JMIR Publications

ABSTRACT

Background:

Digital health, or technology-based tools and services created to support the health and well-being of individuals, has the potential to improve and complement traditional models of healthcare. However, significant disparities exist in the access to and use of digital health tools limiting use among certain populations, including those with limited ability to navigate digital tools.

Objective:

To assess the role of digital health literacy on patient enrollment in and use of the electronic medical record patient portal.

Methods:

A multi-modal, cross-sectional survey was developed and deployed to 11,424 individuals based on preferred mode and language documented within the clinical Electronic Medical Record. Enrollment in the patient portal and intent to use the patient portal were the outcomes of interest. Counts (n) and proportions (%) were used to describe response categories and unadjusted and adjusted odds ratios are reported to validate the known constructs of the Technology Acceptance Model, and to investigate the role of digital health literacy, assessed via validated questionnaire.

Results:

This study included 1,850 respondents (11,424 invited; 16.2% response rate) who were majority female (58.3%), White (77.2%), and an average age of 63 years. In validation of the Technology Acceptance Model, measures of perceived ease of use (i.e., portal requiring mental effort, portal easy to use) and perceived usefulness (i.e., usefulness of the portal in messaging with providers, scheduling appointments, refilling medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, portal ease of use and portal usefulness constructs in addition to constructs of digital health literacy, knowing what health resources are available on the internet (aOR=3.5, 95% CI 1.8-6.6), portal ease of use (aOR=2.8, 95% CI 1.6, 5.0), and portal usefulness (aOR=2.4, 95% CI 1.4, 4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send / receive emails, having at home internet access, and access to technology devices (computer, tablet, smartphone, etc.).

Conclusions:

Assessing digital health literacy provides additional insight into the barriers and facilitators for patient engagement with digital health connections to providers, such as the patient portal. Systematically addressing the barriers and advancing the facilitators holds potential for further improving healthcare delivery and reducing potential health disparities created by the digital divide.