{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:58:59Z","timestamp":1790607539038,"version":"4.1.0"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"\n Background<\/jats:title>\n Digital literacy is a crucial social determinant of health. The COVID-19 pandemic's rapid shift to digital health services has widened disparities for older adults, racial and ethnic minorities, and low-income populations. Understanding barriers to electronic medical record (EMR) use is essential for equitable care in safety-net settings.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a cross-sectional needs assessment survey (\n N<\/jats:italic>\n \u2009=\u2009204) at an urban primary care clinic in Washington Heights, New York City, serving predominantly Latino (83%), Spanish-speaking (31%), and older adult (67% aged \u226565) patients. We assessed demographics, EMR use frequency, digital health literacy [eHealth Literacy Scale (eHEALS)], patient portal (MyChart) functional competency, and learning interest using chi-square tests for categorical variables and t-tests for continuous variables. Pairwise comparisons with\n post-hoc<\/jats:italic>\n correction were conducted for multi-category variables. EMR patterns were operationalized as self-reported frequency of patient-initiated digital communication with healthcare providers using the clinic's electronic patient portal system within the past 6 months.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n EMR use varied significantly by age among stable age groups,\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (2)\u2009=\u200912.34,\n p<\/jats:italic>\n \u2009=\u20090.002: 63.9% of ages 31\u201364 and 53.7% of ages \u226565 reported EMR use. [Note: Adults ages 18\u201330 comprised only\n n<\/jats:italic>\n \u2009=\u20097 (3.4% of sample); 100% EMR use in this group, 95% CI: 59\u2013100%, is underpowered and excluded from primary interpretation.] Employment status was significantly associated with EMR use [\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (2)\u2009=\u200910.89,\n p<\/jats:italic>\n \u2009=\u20090.003], with full-time employed individuals showing 95.5% usage, compared to 54.6% among retired and 57.7% among unemployed respondents. Bonferroni-corrected pairwise comparisons (adjusted\n \u03b1<\/jats:italic>\n =0.017) confirmed significant differences between full-time employed and retired individuals (\n p<\/jats:italic>\n \u2009&lt;\u20090.001) and between full-time employed and unemployed individuals (\n p<\/jats:italic>\n \u2009=\u20090.002). Mean eHEALS score was 25.33 (SD\u2009=\u20096.83) out of 40, indicating moderate digital literacy. Approximately half of participants demonstrated proficiency with individual MyChart functional tasks: viewing lab results (47% correct), reading physician notes (43% correct), messaging providers (50% correct), requesting refills (46% correct), and scheduling appointments (42% correct). Despite this lower EMR engagement, 71.6% expressed interest in learning EMR skills overall [83.1% among ages \u226565, 83.1% among Spanish speakers,\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (2)\u2009=\u200918.76,\n p<\/jats:italic>\n \u2009&lt;\u20090.0001, these representing separate subgroup analyses]. Women showed significantly higher interest than men [76.8% vs. 47.2%;\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u200914.32,\n p<\/jats:italic>\n \u2009=\u20090.0004].\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study highlights a key tension: EMR engagement is lowest among older, retired, and Medicare-only patients, yet these groups show the greatest motivation to build digital health skills. Overall, 71.6% of participants report interest in learning digital health skills, with notably high interest among seniors (83.1%) and Spanish-speaking patients (83.1%, each analyzed as separate subgroups). These findings point to a strong opportunity for targeted interventions. We recommend integrating digital health navigators into primary care clinics, creating culturally tailored training programs with Spanish-language options, and advocating for user-centered EMR design to promote health equity in digital health access.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1907871","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:30:38Z","timestamp":1790605838000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital health literacy in safety-net primary care: a needs assessment and call to action for health equity"],"prefix":"10.3389","volume":"8","author":[{"given":"Julie","family":"Glickstein","sequence":"first","affiliation":[{"name":"Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica O.","family":"Idumonyi","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Ting","sequence":"additional","affiliation":[{"name":"Rush University School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Robles-Aponte","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Ramey","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Fullilove","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Mailman School of Public Health","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Singer","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.897250","article-title":"A socio-ecological approach to addressing digital redlining in the United States: a call to action for health equity","volume":"4","author":"Mccall","year":"2022","journal-title":"Front Digit 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Assoc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1093\/jamia\/ocx157","article-title":"Erratum","volume":"25","author":"Baker","year":"2018","journal-title":"J Am Med Inform Assoc"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1907871\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:30:38Z","timestamp":1790605838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1907871\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":9,"alternative-id":["10.3389\/fdgth.2026.1907871"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1907871","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1907871"}}