Abstract: Using a Walking App Diminishes Health Literacy Differences between Socio-economic Strata in Dutch Older Adults

◆ Gert-Jan de Bruijn, University of Amsterdam
◆ Anne Vos, University of Amsterdam
◆ Peter Schulz, University of Lugano

Health literacy is particularly prevalent in people from low socio-economic background. We investigated whether the use of health apps can reduce health literacy discrepancies in adults from low, middle, or high socio-economic background. We focused on walking apps as they are the most commonly used health app.

Respondents were 1346 older adults, and members of national survey panel. We assessed health literacy using the e-health literacy scale, that questioned participants about (e.g.) their confidence to find, retrieve, rate, and use health-related information from health apps. Answering categories ranged from 1 (=totally disagree) to 7 (=totally agree). Socio-economic status was derived from obtained educational background, a measure more predictive of SES-related health disparities than income. We used national guidelines to qualify participants as either low, middle, or high socio-economic status. Walking app usage was assessed by asking participants to indicate whether they were either (1) currently using a walking app, (2) no longer using a walking app, but had used in the past, or (3) currently not using a walking app and not having used one either. Data were collected in August 2019.

Mean age was 52.5 years (SD=15.3), and little over half (n = 704, 52.3%) was female. Average literacy levels were above midscale (M = 4.5, SD = 1.4) and the majority had never used a walking app (n = 790, 58.7%), while about a third (n = 429, 31.9%) was currently using a walking app. Less than 10 percent (n = 127, 9.4%) was a previous user. There was a higher proportion of never users amongst low socio-economic respondents (62.8%) than amongst high socio-economic respondents (52.7%), x2 (4) = 13,735, p = .008.

There was an effect of app use status F(2, 1337) = 98.63, p < .001 – health literacy scores were lower in never users (M = 4.1, SD = 1.5) than in previous (M = 5.0, SD = 1.0) or current users (M = 5.2, SD = 0.9) (all ps < .001). There was also an effect of socio-economic status, F(2, 1337) = 15.85, p < .001, on health literacy scores - health literacy scores were lower in low SES participants (M = 4.0, SD = 1.5) than in middle (M = 4.6, SD = 1.3) or in high SES (M = 5.0, SD = 1.2) adults (all ps < .001). Finally, there was a interaction between socio-economic status and app use status F(4, 1337) = 2.14., p = .074, on health literacy scores. Amongst never-users, differences in health literacy scores were much more pronounced between low SES adults and middle and high SES adults (Mdifference = 0.9) than amongst current users (Mdifference = 0.4).

In older adults, health literacy scores are lower in low SES people and in people who have never used a walking app. Differences in health literacy between low, middle, and high SES adults diminish when older adults are or have used a walking app. These findings suggest that stimulating health app use can diminish health literacy levels and, potentially, health disparities.