eHealth Literacy and Participation in Remote Blood Pressure Monitoring Among Patients With Hypertension: Cross-Sectional Study

Abstract

Background: The ability to participate in digital health services such as remote blood pressure monitoring needs digital skills and knowledge known as eHealth literacy (e-HL). However, e-HL is rarely studied among those participating in remote blood pressure monitoring (RBPM).

Objective: This study assessed e-HL levels among participants with hypertension and determined the e-HL domains that predict participation in RBPM. This study provides important focus areas to increase RBPM participation.

Methods: This study was a quantitative, cross-sectional survey of people with hypertension in the United States. The survey included demographics, RBPM participation questions, and the e-HL questionnaire (eHLQ) for assessment of e-HL. The eHLQ is a 35-item, 7-domain validated questionnaire including the (1) ability to process information, (2) engagement in own health, (3) ability to actively engage with digital services, (4) feel safe and in control, (5) motivated to engage with digital services, (6) access to digital services that work, and (7) digital services that suit individual needs. The eHLQ item scores range from 1 to 4, and the higher the score, the higher the e-HL status. Descriptive statistics were used to describe the participants' demographics and e-HL status. χ2 tests were used to compare participants' characteristics between RBPM and nonRBPM groups. The Mann-Whitney U test compared the e-HL domain scores in RBPM and nonRBPM groups. Firth logistic regression was used to predict participation in RBPM. The dependent variable was participation in RBPM. The independent variables were demographics and e-HL domains.

Results: A total of 507 people with hypertension participated in the survey. Sixty participants were currently participating in RBPM, giving a prevalence of 11.8% (60/507). The mean age of RBPM participants was 46.2 (SD 14.7) years and nonRBPM was 62 (SD 13.7) years (P<.001). The e-HL scores in all 7 domains were significantly higher for the RBPM group than the nonRBPM group. Among the e-HL domains, higher scores in digital services that suit individual needs (domain 7) were the only predictor of RBPM participation (adjusted odds ratio 2.84, 95% CI 1.002-8.84) adjusted for age, sex, and race.

Conclusions: Digital services that are tailored to individual patients' needs are more likely to result in participation in RBPM.

Keywords: blood pressure; digital health literacy; electronic health literacy; hypertension; patients; remote blood pressure monitoring; telemonitoring.