Assessing the Effects of eHealth Literacy and the Area Deprivation Index on Barriers to Electronic Patient Portal Use for Orthopedic Surgery: Cross-Sectional Observational Study

Background: As electronic patient portals (EPPs) continue to gain popularity and systems transition to online tools for scheduling, communication, and telehealth, patients without access or skills to use these tools may be overlooked. Objective: This study analyzed patient and neighborhood-level factors, including eHealth literacy level and the Area Deprivation Index (ADI), that may limit EPP access for orthopedic surgery. Methods: A cross-sectional, survey-based study was performed at a single urban tertiary academic medical center in the United States across foot and ankle, hand and upper extremity, and orthopedic trauma subspecialty clinics from June 21, 2022, to August 12, 2022. Survey responses (N=287) provided information on sociodemographic characteristics; barriers to EPP use and frequency of EPP use; the eHealth Literacy Scale; and the ADI, which is an address-generated national census measure of neighborhood-level disadvantage. Barriers to EPP use were inductively coded into barrier types, classified as physical access, technology discomfort, or preference. The primary outcome measure was patient-reported barriers to EPP use, which was treated as a binary outcome (1=barrier; 0=no barrier). Bivariate analyses and multivariable binary logistic regressions were performed. Results: The percentage of patients who self-reported barriers to EPP access was 43.2% (124/287), which related to physical access (13/124, 10.4%), technology discomfort (55/124, 44.3%), and preference (78/124, 63.0%). In the adjusted regressions, only low eHealth literacy and older age predicted barriers to EPP use (low eHealth literacy, adjusted odds ratio [AOR] 1.32, 95% CI 1.13-1.54; P