Presentation
HE5 - Associations Between Health Literacy and Health Information Technology and Patient Portal Engagement
SessionPoster Session 1
DescriptionPatient engagement in care improves health outcomes,1 enhances quality of care and patient compliance,2 and increases patient safety.3 Caregivers (e.g., family members, friends) play a critical role in providing social, psychological, and physical support to care recipients. Caregiver engagement affects outcomes positively inside and outside the clinic by reducing unmet patient needs, promoting better quality care, and facilitating interaction with medical professionals.4
Health information technology (HIT) has emerged as a critical tool to support patient and caregiver engagement beyond clinical settings. HIT platforms can enhance engagement through mobile-based interventions, social media, and video games. HIT offers caregivers an opportunity to better meet the needs of their care recipients by enabling remote access to current health information.5 Yet significant challenges to using patient portals exist for those with limited health or digital literacy. These patients often face difficulties navigating patient portals, hindering patient engagement and limiting the effectiveness of these tools.6 Given these challenges, it is essential to know the potential pitfalls associated with HIT and variable health literacy.
While patient portals provide curated health information, the Internet remains an additional source of broad health information, the quality of which is variable and can include misinformation. Users with inadequate health literacy tend to be less careful when searching online and consequently more likely to rely on misinformation.7
Despite the increasing integration of HIT in patient care, differences in how people with different health literacy levels use HIT still need further exploration to ensure equal access to health information and design HIT tailored to the needs of different health literacy levels. We aim to examine relationships between varying levels of health literacy and the perspectives and experiences of using the Internet to access health information.
Methods
This study employed a mixed-methods design. Quantitative data were collected via an anonymous survey in the greater Gainesville, FL area. Qualitative interviews were conducted using a semi-structured interview guide with interviewees from the same geographic area.
Survey analysis included online health information seeking behaviors, health literacy, and basic demographic information from adult caregivers of children under 18. eHealth literacy was assessed using the eHealth Literacy Scale (eHEALS),8 an 8-item tool which measures perceived knowledge and skills for finding, appraising, and implementing health information using the Internet, and the All Aspects of Health Literacy Scale (AAHLS),9 14-item tool which measures health literacy across three domains (functional, communicative, and critical). We examined demographic characteristics using descriptive analysis, while relationships between health literacy levels and use of HIT are described using Pearson correlation. Early themes from qualitative analyses will also be presented.
Results
The survey sample (N=68) was 80.9% female and 42.6% non-white (mean age 37 years; SD = 9.92). Respondents reported a median income of $75,000-$99,999, and 66.2% reported having a college education or higher. Overall mean health literacy on eHEALS was 31.85 (SD=5.5), demonstrating sufficient health literacy. For AAHLS, our sample demonstrated a mean 25.7 (SD=2.8) with subscales means of 4.9 (SD=0.77) for functional health literacy, 8.28 (SD=1.24) for communicative, and 12.51 (SD=1.93) for critical health literacy respectively. We will discuss detailed results of these subscales as well as the broader findings included below.
Pearson correlation analysis showed a weak correlation between the overall AAHLS and eHEALS (r=0.274, p=0.025). AAHLS showed a moderate and significant relationship to income (r=0.354, p=0.003), while the relationship between income and eHEALS did not reach significance (r=0.217, p=0.078). Relationships between AAHLS and use of the patient portal to communicate with the care team showed moderate associations for both personal use of the patient portal (r=0.421, p<0.001) and use of the patient portal for their child (r=0.317, p=0.009). Weaker relationships were observed between patient portal use and eHEALS (r=0.185, p=0.134 and r=0.274, p=0.025 respectively). Similar patterns were found between AAHLS and use of the patient portal to view test results for the respondent (r=0.466, p<0.001) and their child (r=0.322, p=0.008). These were again stronger than the relationships between eHEALS and use of the portal for test results in either the respondent (r=0.229, p<0.063) or their child (r=0.162, p=0.191). Use of health apps other than the patient portal was related with higher levels of eHEALS, but not AAHLS. Use of the Internet for health information was related to both eHEALS (r=0.418, p<0.001) and AAHLS (r=0.362, p=0.003). Similarly, use of the internet for health decisions was positively related to both eHEALS (r=0.526, p<0.001) and AAHLS (r=0.272, p=0.026).
Qualitative themes describe varying levels of comfort with and access to technology, varying levels of trust in the healthcare system, and a lack of essential tools and resources needed to provide optimal care, including inconsistent Internet connectivity in more rural areas. These themes not only reflect the diversity of challenges faced by caregivers but also emphasize the importance of designing inclusive, accessible, and trustworthy healthcare tools aimed at improving caregivers' experiences and overall care quality.
