The persistence of digital divides in the use of health information: a comparative study in 28 European countries

Alvarez-Galvez, Javier; Salinas-Perez, Jose A.; Montagni, Ilaria; Salvador-Carulla, Luis

doi:10.1007/s00038-020-01363-w

Original article
Published: 10 April 2020

The persistence of digital divides in the use of health information: a comparative study in 28 European countries

Javier Alvarez-Galvez¹,
Jose A. Salinas-Perez^2,3,
Ilaria Montagni⁴ &
Luis Salvador-Carulla³

International Journal of Public Health volume 65, pages 325–333 (2020)Cite this article

892 Accesses
17 Citations
9 Altmetric
Metrics details

Abstract

Objectives

This study aimed to identify which are the socio-demographic factors that can describe health information users’ profiles in Europe and assess which are the factors distinguishing users and non-users and their association with the use of health-related online information.

Methods

Data from the Flash Eurobarometer No. 404 (2014) was analysed through a multilevel logistic regression model and a propensity score matching.

Results

There were significant differences in the use of the Internet for health information according to gender, age, education, long-term illness and health-related knowledge. Thus, some digital divides persisted in the use of health information online. Results showed that a poor health status was associated with a higher use of the Internet for health purposes only for people having chronic conditions.

Conclusions

Findings show a need to increase people’s eHealth literacy, especially for males over 45 years old not suffering from a long-term illness. In order to limit the misuse of poor or untrustworthy health information that might contribute to higher health disparities, special interest should be focused on population socio-demographic characteristics.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

Allcott H, Gentzkow M, Yu C (2019) Trends in the diffusion of misinformation on social media. Res Politics 6:1–8. https://doi.org/10.1177/2053168019848554
Article Google Scholar
Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786
Article Google Scholar
Barbabella MG, Melchiorre S, Quattrini R et al (2016) How can eHealth improve care for people with multimorbidity in Europe?. Eur Obs Health Syst Policies, Berlin
Google Scholar
Baumann E, Czerwinski F, Reifegerste D (2017) Gender-specific determinants and patterns of online health information seeking: results from a representative German health survey. J Med Internet Res 19:e92. https://doi.org/10.2196/jmir.6668
Article PubMed PubMed Central Google Scholar
Bidmon S, Terlutter R (2015) Gender differences in searching for health information on the internet and the virtual patient-physician relationship in Germany: exploratory results on how men and women differ and why. J Med Internet Res 17:e156. https://doi.org/10.2196/jmir.4127
Article PubMed PubMed Central Google Scholar
Bratu S (2018) Fake news, health literacy, and misinformed patients: the fate of scientific facts in the era of digital medicine. Anal Metaphys 17:122–127. https://doi.org/10.22381/AM1720186
Article Google Scholar
Cepeda MS, Boston R, Farrar JT, Strom BL (2003) Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol 158:280–287. https://doi.org/10.1093/aje/kwg115
Article PubMed Google Scholar
Chou W-YS, Oh A, Klein WMP (2018) Addressing health-related misinformation on social media. JAMA 320:2417. https://doi.org/10.1001/jama.2018.16865
Article PubMed Google Scholar
Coulter A, Ellins J, Swain D et al (2006) Assessing the quality of information to support people in making decisions about their health and healthcare. Picker Institute Europe, Oxford
Google Scholar
Czaja SJ, Charness N, Fisk AD et al (2006) Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE). Psychol Aging 21:333–352. https://doi.org/10.1037/0882-7974.21.2.333
Article PubMed PubMed Central Google Scholar
Devine T, Broderick J, Harris LM et al (2016) Making quality health websites a national public health priority: toward quality standards. J Med Internet Res 18:e211. https://doi.org/10.2196/jmir.5999
Article PubMed PubMed Central Google Scholar
Escoffery C (2017) Gender similarities and differences for e-Health behaviors among U.S. adults. Telemed e-Health. https://doi.org/10.1089/tmj.2017.0136
Article Google Scholar
Estacio EV, Whittle R, Protheroe J (2017) The digital divide: examining socio-demographic factors associated with health literacy, access and use of internet to seek health information. J Health Psychol. https://doi.org/10.1177/1359105317695429
Article PubMed Google Scholar
EU Open Data Portal (2015) Flash Eurobarometer 404: Eurobarometer on digital health literacy—datasets. In: EU open data portal. http://data.europa.eu/euodp/en/data/dataset/S2020_404. Accessed 1 June 2019
European Commission (2019) Tackling online disinformation. https://ec.europa.eu/digital-single-market/en/tackling-online-disinformation. Accessed 20 Nov 2019
Eurostat (2018) Digital economy and society statistics—households and individuals. In: Eurostat—stat. Explain. https://ec.europa.eu/eurostat/statistics-explained/index.php/Digital_economy_and_society_statistics_-_households_and_individuals#Internet_access. Accessed 1 June 2019
Gracia E, Herrero J (2009) Internet use and self-rated health among older people: a national survey. J Med Internet Res 11:e49. https://doi.org/10.2196/jmir.1311
Article PubMed PubMed Central Google Scholar
Hesse BW, Moser RP, Rutten LJ (2010) Surveys of physicians and electronic health information. N Engl J Med 362:859–860. https://doi.org/10.1056/NEJMc0909595
CAS Article PubMed Google Scholar
Hill R, Beynon-Davies P, Williams MD (2008) Older people and internet engagement: acknowledging social moderators of internet adoption, access and use. Inf Technol People 21:244–266. https://doi.org/10.1108/09593840810896019
Article Google Scholar
Iverson S, Howard K, Penney B (2008) Impact of internet use on health-related behaviors and the patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc 108:699–711
PubMed Google Scholar
Kontos E, Blake KD, Chou WYS, Prestin A (2014) Predictors of eHealth usage: insights on the digital divide from the health information national trends survey 2012. J Med Internet Res 16:e172. https://doi.org/10.2196/jmir.3117
Article PubMed PubMed Central Google Scholar
Koo M, Lu M-C, Lin S-C (2016) Predictors of internet use for health information among male and female Internet users: findings from the 2009 Taiwan National Health Interview Survey. Int J Med Inform 94:155–163. https://doi.org/10.1016/J.IJMEDINF.2016.07.011
Article PubMed Google Scholar
Liu H, Zeng H, Shen Y et al (2018) Assessment tools for health literacy among the general population: a systematic review. Int J Environ Res Public Health 15:1711. https://doi.org/10.3390/ijerph15081711
Article PubMed Central Google Scholar
McMullan M (2016) Patients using the Internet to obtain health information: how this affects the patient-health professional relationship. Patient Educ Couns 63:24–28. https://doi.org/10.1016/j.pec.2005.10.006
Article Google Scholar
Neter E, Brainin E (2012) eHealth literacy: extending the digital divide to the realm of health information. J Med Internet Res 14:e19. https://doi.org/10.2196/jmir.1619
Article PubMed PubMed Central Google Scholar
Nölke L, Mensing M, Krämer A, Hornberg C (2015) Sociodemographic and health-(care-)related characteristics of online health information seekers: a cross-sectional German study. BMC Public Health. https://doi.org/10.1186/s12889-015-1423-0
Article PubMed PubMed Central Google Scholar
Norman CD, Skinner HA (2006) eHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res 8:e9. https://doi.org/10.2196/jmir.8.2.e9
Article PubMed PubMed Central Google Scholar
Ramtohul I (2015) The adoption of e-health services: comprehensive analysis of the adoption setting from the users perspective. Health Policy Technol 4:286–293. https://doi.org/10.1016/j.hlpt.2015.04.007
Article Google Scholar
Renahy E, Parizot I, Chauvin P (2010) Determinants of the frequency of online health information seeking: results of a web-based survey conducted in France in 2007. Inform Health Soc Care 35:25–39. https://doi.org/10.3109/17538150903358784
Article PubMed PubMed Central Google Scholar
Risling T, Martinez J, Young J, Thorp-Froslie N (2017) Evaluating patient empowerment in association with eHealth technology: scoping review. J Med Internet Res 19:e329. https://doi.org/10.2196/jmir.7809
Article PubMed PubMed Central Google Scholar
Stevenson FA, Kerr C, Murray E, Nazareth I (2007) Information from the internet and the doctor-patient relationship: the patient perspective—a qualitative study. BMC Fam Pract 8:47. https://doi.org/10.1186/1471-2296-8-47
Article PubMed PubMed Central Google Scholar
Tan SS-L, Goonawardene N (2017) Internet health information seeking and the patient-physician relationship: a systematic review. J Med Internet Res 19:e9. https://doi.org/10.2196/jmir.5729
Article PubMed PubMed Central Google Scholar
TNS Political and Social (2014) European citizen’s digital health literacy (Flash Eurobarometer 404)
Tonsaker T, Bartlett G, Trpkov C (2014) Health information on the internet. Gold mine or minefield? J R Soc Promot Health 60:407–410
Google Scholar
Vance K, Howe W, Dellavalle RP (2009) Social internet sites as a source of public health information. Dermatol Clin 27:133–136. https://doi.org/10.1016/j.det.2008.11.010
CAS Article PubMed Google Scholar
Waszak PM, Kasprzycka-Waszak W, Kubanek A (2018) The spread of medical fake news in social media—the pilot quantitative study. Health Policy Technol 7:115–118. https://doi.org/10.1016/J.HLPT.2018.03.002
Article Google Scholar
WHO (2014) The health internet: governing principles for a health top-level domain. In: WHO. http://www.who.int/ehealth/programmes/governance/en/index3.html. Accessed 1 June 2019

