Studies show digital health might not reach seniors, low income populations

By Jonah Comstock

Are digital health tools reaching the populations that need them the most? That was the question that concerned two recent publications: a small study of patients with low health literacy conducted by the Commonwealth Fund, and a research letter published in JAMA looking at digital health usage by a cohort of 7,000 seniors over four years.

The Commonwealth Fund study observed 26 low-income patients using 11 "popular and well-rated" mobile apps for diabetes, depression, and caregiving management. Seventy percent of said patients were deemed to have low health literacy. Researchers gave them specific instructions of things to do in the app and then debriefed them about the experience. 

They found that patients had trouble with manual data entry and were often confused about what information was being asked of them. All the apps required manual entry, but participants were only able to complete half the assigned data entry tasks without assistance. Similarly, they struggled with retrieving data from the apps with only 79 out of 185 data retrieval tasks being successfully completed. Researchers recommended that apps have larger buttons and simpler interfaces, and that they explain the purpose of their functions more -- i.e. telling a person with diabetes why it's valuable to them to record their meals.

In the JAMA letter, Brigham and Women's Hospital physicians looked at four years of survey data from a cohort that began with 7,609 elderly patients and ended with 4,355 (others either dropped out of the study or passed away). Patients were asked whether they used the internet to do each of four things: refill prescriptions, contact a clinician, address insurance matters, or research health conditions.

Between 2011 and 2014 adoption increased in this group, but only incrementally. The proportion of seniors who used any digital health technology increased from 21 percent in 2011 to just 25 percent in 2014. The percentage that used all four crept up from 1.1 percent to 1.8 percent. From 2011 to 2014,14 percent increased the number of modalities used and 10 percent decreased that number. The percent using the internet to obtain health information and to contact clinicians increased the most, while filling prescriptions and addressing insurance concerns were smaller increases.

"Digital health is not reaching most seniors and is associated with socioeconomic disparities, raising concern about its ability to improve quality, cost, and safety of their health care," authors Drs. David Levine, Stuart Lipsitz, and Jeffrey A. Linder wrote. "Future innovations should focus on usability, adherence, and scalability to improve the reach and effectiveness of digital health for seniors."