General health states as indicators of digital inequalities and the moderating effects of age and education (Preprint)

Abstract

Considerable effort has been directed to offering online health information and services aimed at the general population. Such efforts potentially support people obtain improved health outcomes. However, when health information and services are moved online, issues of equality need to be considered. In the current study, we focus on the general population and take as a point of departure how different health states are linked to internet access (spanning attitude, material access, internet skills, and health-related uses).

To reveal to what extent (1) internet access is important for online health-related outcomes, (2) different health states are important for obtaining internet access and outcomes, and (3) age and educational differences moderate the contribution of health states to internet access.

A sequence of two online surveys drawing upon a sample collected in the Netherlands was employed, and a dataset with 1,733 respondents over the age of 18 was obtained.

Internet attitude is positively associated with material access, internet skills, and health outcomes and negatively associated with health-related internet use. Material access is positively associated with internet skills and health internet use and outcomes. Internet skills are positively associated with health internet use and outcomes. Physical functioning contributes positively to internet attitude, material access, and internet skills but negatively to internet health use. Social functioning is related to internet attitude, skills, and health use. Social functioning contributes negatively to internet attitude and positively to internet skills and internet health use. Mental health contributes positively to internet attitude and negatively to material access and internet health use. Perceived health positively contributes to material access, internet skills, and internet health use. Physical pain contributes positively to internet attitude and material access and indirectly to internet skills and internet health use. Finally, these contributions are moderated for age (<65 and ≥65) and education (low and high).

To make online health care attainable for the general population, interventions should focus simultaneously on internet attitudes, material access, skills and internet health use. However, issues of equality need to be considered. In this respect, digital inequality research benefits from considering health as a predictor of all four access stages. Furthermore, studies should go beyond single self-reported measures of health. Physical functioning, social functioning, mental health, perceived health, and physical pain all showed unique contributions to the different internet access stages. Further complicating this issue, online health-related interventions for people with different health states should also consider age and educational level of attainment.