The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE)

Disparities in Enrollment and Use of an Electronic Patient Portal

“…3 Finally, a more recent study from Kaiser Permanente-Northern California of patients with diabetes showed persistence of racial and ethnic disparities in enrollment even after adjustment for health literacy. 5 The only study of a patient population outside of Kaiser Permanente examined enrollment in a patient portal among patients at an academic practice in Boston. This study found that in a small, random sample that patients who were younger, female, or white were more likely to be enrolled in a patient portal 6 , but did not consider whether patients had been offered access by their providers.…”

“…Although preliminary results indicate possible disparities in enrollment by a variety of factors such as race/ethnicity, these studies did not examine whether this was due to differences in patients' ability to access the internet, differential offering of the portal to patients by physicians, or rates of acceptance by patients after being offered access. [3][4][5][6] Low rates of enrollment could be due to a variety of factors including patient level factors such as distrust in electronic communications or barriers to use (e.g., computer literacy). In addition, it is unclear whether there are differences in how often patients use patient portals after enrollment or their type of use (e.g., soliciting advice, requesting medication refills).…”

Health Literacy and the Digital Divide Among Older Americans

“…6 Moreover, the proliferation of health IT may exacerbate the digital divide. [7][8][9] Vulnerable groups such as African-Americans or those with low socioeconomic status are less likely to use EMRs or patient portals, [9][10][11][12][13][14][15][16] in part because they are less likely to use the Internet at all. [17][18][19][20] Health literacy may also play an important role in determining whether elderly patients are willing and able to use EMRs and other Internet-based health tools.…”

“…Surprisingly, given the substantial body of research that documents the importance of health literacy in health behaviors and outcomes, [21][22][23] it has been largely overlooked as a determinant of health IT use. 24,25 One study 16 used a large sample of patients with diabetes enrolled in a single health plan in northern California to document the importance of health literacy as a predictor of Internet-based patient portal use, even after controlling for basic demographic characteristics. This finding supports the idea that individuals with low health literacy are on the wrong side of the digital divide; however, no population-based study to date has estimated the relationship between health literacy and use of the Internet to obtain health information in the general population of older Americans.…”

Rapid Growth in Use of Personal Health Records in New York, 2012–2013

“…Some patients have limited access to computers or to broadband Internet, 15 and the highly technical information in portals may not be easily usable by patients with limited health literacy. [16][17][18][19] Usability may be inferior to the usability of other consumer technologies. 20 Other factors, such as previous level of engagement in health care 21 and trust in the physician, 22 may also affect a patient's likelihood of using the technology.…”