Health Literacy and the Digital Divide Among Older Americans

Abstract

BACKGROUND: Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy. OBJECTIVE: The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older. DESIGN: We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans. PARTICIPANTS: Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users). MAIN MEASURES: Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms. KEY RESULTS: Only 9.7 % of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9 % of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR=0.36 [95 % CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR=0.60 [95 % CI 0.47 to 0.77]). CONCLUSION: Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Webbased health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.

Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD

“…The positive results of our remote usability testing suggest that individuals with CKD are capable of correctly using mobile health technologies if provided with accurate tutorials on proper device usage, even if testing is performed in the absence of a trained moderator. In a manner similar to traditional health literacy, tailored and simplified approaches to health education may be more effective in promoting understanding of complex health concepts than a one-size-fits-all approach (32,33), because prior studies support the belief that digital learning ability is not restricted to young healthy users (34). The MIS tool presented here has been developed with the capabilities of the target population in mind: simplified dialogue, universal imagery, and the ability to be used across various platforms.…”

The relevance of health literacy to mHealth

“…Adapting to the health literacy levels of different mHealth users is one of the most critical communication factors that will influence the effectiveness of mHealth in effectively reaching and influencing system users [2,5,34,36]. Adapting to differing levels of health literacy means that the messaging used in mHealth systems will need to be designed specifically for different groups of users, assuring the utilization of appropriate language, examples, and visuals that are meaningful for these groups of users.…”

“…These challenges include designing appropriate and effective mHealth messaging for use with audiences who possess different communication competencies, styles and health literacy levels [29,34,36]. While sophisticated and often elegant new technological media receive the bulk of attention in mHealth, the effects of these media on health promotion are highly dependent on the quality of messages that are exchanged via these advanced media.…”

“…Message testing with targeted audiences can also provide relevant information about how well potential mHealth users can understand and accept health messages [36]. Additionally, usability testing of mHealth technologies and information programs can provide relevant information for refining mHealth systems [38].…”

“…It is not merely the use of mobile communication channels that can make these applications effective, it is also the ability to match the messages conveyed via these mobile media to the specific health communication needs, orientations, and competencies of intended audience members [49]. For example, practitioners of mHealth must strategically develop and refine health messaging to match the health literacy levels of key audiences [25,35]. This paper examines the tremendous potential of mHealth applications for providing relevant health information to diverse populations of health care providers and consumers and for enhancing health decision making.…”