BACKGROUND
Many healthcare systems have turned to digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. ‘Digital first’ may exacerbate health inequalities due to variation in eHealth literacy.
OBJECTIVE
We explored eHealth literacy amongst users and non-users of the NHS 111 online urgent care service.
METHODS
A cross-sectional sequential convenience sample survey of 2754 adults (October 2020 - July 2021), from primary, urgent/emergency care, third sector organisations and NHS 111 website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use and preferences for using 111 online, and sociodemographic characteristics.
RESULTS
Across almost all domains of the eHLQ, NHS 111 online users had higher mean digital literacy scores than non-users (P<0.001). Four eHLQ domains were significant predictors of 111 online use, most highly significant for domain eHLQ1 (Using technology to process health information) and eHLQ3 (Ability to actively engage with digital services) with odds ratios (95% CI) of 1.86 (1.46 to 2.38) and 1.51 (1.22 to 1.88) respectively. Respondents reporting a long-term condition (LTC) had lower eHLQ scores and a subset of non-users with a LTC had the lowest eHLQ scores. People under 25 (OR (95% CI) 3.24 (1.87 to 5.62)), and those with formal qualifications (0.74 (0.55 to 0.99) were more likely to use 111 online. Users and non-users expressed willingness to use NHS 111 online for a range of symptoms, including chest pain symptoms (70.4%) or for illness in children (70.0%). Users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (X2=138.57; P <0.001).
CONCLUSIONS
These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or willing to use this service. Despite a policy ambition for 111 online to substitute for other services, it appears to be used alongside other urgent care access routes, and thus may not reduce demand.