Summary

There are significant electronic health literacy challenges among elderly arthroplasty patients, which could potentially hinder the accurate collection of patient reported outcomes in this population.

Abstract

Introduction

Electronic health literacy (eHL) is increasingly important as digital systems become the norm in healthcare. eHealth tools such as mobile health apps, telemedicine, and online health information have shown potential to improve health literacy and outcomes. However, these are ineffective if patients lack the digital literacy needed to use them effectively. At our institution, patient reported outcome measures (PROMs) are often collected electronically. With the new national policy mandating the collection of PROMs for arthroplasty patients this year, this issue is critical. The study aims to assess the eHL among elderly patients at our arthroplasty clinic to determine their ability to effectively use digital resources and complete computer-based PROM surveys.

Methods

A cross-sectional institutional study was conducted on patients aged 65 and above at the adult reconstruction and arthroplasty clinic from April to June 2024. Patients completed the validated 35-item eHealth Literacy Questionnaire (eHLQ), covering seven domains: D1) using technology to process health information, D2) understanding of health concepts and language, D3) ability to actively engage with digital services, D4) feel safe and in control, D5) motivated to engage with digital services, D6) access to digital services that work, and D7) digital services that suit individual needs. Responses were on a 4-point scale of strongly disagree (1), disagree (2), agree (3) to strongly agree (4).

Results

67 patients (63% female), with a mean age of 74.8± 6.1, completed the eHLQ. Mean scores for the domains were: D1 = 2.19 ± 0.45, D2 = 2.81 ± 0.60, D3 = 1.84 ± 0.29, D4 = 3.09 ± 0.48, D5 = 2.42 ± 0.52, D6 = 2.43 ± 0.58, and D7 = 1.89 ± 0.38. Patients scored highest in domain 4, indicating most agreed that their data was used appropriately and safely. Patients scored lowest in domains 3 and 7, which are the most relevant to answering PROM questionnaires. Notably, 57/67 patients (85.1%) “strongly disagreed” or “disagreed” with their ability to enter data into technology systems, a concern given PROM surveys are administered digitally.

Conclusions

This study highlights significant eHL challenges among elderly patients at our arthroplasty clinic. Many patients may struggle to use eHealth tools, which could result in inaccuracies in both previously and prospectively collected PROMs data, ultimately impacting patient care and outcomes. Targeted interventions, such as simplified digital interfaces, support assistance, or paper-based forms, may be necessary to ensure these patients can effectively utilize health resources.