Telehealth Literacy as a Social Determinant of Health: A Novel Screening Tool to Support Vulnerable Patient Equity

Abstract

Background: Telehealth has evolved as a solution to COVID-19 isolation precautions and remote care with well-established health, socioeconomic, and practical benefits. However, there are many gaps in the current literature regarding telehealth use among older, low health literate, and resource-limited populations. There are ethical considerations that warrant understanding this digital divide. Objective: The objective of this review is to propose the Telehealth Literacy Screening Tool (TLST) for use in older adults and support the future inclusion of telehealth literacy as an important social determinant of health (SDOH). Methods: Initially a four-week outreach was performed that targeted older adults and low-health literate patients at the MedVantage Clinic (MVC) within Ochsner Health (OH) to identify common barriers to patient engagement with the OH Epic MyChart telehealth platform. Themes from those barriers directed a meta-synthetic review of the methods and ethical considerations of current, validated technological and telehealth literacy screening tools. Those findings were reported based on the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Based on the barriers identified during our MVC patient outreach, PRISMA-reported review of telehealth literacy screening research, and evaluation of the MyChart platform and the technological resources required for its use; we developed a multidimensional questionnaire for telehealth literacy screening of older adults. Conclusion: The TLST is designed to identify patients in need of additional interventions for successful connection to telehealth services. This is an important step towards addressing the ethical obligation to decrease disparities in telehealth literacy for vulnerable populations and identifying telehealth literacy as a SDOH.

Digital literacy as a new determinant of health: A scoping review

“…mHealth literacy focuses on information gathered with the use of mobile devices [ 25 ] while eHealth literacy focuses on information gathered from online resources [ 23 ]. Telehealth literacy specifically focuses on telehealth platforms [ 27 ].…”

“…( S3 Table ) The tools differ in terms of evaluation elements, applicable groups, and intended use. Six of these specifically focus on digital literacy [ 29 , 30 , 39 – 42 ], six on eHealth literacy [ 12 , 33 , 36 , 37 , 43 , 44 ], four on digital health literacy [ 45 – 48 ], one on digital healthy diet literacy [ 49 ], one on telehealth literacy [ 27 ], one on health information literacy [ 50 ] and one on a combination of eHealth and mHealth literacy [ 51 ]. Most of these tools are self-rated Likert scales except for eHealth Literacy Assessment [eHLA) toolkit [ 36 ] and Digital Health Literacy Instrument [DHLI] [ 45 ] which both employ a combination of self-rated and performance-based assessment, and Digital Literacy Evaluation [DILE) tool [ 41 ], which is performance-based.…”

The role of digital literacy in achieving health equity in the third millennium society: A literature review

“…Intimately associated with this concept is the principle that ensuring equity of access to digital health through the enhancement and development of digital literacy must be a priority felt by multiple stakeholders: consumers (patient and carers), consumer advocacy groups, health service staff (clinicians, nurses, pharmacists), health services (providers), policy-makers/funders, researchers, and industries ( 44 ). This is because telemedicine and medical care provided through digital tools in general is now officially and definitively a concrete and tangible reality, so much so that it is universally recognized as a social determinant of health (SDOH) ( 30 , 43 ). A very interesting idea would be to provide for the introduction of specific teachings on digital literacy within school curricula.…”

“It Took Away and Stripped a Part of Myself”: Clinician Distress and Recommendations for Future Telepalliative Care Delivery in the Cancer Context

“…Issues of digital equity and telehealth literacy should be investigated to identify barriers and facilitators to telemedicine access, particularly for underserved or at-risk populations who may lack the fiscal and technological resources needed to readily engage health services through these platforms. [30][31][32] As telehealth services become more widely utilized in palliative care, as well as throughout health systems, user-centered approaches should be prioritized in design, implementation, and evaluation to inform quality and utility. 33 Evidence-based telehealth guidelines should be iteratively developed and improved in concert with clinician, patient, and caregiver stakeholders to optimize technological components, foster empathic communication, and ensure community-based perspectives are heard to inform future best practices.…”