Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey

Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data

BACKGROUND

Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic.

OBJECTIVE

This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points.

METHODS

Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age.

RESULTS

For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking.

CONCLUSIONS

Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women.

Comparison of factors affecting Turkish citizens' search for online health information before and during the COVID-19 pandemic

BACKGROUND

Health information consumers can acquire knowledge regarding health problems, combat health problems, make health-related decisions, and change their behaviour by conducting health information searches. This study aims to identify the sociodemographic and economic factors affecting individuals' search for health information on the internet before and during COVID-19.

METHODS

In this study, micro data sets of the Household Information Technologies (IT) Usage Survey conducted by the Turkish Statistical Institute in 2018 and 2021 were used. The binary logistic regression analysis was also used in the study.

RESULTS

It was determined that age, gender, education level, occupation, social media use, searching for information about goods and services, internet banking use, e-government use, having a desktop computer, having a tablet computer, and region variables were associated with the status of searching for health information on the internet during the COVID-19 period.

CONCLUSION

The main reasons for the increase in health information searches during the COVID-19 epidemic can be attributed to several key factors, such as society's need for information and meeting its need for information, access to up-to-date health data and increased trust in official sources. The study's findings serve as a valuable resource for health service providers and information sources attempting to identify the health information-seeking behaviour of the public and to meet their needs in this context.

Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study

BACKGROUND

Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth).

OBJECTIVE

This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access.

METHODS

We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response.

RESULTS

The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001).

CONCLUSIONS

Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-019-3711-y.

Factors associated with long-term use of digital devices in the electronic Framingham Heart Study

Long-term use of digital devices is critical for successful clinical or research use, but digital health studies are challenged by a rapid drop-off in participation. A nested e-cohort (eFHS) is embedded in the Framingham Heart Study and uses three system components: a new smartphone app, a digital blood pressure (BP) cuff, and a smartwatch. This study aims to identify factors associated with the use of individual eFHS system components over 1-year. Among 1948 eFHS enrollees, we examine participants who returned surveys within 90 days (n = 1918), and those who chose to use the smartwatch (n = 1243) and BP cuff (n = 1115). For each component, we investigate the same set of candidate predictors for usage and use generalized linear mixed models to select predictors (P < 0.1, P value from Z test statistic), adjusting for age, sex, and time (app use: 3-month period, device use: weekly). A multivariable model with the predictors selected from initial testing is used to identify factors associated with use of components (P < 0.05, P value from Z test statistic) adjusting for age, sex, and time. In multivariable models, older age is associated with higher use of all system components. Female sex and higher education levels are associated with higher completion of app-based surveys whereas higher scores for depressive symptoms, and lower than excellent self-rated health are associated with lower use of the smartwatch over the 12-month follow-up. Our findings show that sociodemographic and health related factors are significantly associated with long-term use of digital devices. Future research is needed to test interventional strategies focusing on these factors to evaluate improvement in long-term engagement.

Development and implementation of a quick reference (QR) code linked online education tool in anaesthesiology practice

BACKGROUND

We conducted a feasibility study of an anaesthetic online educational tool that is accessed via quick reference (QR) codes. The primary objective of the study was to assess the feasibility of an online educational tool for providing satisfactory teaching to patients presenting for surgery and assess if using QR codes are a viable method for directing patients to the information. The secondary objective was to obtain feedback from anaesthesiologists.

METHODS

The educational tool was developed and hosted on a password-protected website. The educational material on the website focused on anaesthesia-related processes that the patient should expect to experience in the hospital as well as fasting information. A survey was embedded into the website to obtain patient feedback. The website was redesigned following patient and staff feedback.

RESULTS

Ninety-three patients accessed the online education tool. Of the 73 responses to the survey, 81% of patients reported that the tool improved their knowledge and understanding about anaesthesia. 73% of patients expressed a preference for, or were neutral regarding using online patient education. 36% of patients were familiar with QR codes and 28% were frequent users of QR codes. Most anaesthesiologists expressed satisfaction with the tool being used by their patients following the redesign process (93.1%, 89.6% and 89.6% for general anaesthesia, neuraxial anaesthesia and regional anaesthesia, respectively).

CONCLUSIONS

This feasibility study demonstrated that an online anaesthetic educational tool has utility in promoting patient education about the anaesthetic experience and was well received by both patients and anaesthesiologists. QR codes are not feasible as the sole method for linking our patient population to an online education resource.

Identifying Challenges, Enabling Practices, and Reviewing Existing Policies Regarding Digital Equity and Digital Divide Toward Smart and Healthy Cities: Protocol for an Integrative Review

BACKGROUND

Digital equity denotes that all individuals and communities have equitable access to the information technology required to participate in digital life and can fully capitalize on this technology for their individual and community gain and benefits. Recent research highlighted that COVID-19 heightened the existing structural inequities and further exacerbated the technology-related social divide, especially for racialized communities, including new immigrants, refugees, and ethnic minorities. The intersection of challenges associated with racial identity (eg, racial discrimination and cultural differences), socioeconomic marginalization, and age- and gender-related barriers affects their access to health and social services, education, economic activity, and social life owing to digital inequity.

OBJECTIVE

Our aim is to understand the current state of knowledge on digital equity and the digital divide (which is often considered a complex social-political challenge) among racialized communities in urban cities of high-income countries and how they impact the social interactions, economic activities, and mental well-being of racialized city dwellers.

METHODS

We will conduct an integrative review adapting the Whittemore and Knafl methodology to summarize past empirical or theoretical literature describing digital equity issues pertaining to urban racialized communities. The context will be limited to studies on multicultural cities in high-income countries (eg, Calgary, Alberta) in the last 10 years. We will use a comprehensive search of 8 major databases across multiple disciplines and gray literature (eg, Google Scholar), using appropriate search terms related to digital "in/equity" and "divide." A 2-stage screening will be conducted, including single citation tracking and a hand search of reference lists. Results will be synthesized using thematic analysis guidelines.

RESULTS

As of August 25, 2022, we have completed a systematic search of 8 major academic databases from multiple disciplines, gray literature, and citation or hand searching. After duplicate removal, we identified 8647 articles from all sources. Two independent reviewers are expected to complete the 2-step screening (title, abstract, and full-text screening) using Covidence followed by data extraction and analysis in 4 months (by December 2022). Data will be extracted regarding digital equity-related initiatives, programs, activities, research findings, issues, barriers, policies, recommendations, etc. Thematic analysis will reveal how barriers and facilitators of digital equity affect or benefit racialized population groups and what social, material, and systemic issues need to be addressed to establish digital equity for racialized communities in the context of a multicultural city.

CONCLUSIONS

This project will inform public policy about digital inequity alongside conventional systemic inequities (eg, education and income levels); promote digital equity by exploring and examining the pattern, extent, and determinants and barriers of digital inequity across sociodemographic variables and groups; and analyze its interconnectedness with spatial dimensions and variations of the urban sphere (geographic differences).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40068.

Infodemiology for oral health and disease: A scoping review

INTRODUCTION

Increasing affordability, accessibility and penetration of internet services worldwide, have substantially changed the ways of gathering health-related information. This has led to the origin of concept infodemiology that allows the information to be collected and analysed in near real time. Globally, oral diseases affect nearly 3.5 billion people; thus, volume and profile of oral health searches would help in understanding specific community dental needs and formulation of pertinent oral health strategies.

AIM

To review the published literature on infodemiological aspects of oral health and disease.

METHODOLOGY

This scoping review was conducted in accordance with PRISMA-ScR guidelines. Electronic search engines (Google Scholar) and databases (PubMed, Web of science, Scopus) were searched from 2002 onwards.

RESULTS

Thirty-eight articles were included in this review. The infodemiological studies for oral health and disease were mainly used in two domains. Out of 38 articles, 24 accessed the quality of available online information and 15 studied online oral health-related information seeking behaviour.

CONCLUSION

The most commonly searched oral diseases were toothache, oral cancer, dental caries, periodontal disease, oral maxillofacial surgical procedures and paediatric oral diseases. Most of the studies belonged to developed countries and Google was the most researched search engine.

eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey

BACKGROUND

Digital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population.

OBJECTIVE

The aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians.

METHODS

We analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy.

RESULTS

The analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was "I can tell high-quality health resources from low-quality health resources on the internet" (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient -6.0, 95% CI -9.61 to -2.39).

CONCLUSIONS

In our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions.

Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice

BACKGROUND

South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors.

OBJECTIVE

The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada.

METHODS

This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics.

RESULTS

A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools.

CONCLUSIONS

The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

The Use of Internet and Social Media for Health Information and Its Consequences Among the Population in Saudi Arabia

Background: The Internet is being increasingly used in our lives. Along with Internet use, social media sites are especially popular and are used by many people on a daily basis. Many studies were conducted to see the people’s perception and their attitude towards the use of the Internet for health information. Such studies were also carried out in Saudi Arabia, but most have been limited to a specific target sample of the population. Our study aimed to assess the perception towards and use of different platforms and search engines to seek health information in Saudi Arabia.

Method: A cross‐sectional study was conducted in Saudi Arabia during the year 2021. An Arabic online questionnaire using Google forms was sent to a randomized sample. Microsoft Excel 2016 was used for data entry, and statistical analysis was performed using IBM© SPSS© Statistics version 25 (IBM© Corp., Armonk, NY, USA).

Result: Among the 1363 participants, 56.2% were females and 43.8% were males with a mean age of 30.73 ± 12.3. The majority were living in Western region. The most used social media platforms were WhatsApp (91.5%), YouTube (84.6%), and Twitter (82.6%), respectively. The most common medical websites browsed were the Saudi Ministry of Health (67%) and the Food and Drug Administration (54.4%). Some 40.1% of the participants had a medical consultation online from a doctor, and most of them (67.8%) trusted the online physician. Finally, most of the participants (90.9%) thought that health information on the Internet or social media contributes to raising the level of health awareness among the general population. There was a significant relationship between educational level and gender and online health-seeking behavior (p > 0.05).

Conclusion: The study reinforced that health information that is sought from the Internet and social media platforms has a great impact on the population, emphasizing the need for credible information sources and how to access them.

Mobile App-Reported Use of Traditional Medicine for Maintenance of Health in India During the COVID-19 Pandemic: Cross-sectional Questionnaire Study

Background

India follows a pluralistic system for strategic and focused health care delivery in which traditional systems of medicine such as Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homoeopathy (AYUSH) coexist with contemporary medicine, and this system functions under the Ministry of AYUSH (MoA). The MoA developed a mobile app, called AYUSH Sanjivani, to document the trends of the use of AYUSH-based traditional and holistic measures by the public across India. Analysis of the data generated through this app can help monitor the extent of the use of AYUSH measures for maintenance of health during the COVID-19 pandemic and aid effective health promotion and communication efforts focused on targeted health care delivery during the pandemic.

Objective

The purpose of the study was to determine the extent of use of AYUSH measures by the public in India for maintenance of health during the COVID-19 pandemic as reported through the AYUSH Sanjivani mobile app.

Methods

Cross-sectional analysis of the data generated through the Ayush Sanjivani app from May 4 to July 31, 2020, was performed to study the pattern and extent of the use of AYUSH-based measures by the Indian population. The responses of the respondents in terms of demographic profile, use pattern, and benefits obtained; the association between the use of AYUSH-based measures and symptomatic status; and the association between the duration of use of AYUSH-based measures and the outcome of COVID-19 testing were evaluated based on bivariate and multivariate logistic regression analysis.

Results

Data from 723,459 respondents were used for the analysis, among whom 616,295 (85.2%) reported that they had been using AYUSH measures for maintenance of health during the COVID-19 pandemic. Among these 616,295 users, 553,801 (89.8%) either strongly or moderately agreed to have benefitted from AYUSH measures. Ayurveda and homeopathic measures and interventions were the most preferred by the respondents across India. Among the 359,785 AYUSH users who described their overall improvement in general health, 144,927 (40.3%) rated it as good, 30,848 (8.6%) as moderate, and 133,046 (40.3%) as slight. Respondents who had been using AYUSH measures for less than 30 days were more likely to be COVID-19–positive among those who were tested (odds ratio 1.52, 95% CI 1.44-1.60). The odds of nonusers of AYUSH measures being symptomatic if they tested positive were greater than those of AYUSH users (odds ratio 4.01, 95% CI 3.61-4.59).

Conclusions

The findings of this cross-sectional analysis assert that a large proportion of the representative population practiced AYUSH measures across different geographic locations of the country during the COVID-19 pandemic and benefitted considerably in terms of general well-being, with a possible impact on their quality of life and specific domains of health.