Health literacy and the digital divide among older Americans.
BACKGROUND
Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy.


OBJECTIVE
The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older.


METHODS
We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans.


METHODS
Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users).


METHODS
Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms.


RESULTS
Only 9.7% of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9% of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR = 0.36 [95% CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR = 0.60 [95% CI 0.47 to 0.77]).


CONCLUSIONS
Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Web-based health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.
Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48104, USA, hlevy@umich.edu.
Helen
H
Levy
Alexander T
AT
Janke
Kenneth M
KM
Langa
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D066310:Digital Divide / Q000639:trends; D005260:Female; D057220:Health Literacy / Q000639:trends; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States