Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 17, 2019
Open Peer Review Period: Dec 17, 2019 - Feb 10, 2020
Date Accepted: Mar 21, 2020
(closed for review but you can still tweet)
Beyond health literacy evaluating the need to address digital literacy among hospitalized patients: Cross-sectional study
ABSTRACT
Background:
Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy (HL) who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. While prior research studied the role of HL in technology access/use among outpatients, hospitalized patient populations have not been investigated. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the “digital literacy” of hospitalized patients across HL levels is paramount.
Objective:
We sought to determine the relationship between HL level and technological access, use, and capability among hospitalized patients.
Methods:
Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality-of-care study. Participants’ HL level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed.
Results:
Among 502 enrolled participants, the mean age was 51 years, 75% were African American, half were female, and half had at least some college education. Over one-third (38%) of participants had low HL. The majority of participants owned devices (smartphones: 67% low HL vs 78% adequate HL, P=0.007) and had used the Internet previously (75% vs 91%, P<0.001). Participants with low HL were more likely to report needing help performing online tasks (70% vs 45%, P<0.001). In the multivariate analysis, we found that low HL remained significantly associated with a higher likelihood of needing help performing online tasks, even when adjusting for age, race, gender, and education level.
Conclusions:
The majority of low HL participants had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. Barriers patients face to use of online health information and other health information technology may be more related to online capabilities than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across literacy levels can both understand and have the ability to use them. Clinical Trial: Not Applicable
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