Use of Information and Communication Technology Among Patients with COPD who Smoke: A Mixed Methods Study

Although overall use is on the rise, certain patient populations have persistently low technology use.To inform the creation of a proactive tobacco treatment program, we assessed access to, use of, and barriers surrounding information and communication technology (ICT) among patients with COPD who currently smoke, examining associations between key predictors and electronic health (e-health) literacy.Single-center mixed-methods study of Veterans with COPD who smoke. Eligible participants with smoking were identified by the electronic health record and mailed a survey. E-health literacy was assessed by the eHEALS (electronic health literacy scale, 8-40). Low technology use was defined as no internet capable device and use of ICT less than monthly. Qualitative participants were purposively selected from survey respondents and interviewed using a semi-structured guide. Interviews were transcribed and analyzed using directed content analysis. We used a Bayesian three-component joint model to identify predictors of low technology use and low eHEALS.Participants (n=204) were older (mean age 65.8) primarily white (76.4%) men (87.1%) with low income (44.9% income <$20,000). Low technology use was reported by 25.5% and many reported low use of specific types of ICT. For example, only 36.3% had reliable in-home internet, fewer than half (46.6%) accessed e-mail at least weekly, 58.3% texted at least weekly, and few used the secure patient portal (13.2% accessed it monthly). Mean eHEALS was 24.6 (+/-8.7), indicating low to moderate e-health literacy. In the Bayesian analysis, low technology use was associated with lower eHEALS (Estimate: -8.5, 95% CI: [-12.13, -4.81]). Attainment of at least a college graduate level education was associated with higher eHEALS (3.83, [0.43, 7.24]). Participants reported barriers to use of ICT including: struggles navigating account security, frequently lost login information, mistrust of providing personal information to the internet and lack of familiarity with processes. Many perceived ICT as not useful or necessary.Many patients with COPD who smoke report barriers to engagement with health promotion programs offered electronically, which may perpetuate health disparities. Health promotion programs must account for low use of ICT and e-health literacy to ensure equitable access across the population.