Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients

Abstract

Background Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results In total, 95.1% (234/246) of the participants used their personal digital ID (NemID), 57.7% (142/246) were in contact with their GPs electronically, and 54.0% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control . The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions Information about patients’ eHL may provide clinicians an understanding of patients’ reasons for not using digital health services, better than sociodemographic data or self-rated health.

Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study

“…Associations between DL, eHL and SRH in entry-level students are similar to those in a recent study by our group in an outpatient clinic, where we found the same pattern, with eHLA2 and eHLA5-7 associated with SRH [24]. In addition, eHLQ3, eHLQ5, and eHLQ6 correlated positively with SRH [24]. SRH data for graduate-level students should be interpreted with great care because 22.1% of these respondents marked the response "excellent", which may lead to a pronounced ceiling effect.…”

“…The lack of correlation between SRH in students with the DL tools (eHLA5-7) is surprising because the SRH is correlated with six of the seven eHLQ scales. Associations between DL, eHL and SRH in entry-level students are similar to those in a recent study by our group in an outpatient clinic, where we found the same pattern, with eHLA2 and eHLA5-7 associated with SRH [24]. In addition, eHLQ3, eHLQ5, and eHLQ6 correlated positively with SRH [24].…”

“…The scales eHLA and eHLQ used to measure DL and eHL have only been applied in relatively few studies [24,42] and not in relation to nursing students. It may be argued that the reliability and validity in our context has not yet been fully established.…”

“…To the best of our knowledge, neither the eHLA nor the eHLQ have been previously used among students, nursing or otherwise. Both were recently used to investigate eHL in a medical outpatient clinic [24]. This approach supports gaining insight into nursing students' self-reported capability to navigate and act in the healthcare sector.…”

Measures of eHealth Literacy: Options for the Malaysian Population

“…Thus far, the eHLQ has gained international attention with studies being conducted to translate the measures into different languages (Kayser et al, 2018). Additionally, Holt et al (2019) have utilised the questionnaire to study eHealth literacy levels and use of digital health services among Danish patients. Kayser et al (2019) have also utilised the eHLQ in combination with two other health literacy instruments to form a comprehensive tool for the measurement of one's health technology readiness: the Readiness and Enablement Index for Health Technology (READHY).…”