Health Literacy, Vulnerable Patients, and Health Information Technology Use: Where Do We Go from Here?

Abstract

In the past few years, the rapid adoption of health information technology (HIT) in the US has been very apparent, largely driven by the more than $25 billion in incentives for "Meaningful Use" of HIT provided to date as a part of healthcare reform in the Health Information Technology for Economic and Clinical Health (HITECH) Act. As we move into Stage 2 of the Meaningful Use program with new metrics for patient engagement, healthcare leaders are now shifting their focus from implementation to understanding patient needs and preferences for health technology use. The article by Levy et al. 1 in this issue highlights an important issue in this landscape: the intersection of vulnerable populations and HIT use.At the national level, the Pew Research Center's Internet and American Life Project estimates that the gaps in technology use (that is, the "digital divide") are shrinking. In 2014, 87 % of US adults accessed the Internet including 81 % of African Americans, 83 % of Hispanics/Latinos, and 77 % of those making less than $30,000 annually.2 Thus, many view HIT as a mechanism to reach diverse populations to engage in health.Despite this, there is not much evidence about how HIT use will affect health outcomes or address existing health disparities. The underlying assumption behind incentives to encourage health systems to implement patient portals is that these portals will improve health. While the evidence is far from conclusive, studies do suggest that patient portals can improve processes of care and adherence. 3,4 Technology is also thought to benefit health through improved patient activation and selfmanagement achieved via access to online health information and peer support. 5,6 However, clear and consistent evidence related to health disparities is lacking.In this issue of JGIM, Levy et al. have honed in on an important subgroup where the digital divide persists: those aged 65 years or older, only 57 % of whom are Internet users. Within this older group, the authors were able to explore additional predictors of Internet use-namely, health literacy, which has been previously shown to predict online portal use. 7They also explored patterns of searching for health information online as opposed to simply noting the presence or absence of any Internet use. The results aren't surprising when examining the barriers of age and health literacy simultaneously: only 32 % of older adults used the Internet to get health information and only 10 % of older adults with limited health literacy did so. This was after adjustment for the major potential confounder of cognitive ability.This pattern is also likely to hold within other subgroups not specifically examined in this study, such as income and race/ethnicity. It is clear from national data that older adults with lower income or from racial/ethnic minority groups are least likely to use the Internet. 8 For example, only 25 % of low-income older adults use the Internet at all, 9 compared to more than 50 % of older adults overall. Furthermore, not only are health li...

“I Want to Keep the Personal Relationship With My Doctor”: Understanding Barriers to Portal Use among African Americans and Latinos

“…A large proportion of individuals in our study, even those who used the computer or mobile phone for other tasks, reported that the portal seemed too complex to access. This is consistent with previous evidence that documented lower usability of portal websites among racial/ethnic minority patients as well as those with limited health literacy [ 20 , 21 ]. Moreover, the need for health literacy training or support was also evident, such as the lack of confidence in being able to independently interpret medical content presented on a portal without one-on-one assistance, which is also consistent with other health technology work [ 22 , 23 ].…”

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“…A lower subjective health literacy is associated with less perceived information provision and lower information satisfaction [ 39 , 40 ]. To comprehend written health information, a person must have certain reading and health literacy levels [ 41 ]. HNC patients are known to have lower educational levels [ 42 ], have poor health literacy, have difficulties interpreting commonly used written health information, feeling inadequately informed.…”

The influence of diabetes distress on digital interventions for diabetes management in vulnerable people with type 2 diabetes: A qualitative study of patient perspectives

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