Background:

Electronic health (eHealth) literacy is defined as the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (e.g., healthcare services and information provided online), place increased demands on patients to have high levels of eHealth literacy. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations that affect access, healthcare utilization, successful use of eHealth resources, and may influence OHI seeking for behavioral change for cancer prevention.

Objective:

Guided by the Preventive Health Model (PHM), this study characterized the extent of OHI seeking and eHealth literacy among Spanish language-dominant (SD) Latino adults ages 50-75, and examined associations between sociodemographic characteristics, PHM constructs, OHI, and eHealth literacy.

Methods:

Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening education intervention, ages 50-75, at average risk for CRC, not up to date with CRC screening, and preferred receiving health information in Spanish. This analysis describes sociodemographic characteristics, health beliefs, OHI seeking, and eHealth literacy (among those seeking OHI) assessed at enrollment. Descriptive analyses were first performed for all variables. Next, univariate logistic analyses were performed to assess associations with OHI. Finally, univariate multiple linear regression analyses were performed to assess associations with eHealth literacy among those who reported seeking OHI.

Results:

Sixty-seven percent of participants were female (n=51), sixty-two percent reported not having graduated high school (n=47), and forty-one percent reported unemployment or an annual income of less than $10,000 (n=31). Additionally, 75% of participants reported not having health insurance (n=57). Seventy-one percent of participants (n=54) reported not having sought OHI for themselves or others. Among those seeking OHI (n=22), 27% percent (n=6) were at risk for low eHealth literacy based on an eHealth Literacy Scale (eHEALS) score less than 26. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (OR=17.4 [95%CI: 2.0 – 150.7]; p=.009). Among those having sought OHI (n=22), univariate multiple linear regression found higher eHealth literacy was significantly associated with higher self-efficacy for screening with Fecal Immunochemical Test (FIT), OR=1.20 (95% CI: 0.14 – 2.26; p=.02).

Conclusions:

A high proportion of SD Latino participants had not sought OHI for themselves or others (e.g., family or friends), thus, limiting their potential access to beneficial online resources. Our pilot study communicates preliminary evidence that higher eHealth literacy is occurring among those with higher self-efficacy for CRC screening. Findings highlight there is a need for resources to improve eHealth literacy and reinforce the need to expand investigations among larger sample sizes examining the role of cultural learning preferences, language, and literacy in a growing technological healthcare milieu.

Clinicaltrial:

The study was registered with ClinicalTrials.gov as NCT03078361 (https://clinicaltrials.gov/ct2/show/NCT03078361?titles=Latinos+CARES&draw=2&rank=1) on March 13, 2017. The first participant was recruited on April 28, 2014, for Phase I and August 10, 2015, for Phase II.