JMIR Publications

ABSTRACT

Background:

Effective patient portal access and use require both digital navigation and understanding of clinical information. Health literacy and eHealth literacy reflect these different demands. Although the two constructs overlap, prior research often treats them as interchangeable. It remains unclear whether health literacy and eHealth literacy are associated differently across stages of portal engagement and patterns of portal use.

Objective:

To systematically review the literature on the relationships between health literacy, eHealth literacy, and patient portal access, general use, specific portal features, and frequency of portal use.

Methods:

Following PRISMA guidelines, we searched PubMed, Scopus, CINAHL, PsycINFO, Web of Science, and Embase using keywords related to health literacy, eHealth literacy, patient portals, and portal access or use. Because studies differed substantially in literacy instruments, portal outcomes, and outcome measures, we used direction-based vote counting, complemented by narrative synthesis.

Results:

Among 1,107 screened studies, 30 met the inclusion criteria. Of these, 17 examined health literacy only, 10 examined eHealth literacy only, and 3 examined both constructs in the same sample. Studies focused far more on portal use than on portal access and emphasized general portal use over feature-specific outcomes. Any use was assessed more often than frequency of use. In the eHealth literacy literature, all directionally codable studies of general portal use showed lower use among individuals with lower eHealth literacy, whereas health literacy findings for general portal use were mixed. Lower health literacy showed a more consistent pattern of lower portal access and several feature-specific outcomes, although comparable eHealth literacy evidence for these outcomes was limited.

Conclusions:

Every directionally codable eHealth literacy study reported lower portal use among patients with lower eHealth literacy. Lower health literacy showed similar patterns for portal access and several feature-specific outcomes. These consistent associations point to literacy-related disparities at multiple stages of portal engagement, although comparable within-sample evidence remains limited. Future studies should measure both constructs in the same sample, use comparable modeling approaches, objective portal log data when possible, and distinguish access, any use, frequency, and feature-specific behaviors to identify where literacy-related disparities emerge.