JMIR Publications

ABSTRACT

Background:

Cutting-edge oncology care often depends on patients’ ability to use rapidly evolving health technology. Digital health literacy (DHL, the capacity to understand health-related information with electronic media) is an emerging, yet underexplored social determinant of health in patients with cancer.

Objective:

To characterize sociodemographic and clinical factors associated with DHL in patients with cancer and explore whether a single-item screener could be derived from a widely-used DHL questionnaire to detect low DHL.

Methods:

Patients (n=105) who received systemic treatment in the past year for colorectal carcinoma (CRC) or non-Hodgkin lymphoma (NHL) were recruited through collaborating clinics. Participants self-reported DHL using the eHealth Literacy Scale (eHEALS). They also reported general health literacy and sociodemographic and clinical characteristics. Correlations and group comparisons (independent-samples t-tests and chi-squared tests, as appropriate) were used to evaluate links between DHL and sociodemographic and clinical characteristics. Receiver operating characteristic (ROC) curve analysis was used to determine whether a single eHEALS item could effectively screen for low DHL (eHEALS score ≤ 20).

Results:

Patients with lower education levels (Spearman’s rho=0.29, P=0.004) and lower general health literacy (r=0.25, P=0.009) had lower DHL. Patients with NHL reported lower DHL levels than those with CRC (t(103)=2.72, P=0.008). Additionally, the subset of patients who reported participation in a clinical trial (n=10) exhibited lower DHL than non-participants (t(100)=3.08, P=0.003). Other sociodemographic and clinical characteristics were not significantly associated with DHL (P-values>0.21). In ROC curve analysis, eHEALS item 4 ("I know where to find helpful health resources on the Internet”) was a strong predictor of high versus low DHL (AUC=0.975, 95% CI, 0.949–1.00, P<0.0001).

Conclusions:

In this convenience sample, DHL varied based on cancer type, education level, general health literacy, and clinical trial participation. Furthermore, a single item from the eHEALS has strong potential for identifying those with low DHL. These findings may inform which patients have higher need for or benefit from DHL interventions and suggest avenues for detecting low DHL in oncology clinics.