196262 “Digital Divide”: Inequities in internet access and health care utilization

Monday, November 9, 2009: 5:30 PM

James B. Weaver III, PhD MPH , National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, GA
Darren Mays, MPH , Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA
Dogan Eroglu, PhD , National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, GA
Jay M. Bernhardt, PhD, MPH , Department of Health Education and Behavior, University of Florida, Gainsville, FL
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.

Learning Objectives:
1. To describe the “digital divide” and the knowledge-gap hypothesis ideas and how these notions might extend our understanding of the relationships between internet medical information use and health care utilization. 2. To explicate some of the “non-technology” social and cultural factors that might underlie health care utilization, internet access, and IMI use and consider how a clearly grasp of such factors might inform future health promotion and disease prevention research and policy efforts involving new technologies. 3. To discuss the range of possible interpretations of the data at hand emphasizing it’s correlational nature (e.g., Do differences between internet only users and IMI users indicate a health care utilization advantage for IMI users or that IMI use stimulates medical consumerism?).

Keywords: Internet, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive experience teaching, researching, and publishing in the area of health communication.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.