JMIR Publications

ABSTRACT

Background:

Despite the benefits of digital health tools, individuals often face barriers because of the digital divide that hinders adoption. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers that prevent use is essential to addressing disparities in use.

Objective:

To identify the skill and usability barriers to using digital health tools.

Objective:

To identify the skill and usability barriers to using digital health tools.

Methods:

This study included patients aged ≥50 who speak English, Spanish, or Cantonese and receive care at an urban safety-net health system in the US. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital healthcare tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant’s preferred language. Kruskal-Wallis, Chi-squared, and Fisher’s exact tests examined the association between key participant demographics and the ability to complete each task independently. Thematic coding was used to identify key skills needed to use the digital tools effectively and determine usability barriers. Chi-squared and Fisher’s exact tests examined the association between themes and the ability to complete the task independently.

Results:

Of the 64 participants, 42 preferred English, 8 preferred Spanish, and 14 preferred Cantonese. 52-74% of participants completed the digital tasks independently (Task 1: 72%, Task 2: 52%, Task 3: 74%, Task 4: 71%). Independent task completion varied by age, race and ethnicity, language preference, education, internet access, and patient portal enrollment. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task. Video observations revealed keyboard navigation, device skills, and human-computer interaction skills as the foundational skills required to navigate the digital tasks. Chi-squared and Fisher’s exact tests indicated significant associations between these skills and the ability to complete each digital task independently. Qualitative codes further identified learnability and operability difficulties for each task that presented key usability barriers for individuals, ranging from hard-to-detect errors that led to repeated mistakes to confusion with where to put information and how to proceed.

Conclusions:

This study identified the foundational skills needed, as well as the learnability and operability issues related to using digital health tools effectively, which are underspecified in the literature. Focusing on a diverse sample from a safety net healthcare setting underscored the importance of these foundational skills for individuals from marginalized communities who face digital exclusion.