Patient Data Access News

How Does Patient Health Literacy Affect Digital Health Use?

New research shows that patients with lower health literacy are less likely to use different forms of digital health tools than those with high health literacy.

By Sara Heath

Patients with high health literacy are more likely to use digital health tools than those with lower health literacy, finds a new study published in the Journal of Medical Internet Research.


The study of nearly 5,000 adult patients first tested patient health literacy using the Newest Vital Sign measure for health literacy. Patients then answered questions regarding their relationship with digital health, including whether or not they had used fitness and nutrition apps, activity trackers, or patient portals.

Overall, 16 percent of participants displayed low health literacy, and the remaining participants had at least adequate health literacy.

Twenty-eight percent of respondents had used a fitness app, 34 percent had used a nutrition app, 33 percent had used an activity tracker, and 42 percent had used a patient portal.

Fewer patients with low health literacy had used each of the four tested digital health tools than those with adequate health literacy. For example, 25.7 percent of patients with low health literacy had used a patient portal, while 45 percent with high health literacy had reported the same.

The researchers also surveyed participants on their views of digital health, including the tools’ ease-of-use. Overall, patients with lower health literacy did not find the tools as easy-to-use as patients with higher health literacy. This may have implications for patient health IT adoption.

“HIT adoption—linked to perceived ease of use and perceived usefulness—was associated with higher health literacy,” the researchers, led by Michael Mackert, PhD, wrote. “This stands to reason, given that health literacy is defined as how people obtain, understand, use, and communicate about health-related information.”

These findings suggest that health IT developers need to make these tools more navigable for less health literate patients.

“Given that more health-literate users still appreciate the simplicity and approach of interventions designed for lower health-literate users, a focus on design and usability for lower health-literate users would benefit all users,” they explained.

The results highlighted a distinction between ease-of-use and usefulness. Although high health literacy was strongly correlated with ease-of-use, it was not with usefulness. Patients with high health literacy may have been able to navigate digital health tools, but they did not find them relevant to or useful for health improvement.

Additionally, the researchers questioned participants about notions of digital health privacy, finding that those with lower health literacy were more likely to think digital health kept information private than their more literate counterparts were.

“This finding also suggests a need for education on information privacy, perhaps as part of interventions designed to build health literacy and computer self-efficacy skills for underserved populations, to help them make the most informed decisions possible about their health information privacy,” Mackert and colleagues offered.

Patient trust in health-related institutions was less clear, however. The researchers examined this area because certain institutions – including healthcare organizations, government, media, and technology companies – hold a stake in developing new digital health apps and devices.

Patients with lower health literacy scores reportedly held trust in some institutions more than others. For example, lower health literacy indicated distrust in government, media, and technology companies. In contrast, these patients trust healthcare organizations.

Although the researchers said they need to conduct further investigations to understand this pattern, they maintain that it has implications for future health IT rollout.

“The greater feelings of trust in health care providers among lower health-literate users suggest that companies and government organizations interested in rolling out new HIT to lower health-literate populations should consider partnering with trusted health care providers to help ensure adoption,” they explained.

In the future, health IT developers and industry professionals should consider their target audiences, ensuring that technologies are designed for actual patient use. According to Mackert and colleagues, ample research could lead to better developed tools that are useable for all patient populations.

“The pace of development and capabilities of such tools will only increase in the future,” the researchers concluded.

“There is a pressing need to understand how health literacy is related to HIT app adoption and usage to ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.”

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