Addressing the Digital Divide in Health Literacy

About half of Americans have low health literacy and struggle to find and use health information, which is associated with negative outcomes, including overall poorer health. Health information technology (IT) can be used to make health information directly available to patients via electronic tools, such as patient portals, wearable technology, and mobile apps.

A new study in Journal of Medical Internet Research found that the use of health IT, such as fitness and nutrition apps, activity trackers, and patient portals, are significantly associated with improved health literacy, but patients with low health literacy were less likely to use health IT tools or perceive them as easy or useful. The study also explored whether health literacy is associated with patients’ perceived ease of use and usefulness of these health IT tools, as well as patients’ perceptions of privacy as offered by health IT, and trust in media, government, technology companies, and healthcare.

Michael Mackert, PhD, of the University of Texas at Austin, and colleagues followed 4974 American adults who completed the task-based Newest Vital Sign (NVS) measure of health literacy, which asks patients to read and answer 6 questions about a nutrition label. The NVS is considered a valid and reliable measure of health literacy and is commonly used in studies of health literacy.

Participants were also asked if they had ever used 4 different types of health IT (fitness apps, nutrition apps, activity trackers, and patient portals). For each health IT they were asked to answer questions about perceived ease of use and usefulness of the technology. Perceptions of privacy were assessed for each HIT, and their perceptions of trust in government, media, technology companies, and the healthcare system were assessed. Demographic information on sex, race/ethnicity, age, income, and whether the participant worked in healthcare was gathered. Overall, 15.96% of the sample exhibited low health literacy (scored 3 or less on the NVS).

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). Across all health IT tools, fewer participants with less-than-adequate health literacy indicated technology use than those with adequate health literacy. Greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all health IT tools. Patients with greater health literacy often demonstrated decreased privacy perceptions for health IT 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). In what the researchers call an interesting finding, health literacy score was positively associated with trust in healthcare (P = .03).

“Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to health IT app adoption and usage,” the researchers wrote. “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.”