Characterizing the digital divide in a diverse cohort of African American (AA) patients (pts) with prostate cancer (PCa).
Authors: Kilbridge Kerry L. , Martin-Doyle William , Filson Christopher Paul , Williams Sierra , Trinh Quoc-Dien , Master Viraj A. 
Published: June 2023

e18571

Background: We assessed pts’ self-reported access and ability to use a computer (C) and/or smart phone as part of a larger study exploring treatment decisions in a diverse group of AA PCa pts. Methods: Face-to-face interviews were conducted in a prospective cohort of 152 newly diagnosed early-stage AA PCa pts at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Pts were asked whether they had access to a C, whether they had a C in their home, and whether they knew how to use a C. The questions were also asked about smart phones with Internet access. Demographics were collected including income, education (ed), and health literacy (lit) measured with the Rapid Estimate of Adult Literacy in Medicine (categorized as ≤ Grade (Gr) 3; Gr 4-6; Gr 7-8; and high school (HS)). Fisher’s exact test and logistic regression were employed to identify variables associated with the ability to use a C or smart phone. Due to the hypothesis generating, exploratory nature of the current analysis, no adjustments were made for multiple comparisons. Results: Age ranged 44-81. Annual income categories ranged from <$10,000 to >$76,000. Ed ranged from 4 years to 20. Most pts, 62%, had low health lit (< Gr 7-8) but 38% had adequate health lit (HS). In the lowest categories of each variable, more pts had access to a smart phone or C than had a smart phone or C at home, which in turn was greater than the number of pts who knew how to use a smart phone or C. In the lowest categories of each variable, more men knew how to use a smart phone than a C. Of 72 men with some college ed or higher, 90% or more had a smart phone or C and knew how to use them compared with 67% (39/58) with HS ed and 50% (11/22) with < HS ed who knew how to use a smart phone (p < 0.001), and 55% (32/58) with HS ed and 27% (6/22) with < HS ed who knew how to use a C (p < 0.001). Although ~ 90% of pts with income <$25,000 annually had access to smart phones or Cs, 72% (46/64) knew how to use a smart phone (p = 0.016) and just 56% (36/64) knew how to use a C (p = 0.004). Among pts reading at < Gr 4-6, 62% (23/37) knew how to use a smart phone (p = 0.006) and only 43% (16/37) knew how to use a C (p < 0.001). In multivariate logistic models predicting knowledge of how to use Cs or smart phones including the covariates education, income, health lit, and age, education remained a significant predictor of knowledge. Compared to men with < HS ed, men with some college ed or higher were more likely to know how to use a C (OR 77.1, 95% CI 13.8-689, p < 0.001) and were also more likely to know how to use a smart phone (OR 23.0, 95% CI 4.7-176, p < 0.001). Conclusions: Between 28-50% of pts with < HS ed, annual income < $25,000, and < Gr 4-6 health lit do not know how to use a smart phone. Between 44-73% of pts with < HS ed, annual income < $25,000, and < Gr 4-6 health lit do not know how to use a C. Presuming that pts can use the Internet through a C or smart phone to participate in cancer care and research may exacerbate health disparities for the most vulnerable pts. Clinical trial information: NCT03322891 .