Health Literacy and Global Cognitive Function Predict E-Mail but Not Internet Use in Heart Failure Patients

Background. The internet offers a potential for improving patient knowledge, and e-mail may be used in patient communication with providers. However, barriers to internet and e-mail use, such as low health literacy and cognitive impairment, may prevent patients from using technological resources. Purpose. We investigated whether health literacy, heart failure knowledge, and cognitive function were related to internet and e-mail use in older adults with heart failure (HF). Methods. Older adults ( ) with heart failure ( years) completed measures of health literacy, heart failure knowledge, cognitive functioning, and internet use in a cross-sectional study. Results. Internet and e-mail use were reported in 78.2% and 71.4% of this sample of patients with HF, respectively. Controlling for age and education, logistic regression analyses indicated that higher health literacy predicted e-mail ( ) but not internet use. Global cognitive function predicted e-mail ( ) but not internet use. Only 45% used the Internet to obtain information on HF and internet use was not associated with greater HF knowledge. Conclusions. The majority of HF patients use the internet and e-mail, but poor health literacy and cognitive impairment may prevent some patients from accessing these resources. Future studies that examine specific internet and email interventions to increase HF knowledge are needed. 1. Introduction Healthcare is experiencing a push towards the increasing use of electronic communication. The Health Information Technology for Economic and Clinical Health Act enables providers to receive incentive payments for transitioning to electronic medical records [1]. Allowing patient access to medical records electronically offers the potential to improve health outcomes [2, 3]. For example, electronic portals enable patients to securely communicate with their physician, request medication refills, and view lab results [4]. Electronic resources such as patient portals may even assist patients in disease self-management by tracking refill history and changes in health status. However, adoption has been limited. Although growing in popularity, only 7% of Americans utilize patient portals [5]. However, internet use among older adults is increasing. In 2005, approximately 30% of adults aged 65 and older reported ever using internet or e-mail, and only 46% of those who used the internet reported daily internet use [6]. More recent estimates suggest that 53% of American adults aged 65 and older report internet or e-mail use and that 70% of those regularly use the internet [7]. As