City Research Online

Abstract

OBJECTIVE
Older adults may require additional support to comprehend written information due to inadequate health literacy, which involves components of cognitive function including reaction time. This study tested the acceptability of web-based reaction time testing in the UK Women’s Cohort Study and possible sources of bias. Additionally, it assessed the association between health literacy and reaction time.

DESIGN
A cross-sectional analysis was conducted using data from the UK Women’s Cohort Study, a prospective cohort study.

PARTICIPANTS
The study involved women aged 48 to 85 without cancer registration who participated in the 2010/11 follow-up (n = 768)..

SETTING
Postal questionnaires and web-based cognitive function tests were administered in participants’ homes.

METHODS AND ANALYSIS
Logistic regression identified predictors of volunteering for reaction time testing, used to calculate inverse probability weights for the primary analysis. Associations between health literacy and reaction time were estimated with linear regression models, adjusting for volunteer effects. Poisson regression models assessed associations between health literacy and choice reaction time errors.

PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was acceptability of web-based testing (response rate, task distress, task difficulty). Secondary outcomes were sources of volunteer bias, and the association between health literacy and reaction time.

RESULTS
Web-based testing of cognitive function was attempted by 67% of women (maximum age 80), with little distress or difficulty reported. There was substantive volunteer bias. Women providing data on cognitive function were younger, had higher health literacy, higher educational attainment and were higher in self-rated intelligence. Inadequate health literacy was associated with making fewer choice reaction time errors among those providing valid data, but was also associated with not providing valid data. Health literacy was not associated with other aspects of reaction time (speed, variability). Additionally, selection bias may have restricted range on study variables, given that 2010/11 volunteers were younger and more educated compared to those at recruitment in 1995/98.

CONCLUSION
Brief web-based measures of cognitive function in the home are acceptable to women aged 48 to 80, but there are substantive selection effects and volunteer biases. Additionally, there are potentially vulnerable subgroups who provide poorer quality data.

Publication Type:	Article
Additional Information:	© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine Z Bibliography. Library Science. Information Resources > Z665 Library Science. Information Science
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Psychology
SWORD Depositor:	Symplectic Administrator

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