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Background Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use. Objective To assess the association between patients’ literacy skills and mobile phone ownership, use of text messaging, internet access, and use of the internet for health-related purposes. Methods A secondary analysis utilizing data from 1,077 primary care patients enrolled in two, multi-site studies from 2011–2013. Patients were administered an in-person, structured interview. Results Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison to patients with low or marginal literacy (mobile phone ownership: 96.8% vs. 95.2% vs. 90.1%, respectively, p<.001; smartphone ownership: 70.6% vs. 62.5% vs. 40.1%, p<.001) and to report text messaging (78.6% vs. 75.2% vs. 53.1%, p<.001). They were also more likely to have access to the internet from their home (92.1% vs. 74.7% vs. 44.9%, p<.001) and to report using the internet for email (93.0% vs. 75.7% vs. 38.5%, p<.001), browsing the web (93.9% vs. 80.2% vs. 44.5%, p<.001), accessing health information (86.3% vs. 75.5% vs. 40.8%, p<.001), and communicating with providers (54.2% vs. 29.8% vs. 13.0%, p<.001). Relationships remained significant in multivariable analyses controlling for relevant covariates. Conclusions Results reveal that literacy-related disparities in technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities.

Background & Aims Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation. Methods We analyzed outpatient colonoscopy results from 462 adults, 55–74 y old (mean 62±6 y), who previously completed extensive neurocognitive assessments as part of a prospective study (Health Literacy and Cognitive Function in Older Adults). We collected information on cecal intubation, polyp detection, bowel preparation quality, and histopathology. Results One third of the patients (n=134) had suboptimal quality of bowel preparation, 15% (n=62) had fair quality, and 17% (n=72) had poor quality. Limited health literacy was associated with a lower level of education (P<.001), diabetes (P<.001), and a higher number of chronic conditions (P<.001), but not quality of colonoscopy preparation. No baseline characteristics were associated with patient activation. In multivariable analysis, after adjusting for demographics and clinical characteristics, diabetes (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.35–6.36) and patient activation (OR, 2.07; 95% CI, 1.27–3.40) were independent predictors of suboptimal bowel preparation quality, but limited health literacy was not (OR, 0.76; 95% CI, 0.44–1.31). Conclusions We investigated the relationship between health literacy, patient activation, and colonoscopy preparation quality. Lower patient activation was an independent predictor of suboptimal bowel preparation quality. Interventions to improve colonoscopy preparation quality should consider the importance of patient activation within their design.

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