Improving Health Literacy Critical to Optimize Global Telemedicine During COVID-19 (Re: Telemed J E Health [Epub ahead of print]; DOI: 10.1089/tmj.2020.0105)

Dear Editor,

Keshvardoost et al., “Role of telehealth in the management of COVID-19: lessons learned from previous SARS, MERS and Ebola Outbreaks,”¹ address the challenges of implementing telehealth services in developing countries. Indeed, hospitals worldwide are currently inundated with COVID-19 patients, forcing difficult decisions about manpower and resource allocation. Amid the infectious outbreak and ensuing panic of this public health crisis, there is an immediate need to restructure health care delivery. Globally, telemedicine has emerged as an option to protect frontline health care providers, and assist vulnerable patients with chronic conditions. Socioeconomic and racial disparities prevalent in the low- and middle-income countries have prevented the effective deployment of telemedicine.² However, health literacy is an often neglected but critical element for the implementation of telemedicine in developing and developed countries. Health literacy is defined as the ability to obtain, read, understand, and use health information to make health decisions.³

The United Arab Emirates (UAE) has a population of ∼9 million, with a high prevalence of genetic and cardiovascular diseases, obesity, and age-adjusted diabetes.^4,5 Having experienced severe acute respiratory syndrome, Middle East respiratory syndrome, and the recent COVID-19 pandemic, the UAE is rapidly implementing telemedicine services. In a recent nationwide health literacy assessment of 2,651 UAE residents, only 25.8% of the study population demonstrated low general literacy, but ∼60.6% (1,610/2,651) possessed inadequate health literacy. Only 20.1% of the residents with high general literacy showed adequate health literacy. Our findings suggest that even in high-income countries, such as the UAE, with modern digital access and high general literacy rates, health literacy may pose an obstacle for the adoption of telemedicine. It is, therefore, critical for countries worldwide to improve health literacy to optimize patient access and engagement in this expanding world of digital medical care delivery.