New screening tool captures digital health readiness

A Philadelphia-based research team has developed a screening tool that can quantify an individual's digital health readiness, that is, their ability to use digital health tools and comfort level.

Researchers from Thomas Jefferson University and Edward Hines Jr. Veterans Administration Hospital detailed the development and preliminary validation of the tool in a recent JAMA Network Open study.

Digital health readiness is vital to expanding patient access to virtual healthcare technologies and services. Digital health readiness falls under a more recently recognized social determinant of health: the digital divide, which is the gap between those with access to technologies and the digital health literacy prowess to use them and those without.

Prior research has shown that an inability to use digital health tools limits telehealth use. Though there are screening tools that assess digital health literacy, study authors contend that existing tools do not account for other factors relating to digital health readiness, such as patient trust in digital healthcare.

Thus, the researchers set out to create a standardized approach to measure digital health readiness, with a focus on identifying individual barriers to readiness. They conducted a qualitative mixed-methods study at Thomas Jefferson University in Philadelphia from April 26, 2022, to June 8, 2023.

They interviewed patients and healthcare professionals to explore barriers to telehealth use, developed scale items for the screening tool, conducted cognitive interviews to refine the scale items and evaluated the psychometric properties of the screening tool.

Overall, the researchers gathered interview and survey data on 367 individuals, of which 32 participated in patient interviews, 16 in clinician and telehealth support interviews, 15 in patient cognitive interviews, and 304 in patient surveys for psychometric testing.

Using this data, they identified 21 concepts, from which they developed 48 scale items for the tool that were refined through cognitive interviews. They then conducted psychometric analyses of the 29 items that emerged from the cognitive interviews, resulting in a final screening tool with 24 items across two factors: technical readiness and quality-of-care concerns.

The psychometric analyses showed that the screening tool could be used to assess digital health readiness.

"Converging evidence from the correlations with health literacy and the known-groups differences in technical readiness and quality-of-care concerns among the educational level attainment groups suggests that this tool is capturing what it was intended to capture, namely, how ready a patient might be for using various digital health services," the researchers wrote.

For instance, the researchers observed that patients with higher health literacy scores had higher readiness scores related to both the technical readiness and quality-of-care concerns factors.

Thus, they noted that the screening tool can help healthcare providers offer digital health support to address specific barriers to virtual healthcare utilization.

"The screening tool in its entirety exemplifies the complexity of factors influencing digital health uptake among various populations and highlights several areas for potential intervention to support increased digital health uptake at both the individual and population levels," the researchers concluded.

Using screening tools to identify areas for interventions can help healthcare organizations more strategically deploy resources to support patients who are not comfortable with digital tools.

These resources include assigning medical assistants to help patients connect to video calls, which prior research shows can be effective in narrowing the digital divide. A study published in April 2022 assessed an initiative developed by the Permanente Medical Group that included "virtual rooming."

Virtual rooming involves a medical assistant calling the patient 15 minutes before a telehealth appointment to help connect them to the video visit. Based on an analysis of 136,699 video visits, the researchers found patients receiving care at medical offices with high virtual rooming rates were 7% more likely to have a successful connection to the video visit.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.