Assessment of Electronic Health Literacy among Patients in an Urban, Academic Radiation Therapy Department

Abstract

The COVID-19 pandemic dramatically affected health outcomes and healthcare access, especially with the abrupt transition to virtual care. Cancer patients in the New York City borough of the Bronx, a potentially marginalized community with high rates of poverty and non-English speakers, may be particularly vulnerable to healthcare disparities, given their advanced age and possible difficulty navigating telemedicine appointments due to decreased electronic health literacy (EHL). We investigated EHL levels using both subjective and objective measures and associated predictors of EHL in patients within an academic, urban radiation oncology department. We conducted a prospective IRB-approved study of patients aged ≥18 presenting for care in our department. Patients' internet access and established habits were surveyed via Health Information National Trends Survey (HINTS). Subjective EHL, self-reported comfort using the internet for health information, was assessed via the eHealth Literacy Scale (eHEALS), which calculates a score by adding participants' answers for 8 questions (each on a 1 to 5-point Likert scale). Subjective EHL was categorized as low (8-23), moderate (24-31), or good (32-40). Objective EHL was determined by the eHealth Literacy Objective Scale (eHeLiOS), which tests responses to 9 common scenarios on gathering and assessing electronic health information via multiple-choice questions. The numbers of correct answers were totaled and categorized into low (1-4), moderate (5-7), or good (8-9) EHL. Patients were enrolled between December 2020 and December 2022. 56 patients completed the subjective eHEALS assessment, while 49 completed the eHeLiOS objective test. 52% and 27% of patients identified as Black and Hispanic, respectively; 66% were male, and the median age was 67 (range 28-86). 76% reported accessing the internet regularly, of which 92% reported doing so via broadband network. The prevalence of good EHL was 10% using objective and 29% using subjective surveys. Using a proportional odds logistic model, only age was associated with EHL. For every increased year of age, there was an 11% decrease in objective (OR 0.89, p = 0.02) and 5% decrease in subjective (OR 0.95, p = 0.08) EHL odds, respectively. Gender, race/ethnicity, income, insurance, and employment status were not significantly associated with EHL. Few study patients, who represent an older and potentially marginalized population, showed good EHL levels; more perceived good EHL via subjective testing than we observed using our objective measure. These data suggest implementation of an objective EHL assessment would aid in identifying patients who may benefit from learning activities to improve EHL and support to navigate telehealth visits effectively. Further research is needed to optimize telemedicine strategies for older cancer patients with low EHL.