Clinical and sociodemographic factors associated with digital health literacy in patients with non-Hodgkin lymphoma or colorectal carcinoma.
Authors: Gunning Thomas S , Khoudary Amanda , Billini Osairys , Ip Andrew , Sorgen Lia , Potosky Arnold , Schwartz Marc , Conley Claire C , Derry-Vick Heather 
Published: June 2024

1562

Background: Digital health literacy (DHL), the capacity to find and understand health information using electronic media, is an emerging social determinant of health. Because DHL may impact patients’ ability to benefit from digital health tools and technology-based models of care, it is important to understand how DHL varies in people with cancer. Methods: Patients (N=105) who received systemic treatment for non-Hodgkin lymphoma (NHL) or colorectal carcinoma (CRC) in the past year were recruited from 3 cancer clinics. Participants self-reported DHL (on the electronic Health Literacy Scale, eHEALS), general health literacy (3-item Health Literacy Screening questionnaire), sociodemographic characteristics, and clinical trial enrollment. Independent-samples t-tests (two-tailed; α level of 0.05) and correlations were used to test binary associations between sociodemographic and clinical factors with DHL. Linear regression models were used to test whether associations between clinical factors and DHL remained when adjusting for covariates (based on potential relationships with DHL, p<0.25). Results: Of the 105 participants, 50 (48%) had NHL and 55 (52%) had CRC. Participants were primarily middle-aged to older adults (median age 63, IQR 53-69.5), male (54%), and white/Caucasian (62%), with a college-level education or higher (54%). The mean eHEALS score was 26.9 (SD=8.24, range: 8-40). Higher DHL was related to higher education level ( r s=0.29, p=0.004) and better general health literacy ( r=0.25, p=0.009). Older participants tended to have lower DHL, though this pattern was not statistically significant ( r=-0.12, p=0.21). DHL did not vary significantly by gender, race/ethnicity, or household income in this sample (all ps>0.46). Patients with NHL (mean=24.6, SD=8.10) reported lower DHL than patients with CRC (mean=28.9, SD=7.91; t(103)=2.72, p=0.008); this pattern was similar when controlling for age, education, and general health literacy (unstandardized b=3.07, SE=1.65, p=0.07). Interestingly, the small subset of patients who reported participating in a clinical trial (N=10) reported lower DHL than patients who had not ( t(100)=3.08, p=0.003). In the adjusted model, patients reporting trial enrollment still showed lower DHL above and beyond the effects of age, education, general health literacy, and disease type ( b=-10.45, SE=3.20, p=0.002). Conclusions: In this convenience sample, DHL varied by cancer type, general health literacy, and education level, suggesting interventions to increase DHL may be well-suited for those with NHL and/or lower education level. Further, these factors may affect technology-based care, an important consideration in eHealth intervention development. This study also indicated a possible link between clinical trial enrollment and lower DHL that should be explored in future studies with larger samples.