Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review

Abstract

Objective The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States. Materials and Methods We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics. Results We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use. Discussion Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed. Conclusion Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use.

eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study

“…Collectively, these results demonstrate that although younger age and better health status jointly predict greater engagement in using eHealth for self-management, there is no generational divide in having health-related apps, accessing electronic health records, and sharing eHealth data with clinicians among cancer survivors with BMI in overweight or obese categories. Our results show agreement with mixed evidence that age is associated with eHealth use [ 34 , 35 , 37 ], and echo findings indicating that better health was associated with greater eHealth use to track health and goals [ 34 , 35 ].…”

“…Individuals in the increasingly culturally and linguistically diverse survivor population may have different medical experiences, as well as different digital access and engagement [33]. The few studies [34][35][36][37] that have investigated associations among eHealth use, sociodemographic characteristics, and medical history examined the general population rather than cancer survivors. In these studies [34][35][36][37], researchers found poorer engagement in eHealth practices among adults who are older, male, in a lower annual income bracket, less healthy, or without a regular provider.…”

“…The few studies [ 34 - 37 ] that have investigated associations among eHealth use, sociodemographic characteristics, and medical history examined the general population rather than cancer survivors. In these studies [ 34 - 37 ], researchers found poorer engagement in eHealth practices among adults who are older, male, in a lower annual income bracket, less healthy, or without a regular provider. Even less is known about how different care experiences are associated with different types of eHealth practices.…”

Patient Preferences for Using Technology in Communication Post Hospital Discharge

“…Some have suggested that there is an emerging 'digital divide' where patients that lack access to computers and smartphones for a variety of reasons could miss out on health innovations that use digital technology (26). However, a recent review (albeit of few studies) reported no associations with patient characteristics (including income) and digital health tool use (27).…”

Devil in the details: understanding the effects of providing electronic health record access to patients and families

“…First, all studies need to both include diverse participants and report on race, ethnicity, educational attainment, and health and digital literacy. 13 Second, future work must focus on both internal and external validity of patient access/use of EHR data. The review by Neves et al gives us some clearer understanding of the internal validity of studies on clinical and patient-reported outcomes, but it remains unclear what impact these types of interventions will have on health outcomes across an entire healthcare system or region outside of RCT samples.…”