Supplemental Digital Content 2. The extracted data from the included studies (n=27) Research design

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Supplemental Digital Content 2. The extracted data from the included studies (n=27)

Research design First author (Year) Location

Purpose Participants

∙Number

∙Mean age (range)

Theoretical

framework Key findings Quantitative

(non- experimental)

Chang³⁰ (2014) Korea

To explore the effects of multiple factors on IHI seeking behaviors in older adults

∙300

∙70.0 (over 55)

Technology acceptance model 3

∙IHI seeking behaviors were affected by health relevance, computer self-efficacy, perception of external control, computer anxiety, perceived enjoyment, prior experiences, perceived ease of use, and intention to use.

Choi²⁷ (2011) USA

To explore the association between using health services and health-related internet activities in older adults

∙5294

∙over 65

- ∙32.2% and 14.5% of those aged 65 to 74 and 75 to 84 used the Internet for searching health information.

∙The predictors of health-related internet activities were using health services including general practitioners, medical & mental health specialist, and ophthalmologist, age, gender, education, self-rated health, and family income

Crabb⁵⁵ (2012) USA

To explore the acceptance toward the internet for providing health-related interventions

∙50

∙80.3(65-95) - ∙78% of the participants used the Internet for searching health information.

∙The most popular topics were diseases, medications, and health behaviors such as diet and exercise.

∙Over 70% had positive attitudes toward using internet for health-related issues.

Czaja⁴² (2010) USA

To compare the factors affecting performance of IHI search among young adults and older-old and younger-old adults

∙40

∙70.9 (60-83) [10 Young adults with 27.9 years]

- ∙There were no differences in performance scores between the high performing older and young adults.

∙Internet knowledge for younger-old adults and cognitive abilities for older-old adults were significant predictors of performance of IHI.

Gazibara²⁵ (2016) Serbia

To explore factors affecting computer use and IHI use in older adults

∙346

∙66-89

- ∙About 4% of total participants used internet for searching health information.

∙The predictors of computer use were age, the number of family members, education, income, and comorbidities.

∙The predictors of IHI use were gender and education.

Hall⁴⁰ (2015) USA

To explore the different factors among older users and nonusers of IHI

∙225

∙68.9(50-92)

- ∙46.7% of the participants used the Internet for searching health information.

∙Age, education, healthcare system experience, and computer self-efficacy were differed between older users and nonusers of IHI

Honey⁵⁶ (2016) New Zealand

To explore the attitudes toward and factors affecting IHI in older consumers

∙263

∙over 65

- ∙36% of the participants used the Internet for searching health information.

∙Most participants perceived that IHI was useful and reliable.

∙Gender, ethnicity, education, and health status were not significantly different between user and nonuser of IHI

Medlock²⁶ (2013) Netherlands

To explore the

consequences after finding IHI in seniors

∙100

∙72 (49-94)

- ∙84% of the participants used the Internet for searching health information.

∙58% thought they acquired more knowledge about health

∙51% and 34% made decisions to change their lifestyle and to visit doctors, respectively.

Robertson- Lang²⁹ (2011) Canada

To explore the pattern of searching IHI, topics, and credibility in older adults

∙83

∙62.16(55-86)

Model of web searching

∙71% of the participants used the Internet for searching health information.

∙The most frequently searched health topic was heart diseases.

∙29% confirmed the website credibility whereas 96% counted on the information searched

∙The time for searching was not different between those who accessed high- and low-quality websites.

Sheng³⁸ (2013) USA

To explore factors affecting likelihood of Internet use for health information in seniors

∙771

∙over 50

Theory of consumer’s preventive health behaviors

∙Health information orientation, internet knowledge, and eHealth literacy positively affected likelihood of internet use for health information.

∙eHealth literacy mediated the paths from each of health information orientation and internet knowledge to likelihood of internet use for health information.

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∙Number

∙Mean age (range)

Theoretical framework

Key findings

Sheng³⁵ (2015) USA

To explore factors affecting Internet use for health information in seniors

∙832

∙over 65: 74.9%

Comprehensive model of information seeking

∙The predictors of internet use for seeking health information were intention, perceived usefulness, trust in websites, age, and education.

∙The predictors of intention to internet for seeking health information were perceived usefulness and trust in websites.

Tennant³⁶ (2015) USA

To explore factors affecting eHealth literacy and using of Web 2.0 for health information

∙283

∙67.46 (50-91)

Structural influence model of health communication

∙50.5% of the participants used the Internet for searching health information.

∙The predictors of eHealth literacy were age, education level, the number of electronic devices for seeking health information.

∙The predictors of using of Web 2.0 were gender, education level, having at least one electronic device for seeking health information.

Zulman³⁷ (2011) USA

To explore the relationships between credibility and using online for health information in older adults

∙1450

∙63.7 (over 50)

Conceptual model developed by the

researchers

∙The predictor of using online for health information was credibility.

∙The predictors of credibility in IHI were age, gender, education, negative attitudes toward IHI, and lack of knowledge about the sources for IHI.

