Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota; and.
Division of Pulmonary, Allergy, Critical Care, and Sleep.
Ann Am Thorac Soc. 2023 Mar;20(3):381-389. doi: 10.1513/AnnalsATS.202208-740OC.
Although overall use is on the rise, certain patient populations have persistently low technology use. To inform the creation of a proactive tobacco treatment program, we assessed access to, use of, and barriers surrounding information and communication technology (ICT) among patients with chronic obstructive pulmonary disease (COPD) who currently smoke, examining associations between key predictors and electronic health (e-health) literacy. Single-center mixed-methods study of veterans with COPD who smoke. Eligible participants who smoked were identified by the e-health record and mailed a survey. E-health literacy was assessed by the eHEALS (Electronic Health Literacy Scale; 8-40). Low technology use was defined as no Internet-capable device and use of ICT less than monthly. Qualitative participants were purposively selected from survey respondents and interviewed using a semistructured guide. Interviews were transcribed and analyzed using directed content analysis. We used a Bayesian three-component joint model to identify predictors of low technology use and low eHEALS. Participants ( = 204) were older (mean age, 65.8), primarily White (76.4%), men (87.1%), and with low income (44.9% income under $20,000). Low technology use was reported by 25.5%, and many reported low use of specific types of ICT. For example, only 36.3% had reliable in-home Internet, fewer than half (46.6%) accessed e-mail at least weekly, 58.3% texted at least weekly, and few used the secure patient portal (13.2% accessed it monthly). The mean eHEALS was 24.6 (±8.7), indicating low to moderate e-health literacy. In the Bayesian analysis, low technology use was associated with lower eHEALS (estimate: -8.5 [95% confidence interval, -12.13 to -4.81]). Attainment of at least a college graduate-level education was associated with higher eHEALS (3.83 [0.43-7.24]). Participants reported barriers to use of ICT, including struggles navigating account security, frequently lost login information, mistrust of providing personal information to the Internet, and lack of familiarity with processes. Many perceived ICT as not useful or necessary. Many patients with COPD who smoke report barriers to engagement with health promotion programs offered electronically, which may perpetuate health disparities. Health promotion programs must account for the low use of ICT and e-health literacy to ensure equitable access across the population.
尽管整体使用率呈上升趋势，但某些特定患者群体的技术使用率仍然较低。为了为主动的烟草治疗计划提供信息，我们评估了目前吸烟的慢性阻塞性肺疾病 (COPD) 患者在获取、使用和面临信息和通信技术 (ICT) 障碍方面的情况，并检查了关键预测因素与电子健康 (e-health) 素养之间的关联。这是一项针对吸烟的退伍军人 COPD 的单中心混合方法研究。通过电子健康记录识别出符合条件的吸烟参与者，并向他们邮寄了一份调查。通过电子健康素养量表 (eHEALS; 8-40) 评估 e-health 素养。低技术使用率的定义是没有互联网功能的设备，并且每月使用 ICT 的次数少于一次。从调查参与者中有意选择定性参与者，并使用半结构化指南进行访谈。对访谈进行转录并使用有针对性的内容分析进行分析。我们使用贝叶斯三组件联合模型来确定低技术使用率和低 eHEALS 的预测因素。参与者（n=204）年龄较大（平均年龄 65.8 岁），主要为白人（76.4%），男性（87.1%），收入较低（44.9%的收入低于 20,000 美元）。25.5%的人报告说技术使用率低，许多人报告说他们很少使用特定类型的 ICT。例如，只有 36.3%的人在家中拥有可靠的互联网，不到一半（46.6%）每周至少查看一次电子邮件，58.3%每周至少发短信，很少有人使用安全的患者门户（13.2%的人每月访问一次）。eHEALS 的平均得分为 24.6（±8.7），表明电子健康素养较低。在贝叶斯分析中，低技术使用率与较低的 eHEALS 相关（估计值：-8.5[95%置信区间，-12.13 至-4.81]）。至少获得大学毕业学历与较高的 eHEALS 相关（3.83[0.43-7.24]）。参与者报告了使用 ICT 的障碍，包括在导航帐户安全方面的困难、经常丢失登录信息、不信任将个人信息提供给互联网以及对流程不熟悉。许多人认为 ICT 没有用或没有必要。许多目前吸烟的 COPD 患者报告说，他们在参与电子健康促进计划方面存在障碍，这可能会延续健康差距。健康促进计划必须考虑到 ICT 和电子健康素养的低使用率，以确保在整个人群中获得公平的机会。
