Frontiers in digital health · 2026
Digital health literacy in safety-net primary care: a needs assessment and call to action for health equity.
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Glickstein Julie, Idumonyi Jessica O, Ting Tina, Robles-Aponte Ines, Ramey Matthew, Fullilove Robert, Singer Jessica
Аннотация
BACKGROUND: Digital literacy is a crucial social determinant of health. The COVID-19 pandemic's rapid shift to digital health services has widened disparities for older adults, racial and ethnic minorities, and low-income populations. Understanding barriers to electronic medical record (EMR) use is essential for equitable care in safety-net settings.
METHODS: We conducted a cross-sectional needs assessment survey (N = 204) at an urban primary care clinic in Washington Heights, New York City, serving predominantly Latino (83%), Spanish-speaking (31%), and older adult (67% aged ≥65) patients. We assessed demographics, EMR use frequency, digital health literacy [eHealth Literacy Scale (eHEALS)], patient portal (MyChart) functional competency, and learning interest using chi-square tests for categorical variables and t-tests for continuous variables. Pairwise comparisons with post-hoc correction were conducted for multi-category variables. EMR patterns were operationalized as self-reported frequency of patient-initiated digital communication with healthcare providers using the clinic's electronic patient portal system within the past 6 months.
RESULTS: EMR use varied significantly by age among stable age groups, χ 2 (2) = 12.34, p = 0.002: 63.9% of ages 31-64 and 53.7% of ages ≥65 reported EMR use. [Note: Adults ages 18-30 comprised only n = 7 (3.4% of sample); 100% EMR use in this group, 95% CI: 59-100%, is underpowered and excluded from primary interpretation.] Employment status was significantly associated with EMR use [χ 2 (2) = 10.89, p = 0.003], with full-time employed individuals showing 95.5% usage, compared to 54.6% among retired and 57.7% among unemployed respondents. Bonferroni-corrected pairwise comparisons (adjusted α=0.017) confirmed significant differences between full-time employed and retired individuals (p < 0.001) and between full-time employed and unemployed individuals (p = 0.002). Mean eHEALS score was 25.33 (SD = 6.83) out of 40, indicating moderate digital literacy. Approximately half of participants demonstrated proficiency with individual MyChart functional tasks: viewing lab results (47% correct), reading physician notes (43% correct), messaging providers (50% correct), requesting refills (46% correct), and scheduling appointments (42% correct). Despite this lower EMR engagement, 71.6% expressed interest in learning EMR skills overall [83.1% among ages ≥65, 83.1% among Spanish speakers, χ 2 (2) = 18.76, p < 0.0001, these representing separate subgroup analyses]. Women showed significantly higher interest than men [76.8% vs. 47.2%; χ 2 (1) = 14.32, p = 0.0004].
CONCLUSIONS: This study highlights a key tension: EMR engagement is lowest among older, retired, and Medicare-only patients, yet these groups show the greatest motivation to build digital health skills. Overall, 71.6% of participants report interest in learning digital health skills, with notably high interest among seniors (83.1%) and Spanish-speaking patients (83.1%, each analyzed as separate subgroups). These findings point to a strong opportunity for targeted interventions. We recommend integrating digital health navigators into primary care clinics, creating culturally tailored training programs with Spanish-language options, and advocating for user-centered EMR design to promote health equity in digital health access.
METHODS: We conducted a cross-sectional needs assessment survey (N = 204) at an urban primary care clinic in Washington Heights, New York City, serving predominantly Latino (83%), Spanish-speaking (31%), and older adult (67% aged ≥65) patients. We assessed demographics, EMR use frequency, digital health literacy [eHealth Literacy Scale (eHEALS)], patient portal (MyChart) functional competency, and learning interest using chi-square tests for categorical variables and t-tests for continuous variables. Pairwise comparisons with post-hoc correction were conducted for multi-category variables. EMR patterns were operationalized as self-reported frequency of patient-initiated digital communication with healthcare providers using the clinic's electronic patient portal system within the past 6 months.
RESULTS: EMR use varied significantly by age among stable age groups, χ 2 (2) = 12.34, p = 0.002: 63.9% of ages 31-64 and 53.7% of ages ≥65 reported EMR use. [Note: Adults ages 18-30 comprised only n = 7 (3.4% of sample); 100% EMR use in this group, 95% CI: 59-100%, is underpowered and excluded from primary interpretation.] Employment status was significantly associated with EMR use [χ 2 (2) = 10.89, p = 0.003], with full-time employed individuals showing 95.5% usage, compared to 54.6% among retired and 57.7% among unemployed respondents. Bonferroni-corrected pairwise comparisons (adjusted α=0.017) confirmed significant differences between full-time employed and retired individuals (p < 0.001) and between full-time employed and unemployed individuals (p = 0.002). Mean eHEALS score was 25.33 (SD = 6.83) out of 40, indicating moderate digital literacy. Approximately half of participants demonstrated proficiency with individual MyChart functional tasks: viewing lab results (47% correct), reading physician notes (43% correct), messaging providers (50% correct), requesting refills (46% correct), and scheduling appointments (42% correct). Despite this lower EMR engagement, 71.6% expressed interest in learning EMR skills overall [83.1% among ages ≥65, 83.1% among Spanish speakers, χ 2 (2) = 18.76, p < 0.0001, these representing separate subgroup analyses]. Women showed significantly higher interest than men [76.8% vs. 47.2%; χ 2 (1) = 14.32, p = 0.0004].
CONCLUSIONS: This study highlights a key tension: EMR engagement is lowest among older, retired, and Medicare-only patients, yet these groups show the greatest motivation to build digital health skills. Overall, 71.6% of participants report interest in learning digital health skills, with notably high interest among seniors (83.1%) and Spanish-speaking patients (83.1%, each analyzed as separate subgroups). These findings point to a strong opportunity for targeted interventions. We recommend integrating digital health navigators into primary care clinics, creating culturally tailored training programs with Spanish-language options, and advocating for user-centered EMR design to promote health equity in digital health access.