Friday, October 27, 2023

Digital Health Literacy Access and Skills

 

Image credit: Pexels, Telehealth

By Lilian H. Hill, PhD

Health literacy and digital health literacy are related but distinct ideas. This blog post is part of our series on different forms of literacy in which we provide definitions of health literacy, digital health literacy, and eHealth literacy. 

Health Literacy

To understand digital health literacy, a definition of health literacy is needed. In Healthy People 2030 (2023), the U.S. Department of Health and Human Services (HHS) provided an updated definition of health literacy that has two components: personal health literacy and organizational health literacy:

  • Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
  • Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. (para. 3)

Begun in 1980 and occurring decennially, the Healthy People initiative sets priority areas to improve population health, provides implementation tools, and tracks progress. This updated definition acknowledges the responsibilities of health providers and systems to communicate effectively with patients of varying identities, language skills, and literacy levels. Older definitions only included reference to personal health literacy skills, burdening patients. 

Digital Health Literacy

Digital health literacy refers to accessing health information online and navigating and using digital or electronic health information and patient resources. It includes electronic patient portals, technology for telehealth visits, and using computers and mobile devices to access medical information and interact with healthcare teams.

The World Health Organization defines electronic health (eHealth) services as the cost-effective and secure use of information communication technologies to support health. Examples include electronic communication between patients and providers, electronic medical records, patient portals, and digital personal health records. A category of eHealth is mobile health (mHealth), including phones, tablets, and computers to use applications (apps), wearable monitoring devices, and texting services. The Centers for Disease Control and Prevention (CDC) defines eHealth literacy as the ability to evaluate health information from electronic sources and apply the knowledge gained to addressing or solving a health problem (CDC).

Digital health literacy involves skills including: 

  • Accessing and using online medical scheduling platforms to make appointments.
  • Using and navigating electronic health records and patient portals.
  • Receiving text message reminders from healthcare providers.
  • Receiving digital health information instead of handouts (for example, information about medication instructions for medication adherence).
  • Obtaining results of medical or diagnostic tests online.
  • Searching for and evaluating online health information. (Rural Health Information Hub, n.d.).
  • Comparing options and enrolling in a health insurance plan on a government website.
  • Searching online for healthy recipes to prepare for a family member with health conditions such as hypertension or diabetes.

Unfortunately, these skills depend on computer and mobile device access, digital tools experience, and a robust broadband network. For example, people with limited income and live in remote rural areas need help accessing broadband. Estimates of people lacking access range between 21 to 162 million (Stauffer et al., 2020). The U.S. government announced investing over 40 billion dollars to extend broadband access to all Americans (The White House, 2023). Access depends on having a data plan with broadband access, yet 40% of low-income households are not subscribed to any data plans. Relying on limited cell phone data or public Wi-Fi spots has limitations, including interruptions and a lack of security and privacy (Sieck, 2021). 

Many healthcare organizations have invested heavily in digital resources to support patient healthcare. Research indicates these tools “can foster greater patient engagement, better support for patients outside of the clinic visit, and can improve health outcomes” (Sieck, 2021, p. 1).

Digital health literacy has become so important to healthcare that it is now included as one of the social determinants of health, the conditions in the environments where people live, learn, work, and play that influence human health, functioning, and quality of life (Sieck et al., 2021). Other elements include: 

  • safe housing, transportation, and neighborhoods;
  • racism, discrimination, and violence;
  • education, job opportunities, and income;
  • access to nutritious foods and physical activity opportunities;
  • polluted air and water; and 
  • language and literacy skills (USHHS, 2023). 

As clinical care delivery is quickly being integrated with digital technologies, Sieck et al. (2021) recommend that healthcare organizations adopt digital inclusive strategies, including assessing patient literacy and access and partnering with community organizations to facilitate digital skills training and connectivity. 

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