Background As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3% [95% CI 30.7-36.0] vs 24.2% [95% CI 21.9-26.5], P<.01), were more often female (34.7% [95% CI 32.0-37.3] vs 6.6% [95% CI 5.5-7.6], P<.01) and identified as Black (13.1% [95% CI 11.2-15.0] vs 10.2% [95% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3% [95% CI 6.9-9.8] vs 5.5% [95% CI 4.6-6.5], P<.01) and social isolation (42.6% [95% CI 40.3-44.9] vs 35.4% [95% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [95% CI 49.2-54.4] vs 45.0% [95% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2% [95% CI 14.5-18.0] vs 11.3% [95% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1% [95% CI 12.4-15.8] vs 11.6% [95% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0% [95% CI 16.1-19.8] vs 13.3% [95% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95% CI 1.12-1.65) of being digitally prepared. Conclusions Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort.

BACKGROUND As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skill set. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health literacy and preparedness of Veterans receiving care in the VA to Veterans receiving care outside the VA. OBJECTIVE Describe digital health literacy and preparedness among Veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (having >2 digital health literacy skills) after accounting for demographic and social risk factors. METHODS We used cross-sectional data from the 2016-18 National Health Interview Survey to identify Veterans (age>18) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. RESULTS Those who received health care within the VA health care system (n=3,188) were younger (age 18-49: 33.3% [30.7-36.0] vs. 24.2% [21.9-26.5], p<0.01), were more often female (34.7% [32.0-37.3] vs. 6.6% [5.5-7.6], p<0.01) and identified as Black (13.1% [11.2-15.0] vs. 10.2% [8.7-11.8], p<0.01), and reported greater economic instability (8.3% [6.9-9.8] vs. 5.5% [4.6-6.5], p<0.01) and social isolation (42.6% [40.3-44.9] vs. 35.4% [33.4-37.5], p<0.01) compared to Veterans who received care outside the VA (n=3,393). Veterans who obtained care within the VA reported higher digital health literacy than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [49.2-54.4] vs. 45.0% [42.6-47.3], p<0.01), filling a prescription using the internet (16.2% [14.5-18.0] vs. 11.3% [9.6-13.0], p<0.01), scheduling a health care appointment on the internet (14.1% [12.4-15.8] vs. 11.6% [10.1-13.1], p=0.02), and communicating with a health care provider by email (18.0% [16.1-19.8] vs. 13.3% [11.6-14.9], p<0.01). In adjusted analysis, age >75 (aOR: 0.59, 95% CI 0.45-0.76), low educational attainment (aOR: 0.40, 95% CI 0.34-0.48) and social isolation (aOR: 0.78, 95% CI 0.66-0.92) were associated with a lower likelihood of being digitally prepared. Receiving health care from the VA was the only characteristic associated with higher odds (aOR: 1.36, 95% CI 1.12-1.65) of being digitally prepared. CONCLUSIONS Despite these demographic disadvantages to digital uptake, Veterans who receive care in the VA have higher digital health literacy and appear more digitally prepared than Veterans who do not receive care within the VA – suggesting a positive, system-level influence on this cohort.