Health-related internet use by rural residents in Veterans Integrated Service Network (VISN) 16 and Central South U.S

Veterans in rural areas rely on Veterans Health Affairs (VHA) facilities for their healthcare. Recommendations that the Internet be better utilized to deliver health treatment to rural Veterans are challenged by reports that rural areas have suboptimal Internet access. In addition, there is no research on whether and how rural residents use the Internet for health information or for meeting health needs. Veterans Integrated Service Network (VISN) 16 stretches across 8 states from Oklahoma to Florida and includes some of the most impoverished areas in the US. VISN16 Veterans are poorer and sicker than other Veterans and a high percentage live in rural areas. We compared the probability of Internet use, use for accessing health information, and use for meeting health needs across rural, suburban, and urban areas in the Central South and VISN16. We used the 2007 Health Information National Trends Survey (HINTS). Although HINTS does not identify Veterans, it provides geographic locations of respondents as well as rural/urban categories. We isolated Central South respondents (N=2276) and then identified respondents living within the geographic boundaries of VISN16 (n=535). We compared VISN16 vs. non-VISN16 on demographic, health/mental health, and Internet-related variables across rural, suburban, and urban areas. We used logistic regression to determine predictors of Internet use. We found that n=1136 (65.1%) non-VISN16 and n=310 (59.4%) VISN16 residents use the Internet. A greater proportion of rural households used dial-up Internet connections (39.3%) than urban (13.9%) (÷2=26.6,p=.0002). Rural VISN16 households were less likely to use the Internet. There was no difference across VISN16 of Internet use for health needs (÷2=5.6,p=.060) or health information (÷2=0.7,p=0.97), but rural non-VISN16 respondents were more likely to use the Internet for health-related needs (÷2=27.7, p=.0001), especially for support groups. Logistic regression analyses revealed differences across geographic areas, with robust predictors being “Trusts Internet Information” and “Using the Internet from Home.” Understanding how the Internet can be used to help maintain contact with or deliver treatment to individuals in rural areas is particularly relevant for the VHA. Although not Veteran-specific and constrained by small sample sizes, these data suggest a profile of Veteran Internet use in two rural populations. When considering use of Internet-based psychiatric treatments for delivery to rural Veterans in VISN16, it is important to consider the constraints of dial-up connections and preference for support groups. These findings suggest that using the Internet to connect with rural Veterans is viable, but will require more research.