Discussion
We conducted a community survey to explore associations between health literacy and HIT use. Our findings suggest a weak relationship between the health literacy measures. AAHLS showed more consistent relationships with income and specific feature use within the patient portal, while eHEALS was more strongly related to internet use for health information and health decisions. These findings suggest multiple health literacy measures may be necessary to understand different types of HIT engagement.
This work represents our first steps in characterizing factors associated with HIT use to understand how to deliver better support across health literacy levels. We recognize a limitation of the current work is the high health literacy of the sample. We are continuing to expand recruitment for this work with specific attention to reaching lower health literacy populations. We are continuing to expand recruitment for the current survey to capture individuals of lower health literacy and those outside of the Gainesville area and will discuss these efforts and related challenges.
Our work adds important early findings on the relationships between two health literacy measures and HIT engagement both through patient portals and the Internet. We will further explore how these findings inform our future work to tailor HIT delivery to better support individual levels of health literacy.
References
1. Epstein R, Street R. Patient-centered care for the 21st century: physicians’ roles, health systems and patients’ preferences. Philadelphia: American Board of Internal Medicine Foundation. Published online 2008.
2. Marzban S, Najafi M, Agolli A, Ashrafi E. Impact of patient engagement on healthcare quality: a scoping review. Journal of patient experience. 2022;9:23743735221125439.
3. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24-27. doi:10.1136/bmj.39246.581169.80
4. Lobo EH, Abdelrazek M, Grundy J, et al. Caregiver engagement in stroke care: opportunities and challenges in Australia and Denmark. Frontiers in Public Health. 2021;9:758808.
5. Zulman DM, Piette JD, Jenchura EC, Asch SM, Rosland AM. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers’ current practices, interests, and perceived barriers. Journal of medical Internet research. 2013;15(7):e2472.
6. Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using electronic health record portals to improve patient engagement: research priorities and best practices. Annals of internal medicine. 2020;172(11_Supplement):S123-S129.
7. Choukou MA, Sanchez-Ramirez DC, Pol M, Uddin M, Monnin C, Syed-Abdul S. COVID-19 infodemic and digital health literacy in vulnerable populations: a scoping review. Digital health. 2022;8:20552076221076927.
8. Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research. 2006;8(4). doi:10.2196/jmir.8.4.e27
9. Chinn D, McCarthy C. All Aspects of Health Literacy Scale (AAHLS): Developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient Education and Counseling. 2013;90(2):247-253. doi:10.1016/j.pec.2012.10.019
Health information technology (HIT) has emerged as a critical tool to support patient and caregiver engagement beyond clinical settings. HIT platforms can enhance engagement through mobile-based interventions, social media, and video games. HIT offers caregivers an opportunity to better meet the needs of their care recipients by enabling remote access to current health information.5 Yet significant challenges to using patient portals exist for those with limited health or digital literacy. These patients often face difficulties navigating patient portals, hindering patient engagement and limiting the effectiveness of these tools.6 Given these challenges, it is essential to know the potential pitfalls associated with HIT and variable health literacy.
While patient portals provide curated health information, the Internet remains an additional source of broad health information, the quality of which is variable and can include misinformation. Users with inadequate health literacy tend to be less careful when searching online and consequently more likely to rely on misinformation.7
Despite the increasing integration of HIT in patient care, differences in how people with different health literacy levels use HIT still need further exploration to ensure equal access to health information and design HIT tailored to the needs of different health literacy levels. We aim to examine relationships between varying levels of health literacy and the perspectives and experiences of using the Internet to access health information.
Methods
This study employed a mixed-methods design. Quantitative data were collected via an anonymous survey in the greater Gainesville, FL area. Qualitative interviews were conducted using a semi-structured interview guide with interviewees from the same geographic area.
Survey analysis included online health information seeking behaviors, health literacy, and basic demographic information from adult caregivers of children under 18. eHealth literacy was assessed using the eHealth Literacy Scale (eHEALS),8 an 8-item tool which measures perceived knowledge and skills for finding, appraising, and implementing health information using the Internet, and the All Aspects of Health Literacy Scale (AAHLS),9 14-item tool which measures health literacy across three domains (functional, communicative, and critical). We examined demographic characteristics using descriptive analysis, while relationships between health literacy levels and use of HIT are described using Pearson correlation. Early themes from qualitative analyses will also be presented.