Download references

Acknowledgements

We would like to acknowledge the support of the University Institute of Research in Social Sustainable Development (INDESS) at the University of Cádiz, and the Ramon and Cajal programme (MIMECO), who contributed to the development of the present manuscript.

Funding

JAG was subsidized by the Ramon and Cajal programme of the Ministry of Economy and Business, European Social Fund (RYC-2016-19353).

Author information

Authors and Affiliations

Department of Biomedicine, Biotechnology, and Public Health, University of Cadiz, Cádiz, Spain
Javier Alvarez-Galvez
Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain
Jose A. Salinas-Perez
Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
Jose A. Salinas-Perez & Luis Salvador-Carulla
Bordeaux Population Health Research Center, Inserm-University of Bordeaux, Bordeaux, France
Ilaria Montagni

Authors

Javier Alvarez-Galvez
View author publications
You can also search for this author in PubMed Google Scholar
Jose A. Salinas-Perez
View author publications
You can also search for this author in PubMed Google Scholar
Ilaria Montagni
View author publications
You can also search for this author in PubMed Google Scholar
Luis Salvador-Carulla
View author publications
You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Javier Alvarez-Galvez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Alvarez-Galvez, J., Salinas-Perez, J.A., Montagni, I. et al. The persistence of digital divides in the use of health information: a comparative study in 28 European countries. Int J Public Health 65, 325–333 (2020). https://doi.org/10.1007/s00038-020-01363-w

Download citation

Received: 06 June 2019
Revised: 16 March 2020
Accepted: 21 March 2020
Published: 10 April 2020
Issue Date: April 2020
DOI: https://doi.org/10.1007/s00038-020-01363-w

Keywords

Internet
eHealth literacy
Health information
Digital divide
Europe