What is digital health literacy and how is COVID-19 exposing another health inequity?

March 3, 2021 / By Steve Delaronde

Health equity exists when all persons have the opportunity to be healthy, regardless of social, economic, demographic or geographic status. Digital health literacy is the ability to access, understand and use electronic health information and services to address a health problem. Digital health care in the United States has accelerated during the COVID-19 pandemic, yet millions of Americans are being left behind and do not experience the benefits of digital health care due to gaps in digital health literacy.

The comedian, John Oliver, recently quipped that we value our phones over food, water and shelter.  While this was a joke, 81 percent of American adults that own a smartphone can relate. Smartphones and other digital devices are used to connect with friends and family through texting, email and social media. Devices have become even more important during the past year for purchasing food and household items, searching for jobs, taking classes, arranging transportation and obtaining health care services.

The use of telemedicine increased by more than 50 percent in the first quarter of 2020 compared to the same period in 2019. While telemedicine offers convenience and patient safety, these benefits are not shared equally. A recent JAMA study found that during the early phase of the pandemic, persons who were older, insured by Medicaid or did not speak English as a primary language had completed fewer telemedicine visits. Additionally, older, female, Black, Latinx and lower income individuals were all less likely to use video for telemedicine visits, which requires more digital bandwidth than audio alone.

Broadband internet access is still unavailable to 19 million Americans, which includes one-fourth of the population in rural areas and one-third in tribal areas. Additionally, 100 million Americans that have broadband availability do not subscribe.  The multiple barriers to digital access have been well-described in the state of North Carolina. North Carolina’s broadband deployment rate is 95 percent, but its broadband adoption rate is only 59.4 percent. Cost, relevancy and digital literacy are cited as the primary barriers to digital access.

Low digital health literacy is both a cause and an effect of digital health care inaccessibility. Those without access do not become literate, and those that are health illiterate do not appreciate or prioritize the value of digital access to maintain or improve their health. This is especially troubling during the COVID-19 pandemic where states are taking different approaches to testing and vaccinations that require digital literacy in the absence of a federal vaccine management system.  Residents that are unable to access information or make appointments for vaccines online may prolong the COVID-19 crisis.

While COVID-19 has accelerated the adoption of digital health care, the transition had already begun, and there is no turning back. An increasing number of health care services will be available remotely, including the use of digital devices to remotely monitor and treat patients with chronic physical and behavioral health conditions. There were already a plethora of digital therapeutics available or being tested before the pandemic, and the development and adoption of these will continue to proliferate.

The health care system must recognize and respond to digital health literacy as a social determinant of health, otherwise the current social, economic, demographic and geographic gaps will only widen as digital health care expands.

Steve Delaronde is manager of products for Population and Payment Solutions at 3M Health Information Systems.

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