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

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: A Randomized Controlled Trial Using AI-Co-Created Materials

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.

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).