eHealth literacy and the use of NHS111 online urgent care service in England: a cross-sectional survey

Abstract

Background: many healthcare systems have employed 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. The relationship between eHealth literacy in relation to online urgent care service use is unknown.

Objective: We measured the association of eHealth literacy with use 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 the NHS 111 online 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 dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than non-users (P<0.001). Four eHLQ dimensions were significant predictors of use, most highly significant for eHLQ1 (Using technology to process health information) and eHLQ3 (Ability to actively engage with digital services) - 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 health condition (LTHC) had lower 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 were likely 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 likely to do this. Despite a policy ambition for 111 online to substitute for other services, it appears to be used alongside other urgent care services, and thus may not reduce demand.

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Identifiers

ORCID for Joanne Turnbull: orcid.org/0000-0002-5006-4438

ORCID for Jane Prichard: orcid.org/0000-0001-7455-2244

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