Understanding the Use of Electronic Means to Seek Personal Health Information Among Adults in the United States

Access to technology, internet usage, and online health information-seeking behaviors in a racially diverse, lower-income population

Background

This study examined access to technology, internet usage, and online health information-seeking behaviors, in a racially diverse, lower-income population.

Methods

Data were obtained via a cross-sectional survey of low-income communities in Houston, Los Angeles, and New York between April and August 2023. Binary responses to the following online health information-seeking behaviors, internet and technology access, were examined: using the internet to (i) understand a medical diagnosis, (ii) fill a prescription, (iii) schedule a healthcare appointment, (iv) email communication with a healthcare provider, and (v) access electronic health records and medical notes.

Results

41% of survey respondents identified as non-Hispanic Black individuals, 33% as non-Hispanic White individuals, and 22% as Hispanic individuals. 69% reported a pre-tax annual household income of less than $35,000. 97% reported ownership/access to a smart device; 97% reported access to reliable internet. In the past year, only 59% reported using the internet to better understand their medical diagnosis, 36% reported filling a prescription online, 47% scheduled a medical appointment online, 47% viewed electronic health records online, and 56% emailed healthcare providers. Female sex, higher incomes, and having at least a bachelor's degree were significantly associated with all five online health information-seeking attributes.

Conclusion

Despite high technology adoption rates, we observed suboptimal online health information-seeking behaviors. This underutilization has potential adverse implications for healthcare access and use given the documented advantage of HIT. Efforts to increase health information-seeking behaviors should explore the identification of HIT barriers, and patient education to increase familiarity and usage in this population.

The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data

BACKGROUND

Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use.

OBJECTIVE

The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2).

METHODS

Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI.

RESULTS

A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees.

CONCLUSIONS

This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.