Electronic Health Literacy: A Key Determinant in Televisit Acceptance in Inner-City Patients With CKD

ABSTRACT

Background: Televisits have become a more widely used since the COVID pandemic in 2020. However, pts in underserved populations may not be as knowledgable about electronic health resources and may not be able to access this type of health care visit, worsening health care disparities. We examined the relationship between electronic health literacy and acceptance of televisits in an underserved inner-City population of pts with CKD. Method(s) 38 randomly selected CKD pts were surveyed in a face to face fashion including a demographics section, the eHEALS electronic health literacy assessment (scored from 8 to 40), and additional sections on televisit history. eHEALS is a validated 8 question survey that characterizes the subjective ability to find and use electronic health resources. Result(s) Mean age of the pts. was 67+/-15 yrs. 66% were female, 74% did not attend any college, 60% make less than $25,000 per year. 21% did not have any Internet access, 5.3% did not own a cell phone, and 5.3% of cell phone owners did not own a smart phone. 61% need help using the internet. The mean eHEALS of those who need help using the internet is 21.1+/-6.0 vs 27.5+/-8.6 (p=<0.05) for those who do not need help.76% of pts. had a televisit before the survey, of which 76% were telephone only and 24% had visits by both telephone and video. No participant had only used video. Those who had televisits did not differ based on age, education, gender and income from those who did not. Of the 24% of participants who did not have televisits, 100% need help using the internet vs 48% who had televisits (p=0.006). Mean eHEALS score of those who had a televisit was 25.1+/-7.9 vs 18.9+/-4.9 for those who did not (p=0.01). Conclusion(s) In our population of older inner-city CKD patients, 1. Almost one quarter had no home internet access, and over half needed help using it 2. Pts who needed help had lower eHealth literacy and were less likely to have televisits. 3. Televisit use related to eHealth literacy rather than age, education or income. 4. Administering eHEALS may identify people who would benefit most from in person visits, directed educational materials to help with televisits or for whom support should be provided 5. The rise in use of telehealth may further health resource inequities if eHealth literacy is not recognized as a potential negative social determinant in vulnerable populations.