JMIR Publications

ABSTRACT

Background:

Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine towards people-centredness. Thus, eHealth literacy may support better experiences of care supported by innovative digital health solutions.

Objective:

To explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary.

Methods:

In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS) and PREMs with outpatient care with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD). Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test and chi-square test. To capture non-linear associations, after controlling covariates, we analysed the relationship between eHEALS quartiles and PREMs using multivariate probit, OLS, ordered logit and logistic regression models.

Results:

653 respondents (356 females, 54.5%) were included in the study with mean age of 49.2 (SD 17.5) and eHEALS score of 29.4 (SD 4.9). Respondents with higher eHEALS score were more likely to understand the healthcare professionals’ explanations (Chi-square(9)=25.6, P=.002) and to be involved in decision-making about care and treatment (Chi-square(9)=18.0, P=.03). In multivariate regression, respondents with lowest (1st quartile) and moderately high (3rd quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.03) and experience fewer problems (P=.03). Also, those respondents had better experiences in terms of how easy it was to understand the healthcare professionals’ explanations (P=.002) and being able to ask questions during their last consultation (P=.03). Patient reported experiences of individuals with highest (4th quartile) and lowest (1st quartile) eHEALS levels did not differ significantly. Also, the relationship between eHealth literacy and self-reported unmet medical needs, and waiting times, was not significant.

Conclusions:

We demonstrated the association between eHealth literacy and PREMs. Individuals with the lowest self-reported eHealth literacy levels have a greater chance of a negative experiences with outpatient care, while those with moderately high eHealth literacy are more likely to have positive experiences. Actions should be taken to identify and support people with low eHealth literacy as they are at higher risk of experiencing problems in outpatient care, and hence, having difficulties to cope with medical treatments. The potential patient-, physician- and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation.