Implications of social media use on health information technology engagement: Data from HINTS 4 cycle 3

Social Disparities in Online Health-Related Activities and Social Support: Findings from Health Information National Trends Survey

It is important to examine gaps in online health-related activities (OHAs) between socially advantaged and disadvantaged groups, considering that emerging information and communication technologies may bring about social disparities in their adoption and possibly expand preexisting health disparities. We thus examined whether digital divide occurs in the area of OHAs, including engagement with a very recent technology. To be more specific, we explored the effects of education, income, and race/ethnicity on OHAs, such as online health information seeking, social media use for health, and health information technologies (HITs) utilization. Moreover, given the importance of socio-contextual factors in digital divide, we examined how social support interacts with education, income, and race/ethnicity, and jointly influences OHAs. Using data from the 2017 Health Information National Trends Survey, we found the effects of education on several OHAs. Income only affected HITs utilization that had just started to diffuse across the U.S. society. We also identified reinforcing effects of social support and education on HITs utilization, and reinforcing effects of social support and income on online health information seeking. The implications of these findings for health communication and public health research were discussed.

Gender Differences in the Nonspecific and Health-Specific Use of Social Media Before and During the COVID-19 Pandemic: Trend Analysis Using HINTS 2017-2020 Data

The use of social media has changed since the outbreak of coronavirus disease 2019 (COVID-19). However, little is known about the gender disparity in social media use for nonspecific and health-specific issues before and during the COVID-19 pandemic. Based on a gender difference perspective, this study aimed to examine how the nonspecific and health-specific uses of social media changed in 2017-2020. The data came from the Health Information National Trends Survey Wave 5 Cycle 1-4. This study included 10,426 participants with complete data. Compared to 2017, there were higher levels of general use in 2019 and 2020, and an increased likelihood of health-related use in 2020 was reported among the general population. Female participants were more likely to be nonspecific and health-specific users than males. Moreover, the relationship of gender with general use increased in 2019 and 2020; however, concerning health-related use, it expanded in 2019 but narrowed in 2020. The COVID-19 global pandemic led to increased use of social media, especially for health-related issues among males. These findings further our understanding of the gender gap in health communication through social media, and contribute to targeted messaging to promote health and reduce disparities between different groups during the pandemic.

Health information seeking on social media: the diversification approach

Purpose

Internet studies have rarely addressed gender and/or ethnic differences in health information seeking on social media. Moreover, the role of locality size in explanation of this phenomenon has been overlooked. This study proposed a diversification approach to address these issues. According to it, belonging to numerous disadvantaged groups increases the probability of health-related Internet/social media use.

Design/methodology/approach

The data were collected via telephone survey. The sample consisted of 798 Israeli Internet users who reported using social media for any purpose, gender, ethnic affiliation and locality of residence. The data were analysed using a logistic regression technique.

Findings

Arab female social media users, who resided in small localities, were more likely than the other studied social groups to seek both non-medical and medical information on social media. Furthermore, Arab female social media users were found having the highest likelihood among all studied social groups to seek information regarding physical activity and medications on social media.

Practical implications

The findings largely supported the diversification approach and signal a major need for a greater supply of public health information for members of minority groups, especially those residing in small localities.

Originality/value

The study investigates triple social disadvantage in health-related social media use.

Willingness to Share Data From Wearable Health and Activity Trackers: Analysis of the 2019 Health Information National Trends Survey Data

BACKGROUND

Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults' willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information-sharing behaviors.

OBJECTIVE

This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults' willingness to share wearable data with health care providers and family or friends.

METHODS

Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics.

RESULTS

Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data.

CONCLUSIONS

The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings.

Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698-3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one's health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09-4.21; P value range < .001-.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention.

Racial/Ethnic Disparities in Patient-Provider Communication and the Role of E-Health Use

Although the health care industry has strived to address racial/ethnic disparities in health communication, several gaps remain. Previous findings suggest that communication technology might help narrow the gaps; however, they do not provide a comprehensive picture of how or why. To answer these questions, we examined the potential role of communication technology in mitigating the racial/ethnic disparities in patient-provider communication. Data analysis of the 2018 Health Information National Trends Survey (N= 3,504) revealed that the levels of perceived quality of communication with health care providers were lower among Asians and Hispanics than non-Hispanic Whites while no difference emerged between Blacks and non-Hispanic Whites. Although the adoption of communication technology was relatively high across minority groups, its use appeared to play different roles in different racial/ethnic populations. The Internet and patient portals showed no particular associations with patient-provider communication except for Black Internet users, who reported poorer experiences with patient-provider communication than non-users. Among Asians and Hispanics, social media and mobile communication appeared to play different roles in impacting communication experiences with health care providers. The findings suggest that communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities.

How clinician-patient communication affects trust in health information sources: Temporal trends from a national cross-sectional survey

Background

Understanding patients’ trust in health information sources is critical to designing work systems in healthcare. Patient-centered communication during the visit might be a major factor in shaping patients’ trust in information sources.

Objective

The purpose of this paper is to explore relationships between patient ratings of clinician communication during the visit and patient trust in health information sources.

Methodology

We conducted a secondary analysis of the nationally-representative Health Information National Trends Surveys; HINTS4 Cycle1 (2011), HINTS4 Cycle4 (2014), and HINTS5 Cycle1 (2017), and HINTS5 Cycle2 (2018). We created a composite score of patient-centered communication from five questions and dichotomized at the median. We created multivariable logistic regression models to see how patient-centered communication influenced trust in different information sources across cycles. Consecutively, we used hierarchical analysis for aggregated data.

Results

We analyzed data from 14,425 individuals. In the adjusted logistic models for each cycle and the hierarchical model, clinicians’ perceived patient-centered communication skills were significantly associated with increased trust in the clinicians as an information source.

Conclusion

Clinicians still represent an essential source of trustworthy information reinforced by patient-centered communication skills. Given that trust helps build healing relationships that lead to better healthcare outcomes, communication sets an essential foundation to establish necessary trust. Interpreting information from the internet sources for patients is likely to remain a vital clinician function.

Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study

BACKGROUND

Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure.

OBJECTIVE

The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption.

METHODS

Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models.

RESULTS

Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2% to 17.5% less) and mobile health for self-regulation (0.8% to 9.7% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8% higher in 2018, P=.01; 10.1% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95% CI 1.26-3.11).

CONCLUSIONS

Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities.

Relationship Between Internet Use and Change in Health Status: Panel Study of Young Adults

Background

Using the internet for health information is a widespread phenomenon documented in considerable scholarship. Less common, however, is the analysis of panel data to examine how internet use may relate to change in health status over time.

Objective

This study examines whether internet use and internet use related to health are associated with a change in health status among young adults.

Methods

We used a unique panel survey data set collected about young adults’ internet use in 2012 and 2016 (n=384). We applied logistic regression to examine the relationships between sociodemographics, internet experiences, frequency of health-related internet use, and sharing health content online with change in health status over time. We additionally examined the variables characterizing sharing health content online (via Facebook, Twitter, and email) in separate models.

Results

In the second wave, over half (236/384, 61.5%) of the sample used the internet for health at least weekly. Approximately one-third (141/384, 36.7%) used Facebook for health-content sharing, while using Twitter and email for sharing health content were far less frequent (14/384, 3.6%, and 55/384, 14.3%, respectively). A change in health status occurred for 43.0% (165/384) of the sample; 18.5% (71/384) reported an improvement while 24.5% (94/384) reported a decline. Greater frequency of internet use was associated with health decline over time (B=–0.58, P=.02). We also found that frequent health-related internet use was related to enhanced health or maintained health (B=0.58, P=.03). Sharing health content on social media or email, however, was not related to young adults’ health changes.

Conclusions

Young adults exhibit a pattern of using the internet for health that influences their health status. Our finding that frequent health-related internet use may promote improved or maintained health suggests that this type of online activity might also support healthy living.

Differences Between Races in Health Information Seeking and Trust Over Time: Evidence From a Cross-Sectional, Pooled Analyses of HINTS Data

PURPOSE

Assessed racial disparities in health information-seeking behavior and trust of information sources from 2007 to 2017.

DESIGN

Pooled cross-sectional survey data.

SETTING

Health Information National Trends Survey (HINTS).

PARTICIPATION

Data included 6 iterations of HINTS (pooled: N = 19 496; 2007: n = 3593; 2011: n = 3959; 2013: n = 3185; Food and Drug Administration [FDA] 2015: n = 3738; 2017: n = 3285; and FDA 2017: n = 1736).

MEASURES

Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variable was race group, controlling for other sociodemographic and socioeconomic variables.

ANALYSIS

Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by race. Fully interacted models with race-survey year interactions compared differences in outcomes between years.

RESULTS

Black respondents, relative to white, had greater odds of having high confidence in their ability to attain health information, trust of health information from newspapers and magazines, radio, internet, television, government, charitable organizations, and religious organizations. Hispanic respondents, relative to white, had lower odds of seeking health information and trusting health information from doctors. They had higher odds of trusting health information from the radio, the internet, television, charitable organizations, and religious organizations.

CONCLUSION

Disparities between races in trust of information sources remained across time. Understanding optimal information media, their reach, and credibility among racial groups could enable more targeted approaches to developing interventions. Our analytical approach minimized limitations present in the HINTS.

Health information technology use among older adults in the United States, 2009-2018

Objectives: The purpose of this study was to assess (1) the trends of and (2) the factors associated with health information technology (HIT) use among older adults in the U.S.Methods: A decade (2009-2018) of data from the U.S. National Health Interview Survey (NHIS) was used. The trends of HIT use among older adults (aged 65 over) were reported and compared to younger adults (aged 18-64) using weighted percentages adjusted by NHIS complex sampling design. HIT use, which was assessed with five questions asking whether respondents used the internet to (1) look up health information, (2) use chat groups to learn about health topics, (3) fill a prescription, (4) schedule medical appointments, and (5) communicate with health care providers by email. Andersen's Behavioral Model of Health Services Use was used to select and categorize the covariates. Multivariable logistic regression models were conducted to identify the predictors of HIT use.Results: The prevalence of HIT use significantly increased from 9.3 million (24.8% of the 37.3 million older adults) in 2009 to 22.3 million (43.9% of the 50.9 million older adults) in 2018 (p < .01). Among U.S. older adults, young-older, white females, higher education, higher income, insurance coverage, and good health status were more likely to report HIT use.Conclusions: This study found an increasing trend of HIT use among older adults in the U.S. from 2009 to 2018. Healthcare providers should be conscious of older adults' increased HIT use patterns and guide them to proper health management.

Criteria to Measure Social Media Value in Health Care Settings: Narrative Literature Review

BACKGROUND

With the growing use of social media in health care settings, there is a need to measure outcomes resulting from its use to ensure continuous performance improvement. Despite the need for measurement, a unified approach for measuring the value of social media used in health care remains elusive.

OBJECTIVE

This study aimed to elucidate how the value of social media in health care settings can be ascertained and to taxonomically identify steps and techniques in social media measurement from a review of relevant literature.

METHODS

A total of 65 relevant articles drawn from 341 articles on the subject of measuring social media in health care settings were qualitatively analyzed and synthesized. The articles were selected from the literature from diverse disciplines including business, information systems, medical informatics, and medicine.

RESULTS

The review of the literature showed different levels and focus of analysis when measuring the value of social media in health care settings. It equally showed that there are various metrics for measurement, levels of measurement, approaches to measurement, and scales of measurement. Each may be relevant, depending on the use case of social media in health care.

CONCLUSIONS

A comprehensive yardstick is required to simplify the measurement of outcomes resulting from the use of social media in health care. At the moment, there is neither a consensus on what indicators to measure nor on how to measure them. We hope that this review is used as a starting point to create a comprehensive measurement criterion for social media used in health care.

Assessment of eHealth behaviors in national surveys: a systematic review of instruments

Objectives

To conduct a systematic review of instruments used in national surveys of eHealth behaviors.

Materials and Methods

Major databases and websites of federal agencies were searched with pre-determined inclusion and exclusion criteria. National surveys with measures of eHealth behaviors were identified. The survey instruments were retrieved, and their measures of eHealth behaviors were categorized and critiqued.

Results

We located 13 national surveys containing eHealth behavior assessment questions that were administered from 1999 to 2017. Most surveys were conducted annually or biennially and typically covered topics on searching health information, obtaining social support, communicating with healthcare providers, and buying medicine online; recent surveys included items related to personal health management and use of mobile tools. There were redundant measures of searching health information online but insufficient measures of use of mobile apps, social media, and wearable devices.

Discussion

Future assessment of eHealth behaviors should reflect the growing varieties of behaviors enabled by technology development and reflect the current mobile ownership patterns in diverse social groups. More studies also need to include longitudinal surveys, integrative and standardized measures, and better designs to allow data linkage and comparison.

Conclusion

The existing survey instruments covering eHealth behaviors are rather limited compared to fast technological progress. We call for more national surveys on eHealth behaviors that are more responsive to technology development; we also advocate for more analysis and dissemination of existing national data on eHealth behaviors for evidence-based health policies.

