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Study: Patients with Low Health Literacy Less Likely to Use Health IT

December 2, 2016
by Heather Landi
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Advancements with patient-facing health information technology tools, such as wearables, patient portals and mobile apps, have the potential to improve healthcare delivery, low health literacy may be a barrier to patients’ use of electronic tools.

Researchers at the University of Texas at Austin sought to identify the correlation between health literacy and patients’ use of health IT tools in a study published in the Journal of Medical Internet Research titled “Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.” The researchers also sought to examine how issues such as information privacy and trust impact health IT adoption.

According to the researchers, approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information, from reading medication labels to following instructions from health care providers. Further, low health literacy is associated with negative outcomes including overall poorer health.

The need for improved models of communicating clear and compelling health information is pressing and eHealth presents a powerful tool for bringing health information to low health-literate audiences in ways that are easier to access.

The study examines the relationship between eHealth and health literacy by exploring an emerging concept, that of health information technology (HIT), which ranges from personalized fitness trackers to apps on smartphones, to patient portals for electronic health record (EHR) systems.

“Health interventions developed specifically to meet the needs of lower health-literate users can be more broadly acceptable to health-literate users too. Overall, creating effective eHealth interventions is an opportunity that could be easily missed, however, if designers of personal HIT apps do not keep in mind the needs and preferences of lower health-literate audiences,” the study authors wrote.

The researchers studied 4,974 adults and evaluated their health literacy and their use of health IT tools, as well as the perceived ease of use and usefulness of the applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items.

Specifically, the study focused on health literacy and patients’ use of four types of health IT tools—fitness and nutrition apps, activity trackers, and patient portals. Additionally, researchers sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of the health IT tools, as well as patients’ perceptions of privacy offered by health IT tools and trust in government, media, technology companies, and healthcare.

The researchers concluded that patients with low health literacy were less likely to use health IT tools or perceive them as easy or useful, but they perceived information on health IT as private.

“As might have been expected, health IT adoption—linked to perceived ease of use and perceived usefulness—was associated with higher health literacy. Our results suggest that the actual design of health IT apps, ranging from wearable technology to patient portals, has room for improvement so that lower health-literate audiences will perceive the apps as more useful and easy to use,” the study authors wrote.

Further, the researchers concluded that the association between health literacy and privacy issues related to health IT apps was straightforward: lower health literacy was associated with greater perceptions of privacy when using HIT apps. “This relationship points to fruitful directions for future research, including focused study of how users of various health literacy levels make decisions about information to share with apps and by what criteria they judge the privacy protections of various HIT apps. This finding also suggests a need for education on information privacy, perhaps as part of interventions designed to build health literacy and computer self-efficacy skills for underserved populations, to help them make the most informed decisions possible about their health information privacy,” the researchers wrote.

Additionally, the study results indicated the less health-literate participants were less trusting of the government, media, and technology companies. However, those with lower health literacy were more likely to place trust in health care providers. “Further research is needed to better understand the drivers of these feelings of trust, but they have major implications for how HIT apps might be successfully rolled out to the public. The greater feelings of trust in health care providers among lower health-literate users suggest that companies and government organizations interested in rolling out new HIT to lower health-literate populations should consider partnering with trusted health care providers to help ensure adoption,’ the researchers wrote.

And, the researchers summarized. “HIT apps, from smartphone apps to wearables devices to patient portals, have seen widespread adoption in recent years. The pace of development and capabilities of such tools will only increase in the future. There is a pressing need to understand how health literacy is related to HIT app adoption and usage to ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.”

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