Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Online Personal Health Record: A Population-based Survey (Preprint)
Authors: Cheng Christina , Gearon Emma , Hawkins Melanie , McPhee Crystal , Hanna Lisa , Batterham Roy , Osborne Richard H 
Published: December 2021

BACKGROUND

Online personal health records (PHR) have the potential to improve quality, accuracy, and timeliness of health care. However, uptake of online PHRs internationally has been slow. Populations experiencing disadvantages are also less likely to use online PHRs, potentially widening health inequities within and between countries.

OBJECTIVE

With limited understanding of the predictors of community uptake and utilization of online PHR, the aim of this study was to determine the predictors of awareness, engagement, and use of the Australian national online PHR, My Health Record (MyHR).

METHODS

A population-based survey of participants aged over 18 residing in regional Victoria, Australia was undertaken in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship between independent variables including digital health literacy, health literacy, and demographic characteristics and 3 dependent variables of MyHR awareness, engagement, and use. Digital health literacy and health literacy were measured by multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire (eHLQ) and 4 out of the 9 scales of the Health Literacy Questionnaire (HLQ).

RESULTS

A total of 998 responses were analyzed. Digital health literacy was found to be a strong statistical predictor of MyHR awareness, engagement, and use. A 1 unit increase in each of the 7 eHLQ scales was associated with a 2- to 4-fold increase in the odds of using MyHR: 1. Using technology to process health information (odd ratio [OR] 4.14, 95% CI 2.34-7.31); 2. Understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69); 3. Ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75); 4. Feel safe and in control (OR 2.36, 95% CI 1.43-3.88); 5. Motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61); 6. Access to digital services that work (OR2.49, 95% CI 1.32-4.69); 7. Digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The HLQ scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor but older people and people with less education were less likely to use MyHR.

CONCLUSIONS

This study provides insights into the predictors of the use of an online PHR. The findings indicate that, while digital skills training is likely to increase uptake and use of online PHR, initiatives to provides access, develop responsive digital services, establish good health care, and social support are also important. Population groups that are likely to be non-users of online PHR were also identified. A holistic approach and targeted solutions are needed to ensure that online PHR can realize its full potential to help reduce health inequities.

CLINICALTRIAL

Not applicable