# Technology Access, Digital Literacy, and Enrollment Support Preferences in a Federally Qualified Health Center: Cross-Sectional Study

## TL;DR

This study explores how comfort with technology, rather than just access, influences enrollment preferences in health research among underrepresented groups.

## Contribution

The study introduces the importance of digital comfort over access in shaping support preferences for digital enrollment in health research.

## Key findings

- Most participants had internet access and felt comfortable with technology.
- Comfort with technology was a stronger predictor of enrollment support preference than internet access.
- Adaptive support paths and individualized onboarding are recommended to improve equitable engagement.

## Abstract

Biomedical research studies are increasingly using digital tools to enroll, recruit, and collect data from participants. However, variability in digital literacy and technological acceptance can be challenging for recruitment from groups traditionally underrepresented in research, including those served by Federally Qualified Health Centers.

This study aimed to (1) measure participant accessibility and comfort with digital platforms and (2) examine the interrelation of technology access, digital literacy, and support preferences during enrollment and data submission.

A cross-sectional analysis was conducted using enrollment data from Federally Qualified Health Centers participating in the All of Us Research Program. Participants had the option of High-Touch (staff-assisted) or Low-Touch (self-directed) support for enrollment and survey completion. Survey items assessed internet access and technology comfort, while support type was recorded by the research staff based on participants’ actual selection. Logistic regression models evaluated relationships between technology access, comfort, and enacted support type, while controlling for age, consent language, and education, as well as race and ethnicity.

The analytic sample included 605 participants. The majority reported access to the internet (539/605, 89.1%) and felt comfortable with technology (448/605, 74.1%). In the group requesting High-Touch support (n=346), 14.5% (n=50) reported no internet access, and 31.5% (n=109) felt uncomfortable with technology. In the group requesting Low-Touch support (n=259), 6.2% (n=16) had no access to the internet, and 3.9% (n=10) reported feeling uncomfortable (P<.001). In the adjusted models, much greater comfort with technology was significantly correlated with reduced odds of requesting High-Touch support (comfortable: adjusted odds ratio 0.118, 95% CI 0.055‐0.255 and neutral: adjusted odds ratio 0.212, 95% CI 0.077‐0.587), but internet access was not significantly correlated.

The strongest predictor for support preference for digital enrollment among the participants was their comfort with technology rather than access alone. These findings illustrate the significance of participant-centric design methods coupling adaptive support paths, mixed enrollment strategies, and individualized onboarding methods aligned with digital confidence to promote equitable engagement in precision health research.