Recommendations for improving digital health literacy in patients with cancer receiving care in the Deep South.

202 Background: As technological advances are developed and implemented in healthcare, cancer patients with low digital health literacy may be at increased risk of health inequities. This study explored recommendations for improving digital health literacy related to electronic patient-reported outcome (ePRO) based remote symptom monitoring (RSM). Methods: This qualitative study, conducted December 2021-May 2023, included (1) patients with cancer and oncology providers from University of Alabama at Birmingham and University of South Alabama Mitchell Cancer Institute participating in RSM, and (2) community health workers (CHWs) who serve communities experiencing care access barriers across Alabama. Semi-structured interviews were conducted via phone, Zoom, or in-person. Recordings were transcribed and inductively content coded using Nvivo software for recurring themes and exemplary quotes by two independent coders. Results: Patients with cancer (n=19), providers (n=15), and community health workers (n=13) participated. Among patients and providers participating in RSM, recommendations included additional tech-focused training opportunities and in-person tech guidance. CHWs expanded upon this with four key recommendations involving provider-facing interventions. The first was to engage in communication-focused interventions that encourage use of lay language, developing cultural competency among providers, and “meeting patients where they are,” because as one CHW explained “if you don't actually understand the actual language, then you're never going to be able to really understand what's going on with your health.” A second recommendation was to focus on individual and community needs, such as lobbying to bring Wi-Fi to rural locations and developing subsidized cost programs for individuals who need them. CHWs then highlighted the existence of community partnerships and technology-focused training programs that largely go underutilized by local populations. Further developing these partnerships would also serve to emphasize the connection to the local community and legitimization of digital healthcare services. Finally, CHWs encouraged providers to emphasize to patients that technology in healthcare is a tool to facilitator greater connection and communication between patients and providers and that there is a “face behind the screen.” Conclusions: This study identifies key recommendations on how to address digital health literacy gaps and communicate the importance of the technologization of the American healthcare system to local communities in Alabama.