The accessibility and usability of an Australian web-based self-management programme (MYJOINTPAIN) for people with lower health literacy and joint pain in the UK: a qualitative interview study

Background Osteoarthritis (OA) is disproportionately prevalent in people from lower socio economic groups (1). People from lower socio economic groups are also more likely to have lower health literacy. Health literacy influences people's ability to access, understand and use health information. Currently, health professionals over estimate patients' health literacy (2), potentially reducing the impact of OA self-management interventions that rely on educational approaches (3). As internet usage increases, online OA self-management resources are an option for delivering patient education. Currently, there is no evidence as to whether online education resources are suitable and accessible for people with joint pain and lower health literacy.Objectives To identify facilitators and barriers experienced by people with joint pain and low health literacy to access and utilise information available on the MyJointPain website. (https://www.myjointpain.org.au).Methods A qualitative interview study was conducted. Participants were invited to use the website for two weeks and then participated in semi-structured interviews. The interview topic guide had been developed in line with current literature. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used by the main researcher (with independent verification) to interrogate the data and identify themes.Results Six people with low health literacy (S-TOFHLA 17±3) were recruited from community groups from an inner-city area with a high index for social deprivation. Four key themes were identified. 1) Dealing with technical issues, where participants demonstrated that they could persevere with technical problems in using online resources; 2) Information overprovision, here participants found there was too much complex health information provided, that hindered usability; 3) Motivation for information seeking, where participants discussed that it was pain that encouraged resource use but motivation to self-manage was influenced by personal beliefs; 4) Specific professional input, the participants whilst willing to use and engage with the website recalled that they also want to have access to a health professional and felt the website could supplement but not replace this contact. “I think you have it from the health care where the healthcare are telling you and explaining to you”.Conclusions Digital online OA self-management presented by MyJointPain showed potential for use by people with joint pain and lower health literacy levels. This is important as outcomes for this group are poor (1). Text volume, detail and image use should be carefully considered when designing new online resources and involvement of people with lower health literacy when designing online tools will help to ensure information is accessible and useful to all OA patients. Clinicians should consider their patients' health literacy level, computer literacy and readiness to change behaviour before prescribing web based self-management tools