Abstract
BACKGROUND: The benefits of digital development in health care may be obscured by unequal opportunities to make use of digital resources. The aim of this study was to investigate the association of health literacy with I) accessing health check test results in the Patient Electronic Health Record (PAEHR), II) searching for information to better understand individual test results, and III) using the national health information online portal provided by the Swedish national health care system. METHODS: This cross-sectional study included data from 434 individuals, 50-64 years old, randomly selected from the Swedish population during the year 2017 to a cohort study including health examination and a web-based survey. Health literacy was assessed at baseline using the Swedish Communicative and Critical Health Literacy scale. Digital information outcomes were assessed after three months. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for the separate outcomes were computed using logistic regression. Covariates included sex, age, education, country of birth, cardiovascular risk factors at baseline, general health, risk perception, referral, and new cardiovascular risk factors detected at health examination. RESULTS: About a third of the participants (35%) had limited health literacy, while 65% had sufficient health literacy. Sufficient health literacy was associated with accessing the PAEHR (adjusted OR 1.81 95% CI 1.07-3.06) and use of the online national health information portal provided by the Swedish national health care system (adjusted OR 2.91 95% CI 1.13-7.52) but not with searching information to better understand individual test results (adjusted OR 1.29 0.75-2.20). CONCLUSIONS: Individuals with limited health literacy do not access their personal health information nor search for health information on the online national health information portal provided by the Swedish national health care system to the same extent as individuals with sufficient health literacy. More research is needed about how the level of health literacy relates to differences in online health information-seeking behavior and how digital health information sources and e-health services can be designed to ensure that the entire population has equal access to trustworthy and quality-ensured health information.