The health literacy divide: user experiences of web-based tools for delivering health information

Abstract

Health Literacy (HL) is ‘the capacity to acquire, understand and use information in ways which promote and maintain good health’(p.304) (Nutbeam, 2009). Low HL is associated with poor health-related knowledge, illness self-management, health service use, health and survival. Addressing HL is therefore key to caring for the health and well being of people worldwide and has become a pressing international priority.

Eighty percent of the adult population are now online. Reports also suggest that 80% of those using the Internet have used it to search for health information (McMullan, 2005). However, there is recognition that some of the most socially deprived and marginalised groups and those with lower education and HL may not be accessing digital and web-based technologies. Even if these groups are accessing online resources, evidence suggests they may not find the content of these accessible or understandable. Whilst webbased and mobile interventions exist, few are designed for people with lower literacy, numeracy or HL (Hou, 2012; Sarkar et al., 2010). With a high proportion of the adult population having low literacy and HL levels this is a challenge for health professionals.

The aim of this research was to explore the acceptability of web-based tools for delivering health information to varied and low HL groups and specifically to look at the acceptability of the ‘Healthy Living with Diabetes’ website and the tools contained within it. A review of qualitative studies was conducted to explore the current evidence base for webbased interventions for people with varied levels of education and HL. A thematic approach drawing on grounded theory was used. The purpose of the review was to specifically explore the acceptability of web-based interventions for chronic and acute health conditions for varied health literate groups and to explore which tools and technologies were preferred. This helped to inform the intervention development for the research.

The research in this thesis explored how, why, where and when web-based, mobile and digital interventions have been used to support people with various long term and acute conditions. Sixty-five interviews were conducted with adults with type 2 diabetes from five participating countries to explore their views on the ‘Healthy Living with Diabetes’ website, a digital health promotion intervention designed to be accessible to people with lower levels of HL. Particular interest was given to exploring user reactions to the interactive and audiovisual elements of the website. A think aloud interview method was used to elicit user views of the website and findings are reported in this thesis.

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Identifiers

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

ORCID for Cynthia Graham: orcid.org/0000-0002-7884-599X

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