“Digital Divide”: Inequities in internet access and health care utilization

Objectives. The relationships between health-care utilization, health insurance status, internet access, and use of internet medical information (IMI) are not well understood. This study, guided by the knowledge-gap hypothesis, investigated these relationships within an adult sample (n=5,708) in Atlanta, GA.

Methods. Secondary, cross-sectional survey data from Scarborough Research were analyzed. Measures assessed demographics, health-care utilization, health insurance status, internet access, and IMI use. Linear and logistic regression models were used, adjusting for demographics.

Results. Respondents not accessing the internet (n=1,879; 32.9%)—compared to those accessing the internet but not using IMI (n=3,022; 52.9%) and those accessing the internet and using IMI (n=807; 14.1%)—were significantly less likely (76.6% vs. 90.1%; OR 0.42 CI 0.35-0.52) to have health insurance. Those using IMI accessed significantly more medical services, visited more medical specialists, and purchased more over-the-counter medications, compared with the other two groups.

Conclusions. The findings are consistent with the knowledge-gap hypothesis and the notion of a “double digital divide.” An internet access gap is evident; those not accessing the internet appear to have more limited health-care opportunities. Additionally, a second divide emerges between IMI users and non-users across health-care factors; those using IMI appear to have more health-care opportunities and utilize them more extensively. Differential internet access alone does not adequately explain these findings. Although the U.S. health promotion agenda has given prominence to universal internet access initiatives, the data at hand indicate that understanding the social and cultural factors underlying IMI use may be vital for improving health.