Study: Patients with low health literacy less likely to use digital tools

By Heather Mack
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Do digital tools lead to better health literacy? Researchers from the University of Texas at Austin explored if there was a link in health knowledge and health information technology, and found, generally speaking, that those with low health literacy were less likely to use tools like apps and online information sources. 

In a recent of 4,974 Americans, researchers explored whether health literacy was associated with four types of digital tools: fitness and nutrition apps, activity trackers and patient portals where they can access their EHR. They also looked at whether one’s health literacy is associated with their perception of how easy or useful digital tools are. On another aspect, researchers also asked whether individuals felt confident in the security of health information technology tools, and also gauged their level of trust in government, media, technology companies and healthcare overall.

To figure this out, researchers recruited participants from an invitation-only research panel. The participants were asked to complete the , an online screening tool to assess health literacy, and then were asked about their use of the aforementioned digital health tools. Of the full sample, nearly 28 percent had used fitness apps, 34 percent had used a nutrition app, 33 percent had used a fitness tracker, and almost 42 percent had used a patient EHR portal. 

To get a sense of each participant’s perception of how easy and useful health information tools are, researchers asked them to indicate their level of agreement on a 7-point Likert scale. (For example, “Learning to use a fitness app is easy for me” or “A nutrition app is beneficial to me.”) Similarly, they were asked to rate their agreement on whether privacy for each app, activity tracker and patient portal was strong enough, and also whether they trusted four different institutions.  

The researchers found 16 percent of respondents had low health literacy, and the associations were pretty straightforward from there on: those with higher health literacy found digital health tools easier to use and more useful. Those with lower health literacy found them more difficult and less useful, even though they were inclined to believe they were safe to use, privacy-wise. Of those with low health literacy, only 26 percent had used a patient portal, compared with almost half of those with high health literacy. 

“As might have been expected, HIT adoption – linked to perceived ease of use and perceived usefulness – was associated with higher health literacy,” the researchers wrote.

Those who were less health literate may have felt digital health tools to be private and secure, but that trust did not extend to government, media and technology companies. However, they were more likely to trust healthcare companies, presenting an opportunity for digital health tools to reach this population.

“The greater feelings of trust in health care providers among lower health-literate users suggest that companies and government organizations interested in rolling out new HIT to lower health-literate populations should consider partnering with trusted health care providers to help ensure adoption,” the researchers wrote.

Considering about one-third to one-half of US adults struggle with health information, from reading medication levels to following instructions from healthcare providers, the researchers say more digital health tools must be designed that take into account the varying needs of patients based on their health literacy.

“The rapid adoption of mobile phones and smartphones among populations who are more likely to have low health literacy presents tremendous opportunity for improving access to health information and tools to improve health,” the researchers wrote. “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.”

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