gov), and HCO sites (.org). Remember that commercial sites (earn money from advertisers and seek to sell products or services) will use the (.com) domain name and may or may not have credible information to share.

The National Library of Medicine and the NIH jointly sponsor MedlinePlus (https://medlineplus.gov), a website that has a tutorial for learning how to evaluate health information and an electronic guide to web surfing that is available in both English and Spanish. A similar guide explains the major things one should evaluate when accessing health-related resources on the web (National Center for Complementary and Integrative Health, 2018). Suggest that patients visit these sites to become more adept at identifying whether a website is credible before they adopt the recommendations provided.

Some healthcare professionals have partnered with their organizations to develop patient education materials. These materials must be carefully reviewed for accuracy and usability. The Agency for Healthcare Research and Quality (2014) published an assessment tool for both print and audiovisual patient education materials. Its tool is designed to assess both understandability and actionability by providing a series of review criteria for each of these domains. Clearly, clinicians need to engage patients to partner with them in the management of their health. Refer to Box 16-4 and Box 16-5 to review effective education methods used in teaching patients and their families about their health challenges.

Some providers have developed a list of credible websites and apps that are shared with patients or family members. Recommendations for websites might include the U.S. Department of Health and Human Services-sponsored MyHealthfinder site (https://health.gov/myhealthfinder), a website dedicated to helping consumers find credible information on the internet. Other excellent sources of reliable information are the NIH, the CDC, MedlinePlus, and the National Health Information Center (https://health.gov/our-work/health-literacy/resources/national-health-information-center). Some of the apps (found on iTunes for iPhones or Google Play for Android devices) that might be recommended include Mayo Clinic on Pregnancy, WebMD Pain Coach, MyFitnessPal, and Understanding Diseases. These are great examples of the wealth of patient information being developed as apps by hospitals and other healthcare providers. More apps are being developed every day to engage people in managing and taking control of their health. Perhaps the most important thing that healthcare professionals can stress is that not all apps have credible and valid information. We must encourage our patients to become savvy users of electronic information sources.

Predicting future directions for technology-based health education is somewhat difficult because one may not be able to completely envision the technology of the future. One can predict, however, that some current technologies will be used increasingly to support health literacy and new technologies will be developed every day. For example, audio and video podcasts may become more commonplace in health education and be provided as free downloads from the websites of HCOs.

Voice recognition software used to navigate the web may reduce the frustration and confusion associated with attempting to spell complex medical terms. However, the confusion and frustration may increase if the patient or client is unable to pronounce the terms. Voice interactivity should help to reduce the digital access disparity associated with those who have limited keyboard or mouse skills. For those persons with visual impairments, some websites may provide both audio and text information and support increased text size for greater ease of reading (Anderson & Klemm, 2008).

Many websites associated with government and national organizations are also providing multiple-language access to health information and decision support tools (MedlinePlus, n.d.). The multilanguage access broadens the population to whom education can be provided, and the decision support programs allow users to access results that are tailored to their age, risk factors, or disease state (Anderson & Klemm, 2008).

As patient engagement strategies become more commonplace, we will also see a movement toward connected health. Those individuals who are frequent email users may be interested in being able to communicate with physicians and other healthcare personnel via email or a practice portal messaging system rather than the telephone. This idea previously met with some resistance from physicians who perceived email correspondence as bothersome and time-consuming. However, it is possible that work efficiency might increase if patients and their needs are screened via secure email or message before an office or a clinic visit. For example, as a result of an email correspondence in lieu of an initial office visit, medications could be changed or diagnostic tests could be performed before the office visit. In addition, patients could be directed to an interactive screening form housed on a secure website where they would answer a series of questions that would help them decide whether they should call for an appointment, head for the emergency room, or self-manage the issue. If self-management is the outcome of the screening tool, then the patient or caregiver could be directed to a credible website for more information. The idea is not to interfere with or replace the face-to-face visit but rather to supplement the provider-patient relationship and perhaps streamline the efficiency of healthcare delivery. Interestingly, Diaz (2022) noted that many physicians and healthcare systems are now billing for email correspondence if the correspondence required physician expertise and took more than 5 minutes.

Wearable technologies are becoming increasingly popular among tech-savvy patients. These technologies are promoting a paradigm shift from provider-centric to consumer-centric care.

The most common consumer-based wearables are fitness trackers, but there are no clear guidelines as to how to integrate the data these devices collect into a patient's health record and make them actionable.

Medgadget (2020) announced its breathable, stretchable, electronic fabric for new medical wearables that offers the “potential to monitor the body over extended periods of time in unprecedented ways. The heart's rhythms, flexion of joints, and other biomedical parameters can be tracked with high fidelity and continuously using devices that can conform to the body” (para. 1). The breathability is the key to the success of its product, with the electronics embedded into the stretchable material. This material permits gases “such as volatile organic compounds and sweat to come through thereby allowing it to be worn over the skin for many days” (para. 2). The more we can make our tools easy to comprehend and use, the more engaged and compliant our patients will be in their health and wellness journey. Virtual and augmented reality tools are increasingly being used for “stress relieving, relaxation, visualization, and guided meditation tools” (Polet, 2022, para. 3). The literature is beginning to reflect an expansion of concepts beyond patient engagement to enablement, empowerment, and action. LeRouge et al. (2022) stated that “the path to empowered activation includes healthy consumers' responses to critical personal assessments, leading to emergent states of engagement, enablement, and empowerment” (p. 2). They defined engagement as “individual motivation to participate in self-management behaviors”; enablement as “having appropriate knowledge, skills, and abilities to understand one's health condition and make decisions”; and empowerment as “a consequence of enablement and engagement and takes a form of an emergent state and process” (p. 3) leading to action.

The healthcare delivery system is honing its engagement strategies for patient-centered, connected health. Hospitals are using social media to engage and connect with their patients. The consumer empowerment and connected health movement will continue to drive the need for access to quality health education, engagement, and support programs. In an ideal world, practitioners would design educational materials that are user friendly, culturally competent, interesting, dynamic, and interactive and that meet the skills, education needs, and interests of the user.