Web-Based Consumer Health Information: Public Access, Digital Division, and Remainders

Daniel Lorence, PhD, JD; Heeyoung Park, MHA, MS

Disclosures
In This Article

Discussion

The results of this study demonstrate that low-income groups are still underserved in their access to the Internet as well their use of computers. However, once the low-income population gained access to the Internet, their behavior patterns on the Web were similar to those of high-income populations.

Few studies have investigated in-depth whether the low-income population had a differentiated pattern of access to and use of the Internet, and if so, why and to what extent. This study examined the degree to which annual income level influences distribution patterns and diffusion trends in access to computers, the Internet, and online health information. In particular, 2 research questions were employed: First, were low-income populations significantly underserved among those with computer access, those with Internet access, and those seeking online health information in 2002? Second, have differences between low- and high-income populations in access to computers, Internet service, and online health information narrowed, remained constant, or widened over recent years? Use of computers here was strongly associated with the level of income in 2000 and 2002. Adults with lower incomes had fewer opportunities to use computers than those with higher incomes. Only 51.8% (48.0%) of the low-income group reported that they occasionally used computers, whereas 80.4% (74.8%) and 93.2% (89.1%) of the medium- and high-income groups, respectively, responded that they used computers in 2002 (2000). These rates indicate that the computer utilization rates of low-, medium-, and high-income populations, respectively, increased 3.8%, 5.6%, and 4.1% between 2000 and 2002. The different increases of computer usage rates in each income group imply that the disparity between the low- and medium- as well as high-income groups was not improved, although the disparity between the medium- and high-income groups was improved somewhat.

Furthermore, the probability of searching for health information on the Web was comparable among the low-, medium-, and high-income Internet users. This suggests that efforts by the government, industry, or another entity to raise the number of low-income people using computers and the Internet would pay off. As shown here, increasing the number of computer and Internet users increases the number of online health information seekers in the low-income population. As a result, healthcare consumers were shown to achieve a variety of information benefits associated with greater use of the Internet.

The digital divide between low- and high-income populations still exists, and has not been improved, although the overall availability of computers and Internet access in the United States has increased somewhat. A possible explanation of the persistence of the digital divide is the relatively lower growth rate of the use of computers for the low-income adult population. The small growth rates suggest that national initiatives aimed at reducing the digital divide have had little effect in providing low-income adult populations with opportunities to use computers. Further study about the effectiveness of computer training or community-based computer centers for adult populations overall is needed.

The low-income Internet users were less likely to actively and frequently participate in online activities than higher income Internet users. The inactivity can be explained with the relatively short Internet experience of the low-income Internet users (4.64 years), suggesting that the Internet users who have little Internet experience are not as active as the Internet users who have greater Internet experience. The inactivity of low-income Internet users is not surprising. It is impressive, however, that medium-income Internet users have similar lengths of Internet experience (5.08 years) as low-income users, and show comparable information-seeking behaviors to high-income Internet users.

Predicting Use of Online Health Information

Medium-income populations are expected to be the main consumers of online health information in the near future. Medium-income populations had higher growth rates in the use of computers, the Internet, and online health information than high-income populations. The higher growth rates have decreased somewhat the gaps relative to high-income populations in the use of online health information as well as Internet and computer use. Increasing gaps with low-income populations, however, remain a problem, because low-income groups face limited access to computers and the Internet. The relatively small demand for online health information of high-income populations, and the limited access to computers and the Internet of low-income populations, will likely serve to make medium-income populations the main consumers of online health information for the foreseeable future.

Resolution for the Digital Divide

To realize the benefits that the Internet can improve the equity of the access to health information, healthcare policymakers and managers need to develop low-income, population-targeted approaches focused on (1) the improvement of the availability of computers and the Internet and (2) education for online information search skill or knowledge. This study revealed that as long as lower income people could occasionally use computers and the Internet, the possibility of people searching for health information on the Web is not so different from that of higher income people. Therefore, the first approach should be to provide lower income populations with enough opportunities to use computers and connect to the Internet. Then, for Internet users, healthcare needs to offer reliable and trusted guidelines about online information search, information-retrieval skills, and easy-to-access health Web pages. In regard to the reasons why Internet users gave up exploring health information on the Web, more Internet users in lower income levels reported that the lack of information retrieval (ie, search) skills impedes their ability to look for online health information.

Limitations

This study has several limitations. The first is that the annual income level was not adjusted by the regions where the participants lived, ignoring the real value of annual income across populations and geographic regions. For instance, the income of $100,000 for a metropolitan respondent could have similar real value of income of $70,000 in a rural area. To minimize the impact of misclassification, we categorized income levels into 3 collapsed groups: low (less than $30,000), medium (from $30,000 to $75,000), and high (over $75,000). It is possible that unadjusted annual income levels still result in some degree of misclassification, however. The second limitation is the restricted options in questionnaires used. This survey elicited data with semistructured questionnaires, which naturally restrict answer options and consequently prevent respondents from including their own unique thoughts or qualifying statements. If the questionnaires had listed different options or allowed more flexible responses for questions asking about online activities, or reasons why the nonhealth seekers did not explore online health information, the findings of this study might have been different. The third limitation is the assumption that a computer is the only device for connecting to the Internet. Advanced electronic communication devices, such as cell phones or personal digital assistants, can also provide Internet access service and health information. If this study had included the use of Internet and health information through all advanced electronic devices, the disparity between the low- and high-income groups would likely have been higher.

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