Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 29, 2025
Date Accepted: May 27, 2025
Electronic Health Literacy and Participation in Remote Blood Pressure Monitoring among Patients with Hypertension: A Cross-sectional Study
ABSTRACT
Background:
The ability to participate in digital health services such as remote blood pressure (BP) monitoring needs digital skills and knowledge known as electronic health literacy (e-HL). However, e-HL is rarely studied among those participating in remote BP monitoring (RBPM).
Objective:
This study assessed e-HL levels among participants with hypertension (HTN) and determined the e-HL domains that predict participation in RBPM. This study provides important focus areas to increase RBPM participation.
Methods:
This study was a quantitative, cross-sectional survey of people with HTN in the United States. The survey included demographics, RBPM participation questions, and the e-HL questionnaire (eHLQ) for assessment of e-HL. The eHLQ is a 35-item, 7-domain validated questionnaire including 1. Ability to process information, 2. Engagement in own health, 3. Ability to actively engage with digital services, 4. Feel safe and in control, 5. Motivated to engage with digital services, 6. Access to digital services that work, and 7. Digital services that suit individual needs. Descriptive statistics were used to describe the participants’ demographics and e-HL status. Chi-square tests were used to compare participants’ characteristics between RBPM and non-RBPM groups. The Mann-Whitney U test compared the e-HL domain scores in RBPM and non-RBPM groups. Firth’s logistic regression was used to predict participation in RBPM. The dependent variable was participation in RBPM. The independent variables were demographics and e-HL domains.
Results:
A total of 507 people with HTN participated in the survey. Sixty participants were currently participating in RBPM, giving a prevalence of 11.8% (60/507). The mean age of RBPM participants was 46.2 years (SD 14.7) and non-RBPM was 62 years (SD 13.7), P < .001. The e-HL scores in all 7 domains were significantly higher for the RBPM group than the non-RBPM group. Among the e-HL domains, higher scores in digital services that suit individual needs (domain 7) were the only predictor of RBPM participation (adjusted odds ratio [AOR] 2.84, 95% CI 1.002 – 8.84) considering age, sex, and race variables.
Conclusions:
Participation in RBPM is likely to increase with increase in digital services that are tailored to individual patients’ needs.
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