Low Prevalence of Adequate eHealth Literacy and Willingness to Use Telemedicine Among Older Adults: Cross-Sectional Study From a Middle-Income Country.

Background: Currently, the rapid aging of global population, especially in low- and middle-income countries, is placing changing demands on health care systems. The preparation of the population for adequate eHealth literacy and good digital health is one of the challenges of social policy. The willingness to understand eHealth literacy and telemedicine use across different age groups of the population will help identify loopholes and bottlenecks in the implementation and help to develop appropriate solutions. Currently, studies on the status of eHealth literacy across different age ranges remain limited and scarce.

Objective: In this study, we aimed to investigate the prevalence and factors associated with adequate eHealth literacy, including attitudes toward eHealth literacy and willingness to use telemedicine as an example of digital technology. We focused on the comparison between older people (aged ≥60 years) and younger adult groups in Thailand, a middle-income country.

Methods: We conducted a cross-sectional, observational study from January 2021 to July 2021. A total of 400 participants who visited the outpatient department of Siriraj Hospital were recruited and completed questionnaires collecting demographic information, frequency of internet use, and devices used for accessing the internet. eHealth literacy was assessed using the eHAELS (eHealth Literacy Scale) questionnaire. We also explored the participants' attitude and willingness to use telemedicine. We applied univariable logistic regression analysis to elucidate the factors associated with eHealth literacy and willingness to use telemedicine.

Results: Our study revealed that the older participants had lower level of eHealth literacy compared to younger participants. Using an eHAELS score ≥26 points to define 'adequate eHealth literacy,' 74.0% (n=97) of older adults compared to 22.7% (n=61) of younger adults had inadequate eHealth literacy. Only 19.8% (n=26) of older adults, compared to 65.1% (n=175) of younger adults showed high levels of eHealth literacy defined by exploring each item using the eHEALS tool. The items with the lowest level of eHealth literacy among older adults pertained to confidence in finding and applying health information for self-care and in using information from the internet for making health decisions. In terms of attitude and interest toward telemedicine use, confidence in security, perceived convenience of telemedicine, and adequate eHealth literacy were the three strongest factors associated with willingness to use telemedicine, with odds ratios (ORs) of 5.90 (95% CI 3.43-10.15), 5.43(95% CI 3.12-9.43), and 4.45 (95% CI 2.60-7.62), respectively. Additionally, the younger adults were more likely to be interested in using telemedicine with an OR of 2.02 (95% CI 1.21-33.37).

Conclusions: Our study addressed the low level of eHealth literacy, with more concerning figures among older adults compared to younger adults in a middle-income country. The willingness to adopt digital technologies related strongly to level of eHealth literacy. This information may be beneficial for guiding further improvements and promoting digital health in low- and middle-income settings facing the challenges of an aging population.