Quantitative (experimental)

Bol³⁴ (2013) Netherland

To explore the effects of adding multimedia contents on cancer related IHI in younger and older adults with cancer

∙95/74

∙54.19(21-64), 70.47(65-85)

Cognitive theory of multimedia learning

∙Recall of cancer related IHI in the groups receiving text with multimedia contents was higher than that in the group receiving text-only contents.

∙The effects of adding multimedia contents on cancer related IHI were similar between older and younger adults.

Bol⁴³ (2014) Netherland

To compare the effects of cognitive and affective illustrations in cancer related IHI in older and younger adults

∙271/165

∙47.47(18-64), 70.34(65-85)

Socioemotional selectivity theory

∙There were no differences in recall of cancer related IHI whether the illustrations were added or not in younger and older adults.

∙Older adult with higher emotional support from online was more likely to recall cancer-related information.

Chin⁴⁴ (2017) Canada

To explore the effects of a multi-faceted intervention for improving

understanding of IHI in older adults

∙128

∙70.8

- ∙When the participants read the redesigned website, their understanding skills including recall of the information, reading efficiency, and summary accuracy were improved.

Freund⁴⁵ (2017) Israel

To explore the effects of a tailored medical website intervention in older adults

∙79

∙over 65

- ∙50.6% of the participants used the Internet for searching health information.

∙There were significant differences in health-related knowledge between the intervention and control groups

Czaja²⁸ (2013) USA

To compare the effects of three training programs on using internet for health information in older adults

∙61

∙70.38 (47-92) - ∙There were no differences in performance accuracy, efficiency, and navigation among the control, unimodal, and multimedia groups.

∙In total participants, the predictors of performance accuracy and efficiency were internet experience, cognitive abilities, and the training whereas those of navigation were internet experience and cognitive abilities.

Xie³¹ (2011) USA

To explore the effects of an eHealth literacy

intervention using collaborative and individualistic learning methods in older adults

∙146

∙69.99 (56-91)

Social interdependence theory

∙Computer and Web knowledge and skills and eHealth literacy efficacy were improved after the intervention.

∙In two groups, attitudes toward the intervention were positive as well as the older adults more participated in their health care.

∙There were no differences in the outcomes between collaborative and individualistic learning methods

Xie³² (2011) USA

To explore the effects of a collaborative learning- based intervention for

∙172

∙70.4(over 52)

∙There were significant changes in computer/web knowledge and skills, eHealth literacy efficacy, and computer anxiety between pre- and post-intervention.

∙The participants reported the IHI was helpful and positively impacted their health behaviors

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∙Number

∙Mean age (range)

Theoretical framework

Key findings

improving eHealth literacy in older adults

and decision making.

Xie³³ (2011) USA

To explore the effects of the combination inventions of learning methods and modalities in older adults

∙124

∙68.15

∙There were no significant differences in eHealth literacy efficacy, eHealth literacy skills, and perceived usefulness among the intervention groups

∙ There were significant changes in eHealth literacy efficacy, eHealth literacy skills, and perceived usefulness after the intervention in each intervention group.

Xie³⁹ (2012) USA

To explore the effects of a computer-based health literacy intervention for older adults

∙218

∙70(60-89)

Theory-driven, but not detailed information

∙There were significant changes in computer/web knowledge, computer anxiety, interest, and efficacy between pre- and post-intervention.

∙78% of the participants engaged in their health care after the intervention.

Quantitative (methodological)

Chung⁴¹ (2015) USA

To explore the

psychometric evaluation of eHealth Literacy Scale for older adults

∙866

∙62.84

- ∙The mean eHEALS was 30.94, ranging from 8 to 40.

∙The alpha coefficient for internal consistency was .94.

∙The eHEALS score was positively correlated with knowledge about computer, internet experience, and internet usage time per week.

Mixed-method Chung²¹ (2011) Korea

To explore the use of IHI and perceived barriers to IHI in older adults

∙91

∙73.2 (over 65)

Access to Information framework

∙Among those who had searched IHI, 85% agreed the usefulness of IHI and 81.8% changed their behaviors.

∙The barriers were no interest, complexity, and limited opportunities for learning.

Fink²² (2015) USA

To explore the effects of a guidance website for improving older adult’s searching skills

∙18(focus group) /64(quantitative)

∙68.5(56-101)

Health belief model Knowles’ theory (andragogy)

∙The participants in the focus group preferred to an interactive guidance website for searching IHI.

∙There were no differences in knowledge about evaluating websites and self-efficacy related to using internet for health information between the guidance interactive website group and traditional tutorial group.

Malone²³ (2017) USA

To explore the use of IHI and perceived barriers to IHI in older adults

∙32

∙over 65: 60%

- ∙Although 88% perceived the importance of internet for health information, 53% could not identify the quality of IHI.

∙The most popular topics were diagnosis, condition, and drugs.

∙The barriers were concerns about credibility in IHI and unfamiliarity on computer and internet.

Qualitative (focus group)

Cresci²⁴ (2012) USA

To explore urban older adult’s perception and needs for Internet use for health

∙18

∙72(56-95)

- ∙Although the participants were interested in using internet for their health, most of them discouraged to find adequate information on the internet

∙The participants were worried about the credibility of the online information.

∙The participants reported their needs for learning computer and internet.