title: Literacy disparities in patient access and health-related use of Internet and mobile technologies.
abstract: BACKGROUND
  Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use.
  
  
  OBJECTIVE
  To assess the association between patients' literacy skills and mobile phone ownership, use of text messaging, Internet access, and use of the Internet for health-related purposes.
  
  
  METHODS
  A secondary analysis utilizing data from 1077 primary care patients enrolled in two, multisite studies from 2011-2013. Patients were administered an in-person, structured interview.
  
  
  RESULTS
  Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison with patients having marginal or low literacy (mobile phone ownership: 96.8 vs. 95.2 vs. 90.1%, respectively, P < 0.001; smartphone ownership: 70.6 vs. 62.5 vs. 40.1%, P < 0.001) and to report text messaging (78.6 vs. 75.2 vs. 53.1%, P < 0.001). They were also more likely to have access to the Internet from their home (92.1 vs. 74.7 vs. 44.9%, P < 0.001) and to report using the Internet for email (93.0 vs. 75.7 vs. 38.5%, P < 0.001), browsing the web (93.9 vs. 80.2 vs. 44.5%, P < 0.001), accessing health information (86.3 vs. 75.5 vs. 40.8%, P < 0.001), and communicating with providers (54.2 vs. 29.8 vs. 13.0%, P < 0.001). Relationships remained significant in multivariable analyses controlling for relevant covariates.
  
  
  CONCLUSIONS
  Results reveal that literacy-related disparities in technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the Internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Stacy C
authors.initials: SC
authors.lastname: Bailey
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Conor
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bojarski
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mullen
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.|School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Mercy Hospital and Medical Center, Chicago, IL, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vicencio
authors.affiliation: School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Jacobson
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D022126:Access to Information; D000368:Aged; D005260:Female; D057220:Health Literacy; D006306:Health Surveys; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D020407:Internet; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D000068997:Smartphone / Q000706:statistics & numerical data; D060145:Text Messaging / Q000706:statistics & numerical data
keywords: health disparities; health information technology; health literacy