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Cited by 506Health Literacy and Information AccessibilityMobile Health and mHealth ApplicationsElectronic Health Records Systems

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide

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Mackert, Michael, Mabry-Flynn, Amanda, Champlin, Sara, Donovan, Erin E, Pounders, Kathrynn·2016·Journal of Medical Internet Research
DOI 10.2196/jmir.6349PMC PMC5069402
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Abstract

BACKGROUND: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. OBJECTIVE: The purpose of this study was to determine whether health literacy is associated with patients' use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients' perceived ease of use and usefulness of these HIT tools, as well as patients' perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. METHODS: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. RESULTS: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). CONCLUSIONS: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

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  • Available health information within an app is perceived by users as beneficial and positively influences their engagement.

    “Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E).”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [53]

    The Methods (HIT Perceptions) measure whether users consider an app beneficial, and the Discussion links perceived usefulness with HIT adoption. The paper does not establish that health information available within an app is what users find beneficial or that this content positively influences engagement. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Being younger than 44 years was associated with a higher level of uptake and engagement than older adults.

    “Being younger than 44 years was associated with a higher level of uptake and engagement [38,41,42,44,49,53,55,63,64] than older adults.”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [53]

    In Results, Research Question 2 (Tables 3–5; page unavailable), greater age is associated with lower perceived ease of use and usefulness for fitness and nutrition apps and activity trackers. The paper does not report an under-44 comparison showing greater uptake or engagement; it measures actual use separately, and Table 6 shows a different age pattern for patient portals. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Having a better education level, such as high school education or higher and college degree or higher, was associated with better engagement with health and well-being apps.

    “Living in an urban area [42,44,55]; having a better education level, such as having high school education or higher [41,42,44,64] and college degree or higher [41,53]; and having a higher income [44] were also associated with better engagement with health and well-being apps.”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [53]

    In Results, Research Question 2 (Tables 3 and 4; page unavailable), higher education is positively associated with perceived ease of use of fitness and nutrition apps. The paper does not establish that the specified high-school or college-degree thresholds are associated with greater app engagement; its education analyses concern perceptions rather than engagement or use. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Adequate health literacy was associated with increased engagement with fitness and nutrition apps.

    “Mackert et al [53] also found that adequate heath literacy was associated with increased engagement with fitness and nutrition apps.”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [53]

  • Apps were more frequently downloaded by women than men, with the percentage ranging from 59% to 74%.

    “Apps were more frequently downloaded by women than men, with the percentage ranging from 59% to 74% [38,41,49,53,55,63], although 1 study found that being male was associated with using an app to manage alcohol consumption [65].”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [53]

    The Results > Participants section reports overall rates of prior fitness- and nutrition-app use, but not downloads by sex. Searches for women-versus-men app downloads and the 59%–74% range found no passage supporting those figures in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

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Authors
Mackert, M., Mabry-Flynn, A., Champlin, S., Donovan, E. E., & Pounders, K.
Affiliations
  • The University of Texas at Austin (US)
  • University of North Texas (US)
Corresponding author
Mackert, Michael
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2016-10-04
Volume
18
Issue
10
Pages
e264
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.6349
PMC
PMC5069402
OpenAlex
W2528685687
Cited by
503
References
31
Citations by year
2026: 57 · 2025: 60 · 2024: 63 · 2023: 46 · 2022: 46 · 2021: 74 · 2020: 68 · 2019: 40 · 2018: 24 · 2017: 25
FWCI
55.26
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of North Texas Digital Library (University of North Texas) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
literacy, health information technology adoption, digital divide, patient portals, fitness apps, nutrition apps, wearable activity trackers, perceived ease of use, perceived usefulness, institutional trust, public trust in government, trust in healthcare, wearable devices, mobile health apps, Newest Vital Sign, health disparities, patient empowerment, health information access, health equity
MeSH terms
Adult, Female, Humans, Male, Medical Informatics, Health Records, Personal, Health Literacy, Mobile Applications, Digital Divide

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