Background: As mobile health and technologies to engage patients in self-care gain increasing attention, it is critical to understand not only access to, but also ability and willingness of, underserved populations to use these resources, to avoid widening the digital divide. While studies estimate up to 80% of adults have internet access, no study to date has evaluated technology access and use in a hospitalized urban patient population. The aim of this study was to determine hospitalized patients’ self-perceptions of their access and willingness to use technology at home.
Methods: Hospitalized adult general medicine inpatients were enrolled in an ongoing study of resource-allocation and quality of care. Participants completed a survey about access and willingness to use technology post-discharge. Descriptive statistics were used to determine means and proportions. T-tests were used for continuous and Chi-squared tests were used for categorical comparisons.
Results: Participants were enrolled between January-September 2014. The majority of the 150 participants were female (80/150, 53%) and African American (115/150, 77%); the median age was 45; 33% had low health literacy (49/150). Almost all participants owned a cell phone (137/150, 91%), of which the majority were smart phones (109/137, 80%). Cell and smart phone ownership did not differ by gender or race (p=NS) to date in this preliminary analysis. However, the mean age of participants owning cell/smart phones was significantly younger than non-owners (44 vs 52, p=0.02; smart: 42 vs 51, p<0.001). Just over 1/2 (78/150) reported having a laptop computer; over 1/3 (52/150) reported owning a tablet computer. Most participants (120/150, 80%) used the internet at least occasionally, of which 83% (99/120) looked for health information online and 87% (104/120) watched a health-related video. Only about 1 in 5 (33/150) participants have downloaded an app to track or manage their health. On average, internet users were significantly younger than non-users (42 vs 54, p<0.001). Internet use did not differ by race or gender (p=NS). Approximately 80% (120/150) of participants reported to be at least somewhat likely to use video-module education after discharge. Of those participants, smartphones (53/120) were the most preferred device, followed by laptops (41/120) and tablets (28/120). Additionally, 45% (68/150) reported being willing to use interactive video-module education, but they do not believe they have the ability to do so even though they have a device.
Conclusions: Access to technology is common among urban underserved inpatients. The majority of patients who use the internet have used it to access health information. Development of technology-based self-management tools is feasible in an urban underserved population, and the digital divide may not be as wide as perceived; however, patient age may be an important factor. Hospitalists can consider use of technology-based self-management tools to help transition patients from hospital to home.