Electronic health Literacy gaps among adults with diabetes in the United States: Role of socioeconomic and demographic factors.

Background: Digital health technologies hold promises for enhancing healthcare and self-management in diabetes. However, disparities in Electronic Health Literacy (EHL) exist among diabetes populations. This study investigates EHL trends and demographic differences among adults with diabetes in the United States from 2011 to 2018. Methods: We analyzed data from the 2011-2018 National Health Interview Study (NHIS) on 27,096 adults with diabetes. The primary outcome was EHL, determined by responses to internet usage questions. Trends in EHL were assessed using the Rao Scott Chi-Square Test. Multivariate logistic regression was used to investigate the association between EHL and various comorbidities, socioeconomic and demographic subgroups. Results: Analytic sample (N = 27,096) represents 10.6 million adults (mean age 62.3, 52.5 % Females) in the USA surveyed between 2011 and 2018. The mean rate of EHL was 38.9 % and trended upward from 35.3 % to 46.8 % over the 2011-2018 period. In a fully adjusted logistic regression model, multiple socioeconomic factors were associated with EHL. Age was inversely associated with odds of EHL (aOR 0.95, 95 % CI: 0.95-0.95). Black individuals had lower odds of EHL compared to Whites (aOR 0.63, 95 % CI: 0.56-0.71). Low-income (<100 % and 100-200 % of federal poverty limit) were negatively associated with EHL. Furthermore, limited English proficiency was associated with lower odds of EHL (aOR 0.29, 95 % CI: 0.22-0.38). Conclusion: The study identified ongoing disparities in EHL among adults with diabetes based on age, race/ethnicity, income, and language proficiency, highlighting the need for targeted interventions to improve digital health access for all.