Journal:Health literacy and health information technology adoption: The potential for a new digital divide

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Full article title Health literacy and health information technology adoption: The potential for a new digital divide
Journal Journal of Medical Internet Research
Author(s) Mackert, Michael; Mabry-Flynn, Amanda; Champlin, Sara; Donovan, Erin E.; Pounders, Kathrynn
Author affiliation(s) University of Texas at Austin, UTHealth, University of Illinois Urbana-Champaign, University of North Texas
Primary contact Email: mackert [at] utexas.edu; Phone: +1 512 471 8558
Editors Eysenbach, G.
Year published 2016
Volume and issue 18 (10)
Page(s) e264
DOI 10.2196/jmir.6349
ISSN 1438-8871
Distribution license Creative Commons Attribution 2.0
Website http://www.jmir.org/2016/10/e264
Download http://www.jmir.org/2016/10/e264/pdf (PDF)
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Abstract

Background: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes, including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing.

Objective: The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts.

Methods: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items.

Results: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03).

Conclusions: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

Keywords: health literacy; personal health information; biomedical technology; medical informatics

Introduction

Health literacy — how people obtain, understand, use, and communicate about health information to make informed decisions[1] — is related to a host of poor health outcomes and increased health care system costs. With approximately one-half to one-third of U.S. adults struggling with health information[1][2], from reading medication labels to following instructions from health care providers, the need for improved models of communicating clear and compelling health information is pressing.

eHealth (the practice of using the internet and telecommunication technology to provide health communication and services)[3] presents a powerful tool for bringing health information to low health-literate audiences in ways that are easier to access. Indeed, populations in which low health literacy is more prevalent, such as households with low incomes and racial or ethnic minorities[1], are also found to be the most likely to own and rely on a smartphone to access the internet.[4] Searching for health topics is a common activity among those with smartphones; a recent survey from the Pew Research Center suggested that 62% of individuals who own smartphones used their phone to acquire information about a health condition or topic.[4] In this study, we further examined the relationship between eHealth and health literacy by exploring an emerging concept, that of health information technology (HIT), which ranges from personalized fitness trackers to apps on smartphones, to patient portals for electronic health record (EHR) systems.

The rapid adoption of mobile phones and smartphones among populations who are more likely to have low health literacy presents a tremendous opportunity for improving access to health information and tools to improve health.[5] eHealth interventions developed specifically to meet the needs of lower health-literate users can be more broadly acceptable to health-literate users too.[5][6] Overall, creating effective eHealth interventions is an opportunity that could be easily missed, however, if designers of personal HIT apps do not keep in mind the needs and preferences of lower health-literate audiences. Häyrinen et al. argue that as HIT continues to evolve, the "needs and requirements of different users [should be] taken into account."[7] Similarly, Bickmore and Paasche-Orlow argue that if researchers work to reduce the barriers related to accessing and using this technology, HIT may “level the playing field” for patients of low health literacy.[8] By enabling this group to receive health information at the right time and place, patients’ understanding and use of this information will be facilitated.[8] Ensuring the broadest possible successful adoption of HIT will ensure a new “digital divide” does not emerge between more health-literate users who can benefit from personal HIT apps and less health-literate users who might struggle to use them to their full potential.

References

  1. ↑ 1.0 1.1 1.2 Berkman, N.D.; Davis, T.C.; McCormack, L. (2010). "Health literacy: What is it?". Journal of Health Communication 15 (Suppl. 2): 9–19. doi:10.1080/10810730.2010.499985. PMID 20845189.  Cite error: Invalid <ref> tag; name "BerkmanHealth10" defined multiple times with different content
  2. ↑ Kutner, M.; Greenberg, E.; Jin, Y.; Paulsen, C. (September 2006). "The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy". U.S. Department of Education. pp. 37. https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483. 
  3. ↑ Eysenbach, G. (2001). "What is e-health?". Journal of Medical Internet Research 3 (2): e20. doi:10.2196/jmir.3.2.e20. PMC PMC1761894. PMID 11720962. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761894. 
  4. ↑ 4.0 4.1 Smith, A. (1 April 2015). "U.S. Smartphone Use in 2015". Pew Research Center. http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/. Retrieved 21 August 2016. 
  5. ↑ 5.0 5.1 Mackert, M.; Love, B.; Whitten, P. (2009). "Patient education on mobile devices: An e-health intervention for low health literate audiences". Journal of Information Science 35 (1): 82–93. doi:10.1177/0165551508092258. 
  6. ↑ Mackert, M.; Whitten, P.; Garcia, A. (2008). "Interventions for low health literate audiences". Journal of Computer-Mediated Communication 13 (2): 504–515. doi:10.1111/j.1083-6101.2008.00407.x. 
  7. ↑ Häyrinen, K.; Saranto, K.; Nykänen, P. (2008). "Definition, structure, content, use and impacts of electronic health records: A review of the research literature". International Journal of Medical Informatics 77 (5): 291-304. doi:10.1016/j.ijmedinf.2007.09.001. PMID 17951106. 
  8. ↑ 8.0 8.1 Bickmore, T.W.; Paasche-Orlow, M.K. (2012). "The role of information technology in health literacy research". Journal of Health Communication 17 (Suppl. 3): 23-9. doi:10.1080/10810730.2012.712626. PMID 23030559. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the PubMed ID was missing and was added to make the reference more useful.

Per the distribution agreement, the following copyright information is also being added:

©Michael Mackert, Amanda Mabry-Flynn, Sara Champlin, Erin E Donovan, Kathrynn Pounders. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.10.2016.

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