Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination)

Abstract

Background Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth.

Cross-Sectional Study on Health Literacy and Internet Accessibility Among Patients With DM in Gansu, China

“…The current study has been able to determine/compare how widely internet accessibility and affordability affect health literacy outcomes among the different regions with different socioeconomic statuses. Our findings are consistent with others, showing that improved accessibility to the internet is able to provide better health education (40), particularly during the current COVID-19 environment with significant curtailment of face-to-face education opportunities (41).…”

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

“…In this study, we simultaneously examined site, provider, and patient characteristics associated with telehealth and video use in PC and confirmed that racial/ethnic minority groups were more likely to use telephone than video, consistent with both VA and non-VA research [ 1 , 6 , 41 , 47 ]. Although studies on inequities regarding access to virtual care are inconsistent [ 48 – 50 ], major gaps persist in access to cellular data, video-capability, computer devices, adequate/high speed internet coverage and connectivity, which cannot be ignored when examining utilization of virtual care for all patient populations [ 13 ]. One component of addressing the racial/ethnic variations involves tackling the digital divide [ 51 ], as select groups, such as older individuals, and those living in rural areas, as well as individuals with socioeconomically disadvantaged backgrounds, may have more limited access to the internet or camera-enabled devices [ 51 – 53 ].…”

Pitfalls using smartphones videos in diagnosing functional seizures

“…However, it is vital that these recordings are reviewed by a neurologist with expertise treating patients with epilepsy to differentiate epileptic seizures from FS based upon video recording alone. This has limitations for medical professionals who lack epilepsy training [3] , [24] and for non-neurologists [29] .…”

“…Smartphones are ubiquitous [5] , [23] , easy to use, and are available immediately for recording any events that may arise at a given time. One study of a diverse population in the US showed 96% of people surveyed had access to a mobile phone and 83% own a smartphone [24] . On the other hand, there are only 230 accredited specialized epilepsy centers in the US where patients can be admitted and monitored using video-EEG [25] .…”