Urmimala Sarkar|Andrew J. Karter|Jennifer Y. Liu|Nancy E. Adler|Robert Nguyen|Andrea García López|Dean Schillinger
The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE)
San Francisco General Hospital|Kaiser Permanente|University of Washington|Kaiser Permanente|Kaiser Foundation Hospital|San Francisco General Hospital|San Francisco General Hospital
internetbased patient portals intended improve access quality play increasingly important role health care especially diabetes chronic diseases diabetes patients limited health literacy worse health outcomes limited health literacy may barrier effectively utilizing internetbased health access services investigated use internetbased patient portal among well characterized population adults diabetes estimated health literacy using three validated selfreport items explored independent association health literacy use internetbased patient portal adjusted age gender raceethnicity educational attainment income among 14102 participants 28 nonhispanic white 14 latino 21 africanamerican 9 asian 12 filipino 17 multiracial ethnicity 6099 62 reported limitation health literacy 5671 40 respondents completed registration patient portal registration adjusted analyses limited health literacy higher odds never signing patient portal 17 14 19 compared report health literacy limitation even among internet access relationship health literacy patient portal use persisted 14 95 ci 12 18 diabetes patients reporting limited health literacy less likely access navigate internetbased patient portal adequate health literacy although internet potential greatly expand capacity reach health care systems current use patterns suggest absence participatory design efforts involving limited health literacy risk poor diabetes health outcomes fall behind health systems increasingly rely internetbased services