As the world grapples with the COVID-19 pandemic, the importance of technology literacy has come to the forefront. A recent op-ed by Chicago Tribune columnist Heidi Stevens highlighted the challenges faced by seniors trying to register for COVID vaccine appointments using apps and online accounts. This issue is not unique to Stevens' parents; many people across the country have reported similar difficulties.

The rapid rise in tech use among those 65 and older over the last decade has been impressive, but data show that over 25% were still not internet users and nearly half didn't own a smartphone in 2019. Access to high-speed internet varies widely across Chicago neighborhoods, adding an additional barrier for our most vulnerable older adults.

As Chicago has progressed to phase 1b of COVID-19 vaccination and expanded eligibility age to those over 65, we are seeing a flood of seniors who want to get vaccinated. However, the primary way vaccinations are being distributed across Chicago requires access to technology and knowledge of how to use it.

The Digital Divide

As healthcare workers who have been vaccinated, we are acutely aware that so much of vaccine administration is reliant on an understanding of how to use technology to advance one's health. Unfortunately, too few will be able to use this technology. In our prior study of over 500 high-risk patients on the South Side of Chicago, we found that one in every three patients had low health literacy.

In a follow-up study among nearly 200 high-risk predominantly Black patients, one out of every four had low technology literacy. Interestingly, there was no association between those who had low health literacy and those who had low technology literacy, highlighting that technology literacy is indeed a separate issue.

Patients with lower technology literacy were less likely to have Wi-Fi at home and were less likely to search for information online. Our most recent data suggest that even though portal use has become more common during the pandemic, both older patients and those with low technology literacy were less likely to use patient portals and less confident in their ability to use a patient portal.

Closing the Digital Divide

To advance equity with vaccine distribution, we must not leave behind any group due to their access to or understanding of technology. Closing this digital divide will require thought and careful planning. First, we must urgently identify and engage those who do not have portals or do not understand how to access health information on portals so that outreach programs can be targeted for their COVID-19 vaccinations.

The good news is data like our own suggest that while many patients may not have a patient portal, they do have a smartphone. Text messaging programs could be a helpful adjunct for reaching those not using portals. However, older patients who may be visually challenged or have dexterity issues using mobile phones will still need more help.

For these reasons, any and all outreach methods will be necessary including hybrid approaches such as phone calls, mailers, and direct outreach visits with community health workers, home health agencies, and mobile vans. Outreach efforts should leverage existing caregiver organizations, pharmacies, and senior housing. Encouraging word-of-mouth outreach via social networks may also help.

The Future of Fitness App Development

Lastly, as we move to a post-pandemic world in which patient portals are considered the mainstay for access to health care, we must urgently measure and improve technology access and literacy among high-risk groups, including our seniors. That will require healthcare organizations to screen all patients for technology literacy and implement tailored solutions to address gaps.

Furthermore, greater effort should be spent adapting technology, including voice-activated technology in the home, to better reach older adults. Without a focus on and solutions directed toward individuals across all levels of health and technology literacy, vaccine distribution will be fraught with inequity.

Valerie G. Press, M.D., M.P.H., is associate professor of medicine and pediatrics at University of Chicago Medicine; Megan Huisingh-Scheetz, M.D., M.P.H., is assistant professor of geriatrics and palliative medicine at University of Chicago Medicine; and Vineet Arora, M.D., MAPP, is professor of medicine at University of Chicago Medicine.