The role of internet-based digital tools in reducing social isolation and addressing support needs among informal caregivers: a scoping review

Background

In Canada, 8.1 million people informally provide care without payment, primarily to family members; 6.1 million of them are employed at a full-time or part-time job. Digital technologies, such as internet-based tools, can provide informal caregivers’ access to information and support. This scoping review aimed to explore the role of internet-based digital tools in reducing social isolation and addressing support needs among informal caregivers.

Methods

A systematic search for relevant peer-reviewed literature was conducted of four electronic databases, guided by Arksey and O’Malley’s framework. An extensive search for relevant grey literature was also conducted.

Results

The screening process yielded twenty-three papers. The following themes were generated from the reviewed studies: searching for and receiving support; gaining a sense of social inclusion and belonging; and benefits and challenges of web-based support. The studies noted that, to connect with peers and obtain social support, informal caregivers often turn to online platforms. By engaging with peers in online communities, these caregivers reported regaining a sense of social inclusion and belonging.

Conclusions

The findings suggest that internet-based digital tools can be a cost-effective and convenient way to develop programs that help unpaid caregivers form communities, gain support, and access resources. Service providers can leverage digital tools to deliver support to caregivers within online communities.

Towards Health Equity: Deaf Adults' Engagement in Social e-Health Activities and e-Communication with Health Care Providers

Deaf people face significant barriers with accessing health information, health care services, and communication with their health care provider and as a result, show poorer health outcomes compared to the general population. Studies on the general population found that those who use social network sites (SNS) for health-related activities were more likely to communicate with their health care provider via the Internet or email. For deaf individuals who use American Sign Language (ASL), using eHealth platforms to communicate with health care providers has the potential to navigate around communication barriers and create greater opportunity to discuss screening and treatment plans. Using national data from the HINTS-ASL survey, we explored whether engagement in social eHealth activities on SNS is linked to electronic communication with health care providers after controlling for deaf patient characteristics. Our sample for this study consisted of 515 deaf participants who reported using (social media/SNS) to read and share health information. Controlling for sociodemographic variables, participants who engaged in social eHealth activity were threefold more likely to communicate with their healthcare provider electronically. Using eHealth platforms for social health engagement demonstrates potential to reduce health inequality among deaf people.

Lung Cancer Messages on Twitter: Content Analysis and Evaluation

PURPOSE

The aim of this project was to describe and evaluate the levels of lung cancer communication across the cancer prevention and control continuum for content posted to Twitter during a 10-day period (September 30 to October 9) in 2016.

METHODS

Descriptive and inferential statistics were used to identify relationships between tweet characteristics in lung cancer communication on Twitter and user-level data. Overall, 3,000 tweets published between September 30 and October 9 were assessed by a team of three coders. Lung cancer-specific tweets by user type (individuals, media, and organizations) were examined to identify content and structural message features. The study also assessed differences by user type in the use of hashtags, directed messages, health topic focus, and lung cancer-specific focus across the cancer control continuum.

RESULTS

Across the universe of lung cancer tweets, the majority of tweets focused on treatment and the use of pharmaceutical and research interventions, followed by awareness and prevention and risk topics. Among all lung cancer tweets, messages were most consistently tweeted by individual users, and personal behavioral mobilizing cues to action were rare.

CONCLUSIONS

Lung cancer advocates, as well as patient and medical advocacy organizations, with an interest in expanding the reach and effectiveness of social media efforts should monitor the topical nature of public tweets across the cancer continuum and consider integrating cues to action as a strategy to increase engagement and behavioral activation pertaining to lung cancer reduction efforts.

How we use the Internet matters for health: The relationship between various online health-related activities and preventive dietary behaviors

This study identified specific types of online health-related activities that may promote preventive dietary behaviors. Two cycles (Cycles 1 and 3) of the Health Information National Trends Survey 4 were analyzed ( N = 2606 and 2284, respectively; Internet users only). Similar types of activities were grouped to create three types of online activities: information seeking, engagement in health information technology, and social media use. In both cycles, online health information seeking and the engagement in health information technology were positively associated with two dietary behaviors (fruit/vegetable consumption and using menu information on calories) but not with soda consumption. Individuals may be exposed to new information or become more aware of their current health status through information seeking or health information technology engagement. However, social media use for health was not related to any of the dietary behavior. The results suggest that “how we use the Internet” may make a difference in health outcomes.