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2. Patient Empowerment - Health - eHealth Literacy
New Buzz-words in the Research field of eHealth
Prof. Dr. Roland Trill / University of Applied Sciences Flensburg

5. Patient Empowerment
The development of personal involvement and responsibility …
… is one of the goals of prevention, promotion and protection in Health;

6. 3 Dimensions of Empowerment
Professional Perspective: An aptitude to comply with expert advice
Consumer Perspective: Self-reliance through individual choice
Community Perspective: Social inclusion through the development of collective support

7. Key tenets of the patient empowerment philosophy:
Patients cannot be forced to follow a lifestyle dictated by others.
Preventive medicine requires patient empowerment for it to be effective.
Patients as consumers have the right to make their own choices and the ability to act on them.

8. P.E. has positive impacts on quality of care and efficiency!
Hypothesis 1:
P.E. has positive impacts on quality of care and efficiency!

9. eHealth is a facilitator of Patient Empowerment!
Hypothesis 2:
eHealth is a facilitator of Patient Empowerment!

10. Questions about P.E. and eHealth
What is the role of eHealth in future Health Care Systems?
What influences P.E.? (participation; acceptance of …; eLiteracy and more …)
What can eHealth do to improve P.E.?
How far is P.E. developed in the European Countries?

11. Applications and P.E.
Monteagudo/Gil: e-Health for patient empowerment in Europe, Informes, Estudios E Invetsigacion, 2007

12. Lupianez-villanueva, Maghiros, Abadie: Strategic Intelligence Monitor on Personal Health Systems Phase 2 (Online Panel; EU-Citizen), page 103

13. Lupianez-villanueva, Maghiros, Abadie: Strategic Intelligence Monitor on Personal Health Systems Phase 2 (Online Panel; EU-Citizen), Page 107

14. The multilingual personal health portal Vivaport supports cross-border health care and allows to collect vital data for self-monitoring.

15. Self-learning (web-based) materials for the citizens with chronic diseases

22. Health Literacy is seen as the key for health-promoting behaviour.
Health Literacy - Definition
The WHO defines Health Literacy as the totality of all cognitive and social skills which motivates people and enables them to adopt a health-promoting lifestyle.
Health Literacy is seen as the key for health-promoting behaviour. (

23. Health Literacy …. is the ability to
obtain and understand health information.
to make approbriate health decisions.
… requires a complex set of skills, not only the ability to read texts
Reading and understanding tables, statistics, data.
Arithmetic skills.
Interpretation skills in order to understand statistics.
Communication skills in order to discuss with health professionals.

24. Three levels of HL
Functional HL: Skills that allow an individual to read consent forms, medicine labels, and health care information and to understand written and oral information given by physicians, nurses, pharmacists, or other health care professionals and to act on directions by taking medication correctly, adhering to self-care at home, and keeping appointment schedules.
Conceptional HL: The wide range of skills, and competencies that people develop over their lifetimes to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life.

25. Three levels of HL
Critical HL: Strengthening active citizenship for health by
bringing together a commitment to citizenship with health promotion and prevention efforts and involving individuals in:
understanding their rights as patients and
their ability to navigate through the health care system; acting as an informed consumer about the health risks of products and services and about options in health care providers, and
acting individually or collectively to improve health through the political system through voting,
advocacy or membership of social movements.
→ Empowerment of people

26. Health Literacy Gap

27. Opportunities from an improved Health Literacy
Risk-conscious health behaviour
Increased use of prevention and screening measures
Improved treatment adherence and compliance
Improved self-management of risk factors / diseases
Decreased hospitalization
Improved physical and mental health
Decrease of early death risk
Decrease in treatment and health care costs
According to estimates by the WHO the share of health expenditures due to insufficient Health Literacy is 3%-5%. (

28. Standardised Health Literacy Score
(European Health Literacy Survey)

29. How to measure HL?
→ The field currently lacks comprehensive measurement tools.
The REALM and TOFHLA tests are the most frequently used tools to measure health literacy.
Quite new: HLS-EU-Q16 (German short form) – HL Survey EU
Problems:
Tools are limited because they rely excessively on the cloze formatted reading test.
Tests focus on word recognition versus actual understanding.
Tests lack cultural sensitivity and are biased towards certain population groups
Tests place a problematic burden and label on patients.
Tests do not evaluate spoken communication skills.

30. Conclusions …
Lifestyle change
Changing one’s own lifestyle is not something that can be prescribed.
The process of lifestyle change must be built upon the three pillars participation, empowerment and community.
The last two pillars are not conceivable without eHealth.

33. Relevance of strengthening prevention
Most countries still put too much emphasis on the treatment of diseases instead of supporting and strengthening the prevention approach.
Past approaches have been too general and not personalized.
They do not fit into daily life routines of the respective target group.
Preventive medicine requires people’s empowerment to be effective.

34. WHY????

35. eHealth Literacy
„eHealth Literacy is the ability to seek, find, understand and appraise health information from electronic resources and apply such knowledge to adressing or solving a health problem“
(Stellefson at all, 2011)
(Norman/Skinner,2006)

36. European becoming enthuasistic users of online health information.
( ( )

37. Gründe und Motivation für die Internetnutzung
(E--‐Patienten Studie 2014 in Deutschland)

38. Zeitpunkt des Internet-Nutzung
(E--‐Patienten Studie 2014 in Deutschland)

39. Genutzte Dienste
(E--‐Patienten Studie 2014 in Deutschland)

40. Genutzte Anbieter
(E--‐Patienten Studie 2014 in Deutschland)

41. Auswirkungen
(E--‐Patienten Studie 2014 in Deutschland)

42. Auswirkungen auf die Therapietreue
(E--‐Patienten Studie 2014 in Deutschland)

44. Each patient carries his or her own doctor with him/her
Each patient carries his or her own doctor with him/her. The patient just don‘t know it yet and visits us. The most important is to give this own inner doctor the chance to be active.
(Albert Schweitzer)
Jeder Patient trägt seinen eigenen Arzt in sich. Der Patient weiß das noch nicht und kommt zu uns. Das Beste und Wichtigste ist, diesem inneren Arzt im Patienten die Chance zu geben, aktiv zu werden.

45. Thank you!