ABSTRACT
BACKGROUND: Considering the increased reliance on health technology during the COVID-19 Pandemic, Electronic Health (eHealth) interventions have become important for DM self-management (e.g., glucose monitoring). We have previously shown low HL to be a barrier to technology usage in the general inpatient adult population. However, the role of lowHL specifically for DM self-management requires further evaluation. METHODS: This is a sub-analysis of the Hospitalist Study, an observational, ongoing, quality improvement study of adults (age ≥18 years) enrolled from June 2019-March 2021. Patients were eligible for our sub-study if they were English speaking, had a DM diagnosis, and completed the brief health literacy screen. Participants completed questionnaires assessing technology access/use and online capabilities. Descriptive statistics, bivariate chi-squared, and multivariate logistic regression analyses (adjusted for age, race, education, and gender) were performed using STATA version 15.1 (StataCorp). RESULTS: Among 110 participants, the mean age was 61±15 years, most identified as Black (76%) and/or female (51%) and had at least some college education (58%). There were no significant differences in device ownership between low (n=15) and adequate (n=95) HL groups (93% vs. 94%, p=0.96). Those with low vs. adequate HL were less-likely to have previously used the internet (47% vs. 83%, p=0.006) and less-likely to independently use several internet features: use search engine (33% vs. 76% p<0.001), open online attachment (33% vs. 68%, p =0.005), upload images/files to a website (20% vs 54%, p=0.005), print webpages/online information (27% vs. 49%, p=0.04), use a video (47% vs. 72%, p=0.02), and/or use an interactive video (27% vs. 52%, p=0.01). In the multivariate analysis, participants with low HL remained significantly associated with decreased ability to independently perform online tasks (all measures p<0.05). CONCLUSIONS: Our data suggest that low HL may be a barrier to internet access and usage among patients with DM, but not for technology ownership. Future studies are necessary to ensure that at-risk populations can effectively utilize novel eHealth technologies particularly in the rapidly changing landscape of technology use in the clinical setting.
ABSTRACT
BACKGROUND: As COVID-19 shifted healthcare delivery online, family assistance in accessing care using technology was highlighted, particularly in vaccine appointments and telehealth. While previous literature has characterized factors associated with patients' technology ownership and use, the role of families in assisting with technology access and use is less characterized. METHODS: This is a cross-sectional observational sub-study of a larger study of adult general medicine inpatients at the University of Chicago between 5/2019-8/2021. Patient reported family technology access, use, and assistance were evaluated. Multivariable logistic regressions were conducted to evaluate for association(s) with patient demographics, education level, and health literacy. Health literacy was measured using the Brief Health Literacy Screening Tool. STATA 15.1 was used for analysis, and significance was measured at p<0.05. RESULTS: Of 383 participants, the median age was 57 years, 65%(248/383) were Black, and 53% (204/383) were female. A third were college graduates (32%, 123/383) and had low health literacy (34%, 130/383). Most participants reported that their families owned technology devices (88%, 336/383) and regularly used the internet (once or more per day;72%, 274/383). Cell phones were the most commonly reported way that their families accessed the internet, with 29% (108/369) mostly using a cell phone, and 10% (38/369) using a cell phone and another device equally. 22% (84/383) of participants reported using the internet at a family or friend's house. In the multivariable logistic regression, family technology ownership was negatively correlated with increasing age (p=0.04) and self-identifying as Black (p=0.03). Increasing age (p <0.001) and low health literacy (p= 0.03) had a negative association with family daily internet use. Most participants (89%;233/263) reported having a family member or caretaker who could help them use technology to access telehealth. Increasing age (p= 0.01) and low health literacy (p= 0.03) were negatively associated with having family assistance, while female gender had a positive correlation (p= 0.04). CONCLUSIONS: Although family ownership and usage of technology devices are generally high, family ownership was reported less often among older and Black participants. Lower usage was also reported among those with lower health literacy. While most do have someone to help with telehealth technology, this was less common in older patients and those with low health literacy. Considering the importance of family technology use and assistance in ensuring healthcare, leveraging family networks to access technology-based care can help bridge the technology divide for patients.