Results
The survey sample (N=68) was 80.9% female and 42.6% non-white (mean age 37 years; SD = 9.92). Respondents reported a median income of $75,000-$99,999, and 66.2% reported having a college education or higher. Overall mean health literacy on eHEALS was 31.85 (SD=5.5), demonstrating sufficient health literacy. For AAHLS, our sample demonstrated a mean 25.7 (SD=2.8) with subscales means of 4.9 (SD=0.77) for functional health literacy, 8.28 (SD=1.24) for communicative, and 12.51 (SD=1.93) for critical health literacy respectively. We will discuss detailed results of these subscales as well as the broader findings included below.
Pearson correlation analysis showed a weak correlation between the overall AAHLS and eHEALS (r=0.274, p=0.025). AAHLS showed a moderate and significant relationship to income (r=0.354, p=0.003), while the relationship between income and eHEALS did not reach significance (r=0.217, p=0.078). Relationships between AAHLS and use of the patient portal to communicate with the care team showed moderate associations for both personal use of the patient portal (r=0.421, p<0.001) and use of the patient portal for their child (r=0.317, p=0.009). Weaker relationships were observed between patient portal use and eHEALS (r=0.185, p=0.134 and r=0.274, p=0.025 respectively). Similar patterns were found between AAHLS and use of the patient portal to view test results for the respondent (r=0.466, p<0.001) and their child (r=0.322, p=0.008). These were again stronger than the relationships between eHEALS and use of the portal for test results in either the respondent (r=0.229, p<0.063) or their child (r=0.162, p=0.191). Use of health apps other than the patient portal was related with higher levels of eHEALS, but not AAHLS. Use of the Internet for health information was related to both eHEALS (r=0.418, p<0.001) and AAHLS (r=0.362, p=0.003). Similarly, use of the internet for health decisions was positively related to both eHEALS (r=0.526, p<0.001) and AAHLS (r=0.272, p=0.026).
Qualitative themes describe varying levels of comfort with and access to technology, varying levels of trust in the healthcare system, and a lack of essential tools and resources needed to provide optimal care, including inconsistent Internet connectivity in more rural areas. These themes not only reflect the diversity of challenges faced by caregivers but also emphasize the importance of designing inclusive, accessible, and trustworthy healthcare tools aimed at improving caregivers' experiences and overall care quality.
Discussion
We conducted a community survey to explore associations between health literacy and HIT use. Our findings suggest a weak relationship between the health literacy measures. AAHLS showed more consistent relationships with income and specific feature use within the patient portal, while eHEALS was more strongly related to internet use for health information and health decisions. These findings suggest multiple health literacy measures may be necessary to understand different types of HIT engagement.
This work represents our first steps in characterizing factors associated with HIT use to understand how to deliver better support across health literacy levels. We recognize a limitation of the current work is the high health literacy of the sample. We are continuing to expand recruitment for this work with specific attention to reaching lower health literacy populations. We are continuing to expand recruitment for the current survey to capture individuals of lower health literacy and those outside of the Gainesville area and will discuss these efforts and related challenges.
Our work adds important early findings on the relationships between two health literacy measures and HIT engagement both through patient portals and the Internet. We will further explore how these findings inform our future work to tailor HIT delivery to better support individual levels of health literacy.
References
1. Epstein R, Street R. Patient-centered care for the 21st century: physicians’ roles, health systems and patients’ preferences. Philadelphia: American Board of Internal Medicine Foundation. Published online 2008.
2. Marzban S, Najafi M, Agolli A, Ashrafi E. Impact of patient engagement on healthcare quality: a scoping review. Journal of patient experience. 2022;9:23743735221125439.
3. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24-27. doi:10.1136/bmj.39246.581169.80
4. Lobo EH, Abdelrazek M, Grundy J, et al. Caregiver engagement in stroke care: opportunities and challenges in Australia and Denmark. Frontiers in Public Health. 2021;9:758808.
5. Zulman DM, Piette JD, Jenchura EC, Asch SM, Rosland AM. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers’ current practices, interests, and perceived barriers. Journal of medical Internet research. 2013;15(7):e2472.
6. Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using electronic health record portals to improve patient engagement: research priorities and best practices. Annals of internal medicine. 2020;172(11_Supplement):S123-S129.
7. Choukou MA, Sanchez-Ramirez DC, Pol M, Uddin M, Monnin C, Syed-Abdul S. COVID-19 infodemic and digital health literacy in vulnerable populations: a scoping review. Digital health. 2022;8:20552076221076927.
8. Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research. 2006;8(4). doi:10.2196/jmir.8.4.e27
9. Chinn D, McCarthy C. All Aspects of Health Literacy Scale (AAHLS): Developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient Education and Counseling. 2013;90(2):247-253. doi:10.1016/j.pec.2012.10.019
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)