Associations of Health Literacy and eHealth Literacy With Patient Portal Access and Use: Systematic Review.
Philipp Haessner, Mahitha Abraham, Aleena Peter et al.
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In 30 seconds
This systematic review synthesized quantitative studies of health literacy and eHealth literacy in relation to real-world patient portal access and use among adults. Of 1107 studies screened, 30 met the inclusion criteria. Findings differed by literacy construct and engagement outcome: 9 of 10 directionally codable studies of eHealth literacy and general portal use found lower use among people with lower eHealth literacy, while health literacy findings for general use were mixed. Lower health literacy was more consistently associated with lower portal access and use of several specific features. The evidence base was heterogeneous, so the authors used direction-based vote counting and narrative synthesis rather than meta-analysis.
Key findings
- Nine of 10 directionally codable studies found lower general portal use among people with lower eHealth literacy.
- Health literacy findings for general portal use were mixed.
- Lower health literacy showed a more consistent pattern of lower portal access and lower use of several portal features.
- Of 30 included studies, 17 examined health literacy only, 10 eHealth literacy only, and 3 both constructs in the same sample.
Why it matters
Portal engagement involves both navigating digital systems and understanding health information. The review suggests that literacy-related disparities may arise at different stages: eHealth literacy is consistently associated with general use, while health literacy appears more consistently related to access and some feature-specific behaviors. Distinguishing these constructs and outcomes may help clarify where barriers occur, although the evidence does not establish causation.
What to keep in mind
Studies varied substantially in literacy measures and portal outcomes, precluding meta-analysis. Most assessed portal use by self-report rather than objective system data, and few examined both literacy constructs in the same sample.