STRATEGIES FOR ADDRESSING DIGITAL LITERACY AND INTERNET ACCESS AS SOCIAL DETERMINANTS OF HEALTH

Abstract

Health information technology (HIT) shows potential for increasing the value of health care. However, HIT use is lower among older adults and disadvantaged patients. We evaluated the effectiveness of a program for increasing patient portal use and internet access among underserved patients. We conducted a quasi-experimental study of a community health worker (CHW) and digital literacy program to improve patient portal use by disadvantaged patients seen at one urban primary care clinic. Patients met with a clinic-based CHW who explained patient portal use, gave referrals for a free, health-focused digital literacy training program, and identified connectivity barriers. We evaluated the program using electronic health record data (intervention vs. a control clinic) and daily CHW experience logs. In all, 186 patients met with a CHW. Of these, 2% lacked adequate English proficiency to use the portal, 18% were not interested, 26% already were using the portal and 55% expressed interest and were directed to the training program. Based on data from 6-months pre- and 6 months post-implementation, the CHW program was associated with a three-fold increase in the rate of first-time patient portal use and double the rate of portal-based visit scheduling for the intervention vs. control site (p = 0.14). Training barriers included lack of transportation, fear/anxiety of internet, and cost of internet service. Perceived benefits included ready access to lab results and proxy access to family members’ health information. These results suggest that a novel clinic-based CHW program and community partnership can promote effective HIT use among disadvantaged populations.