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      Persistent digital divide in health-related internet use among cancer survivors: findings from the Health Information National Trends Survey, 2003–2018

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          Abstract

          Purpose

          Prior research on the use of the internet among cancer survivors indicates a digital divide. The online landscape and patterns of information consumption, however, have notably changed over the past decade necessitating an updated examination of health-related internet use (HRIU) among cancer survivors.

          Methods

          Using survey data from 2003, 2005, 2007, 2011, 2013, 2017, and 2018 Health Information National Trends Survey (HINTS) iterations, the objectives of this study were to report prevalence, trends, and user profiles in HRIU in terms of emailing doctors, buying medicine online, and support group participation. Descriptive analyses and weighted multivariate logistic regression analyses were performed.

          Results

          Cancer survivors who reported not using the internet were more likely to be older, belong to ethnic minorities, be less educated, and reside in rural areas as compared with those who reported using the internet. Except for participation in online support groups, all other types of HRIU increased in prevalence across the years.

          Conclusions

          Consistent with the increased penetration of the internet and the altered online health communication landscape, we found increased prevalence of HRIU among cancer survivors. However, the digital divide persists in terms of internet access. These findings can inform initiatives to bridge the gap among survivors of varying profiles in using the internet for their health needs.

          Implications for Cancer Survivors

          There is increased reliance on online platforms to obtain and communicate health-related information. The risk with this approach is potential oversight of ensuring equity in terms of internet access and technology literacy among survivors.

          Electronic supplementary material

          The online version of this article (10.1007/s11764-020-00913-8) contains supplementary material, which is available to authorized users.

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          Most cited references43

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          The impact of health information on the internet on the physician-patient relationship: patient perceptions.

          Elizabeth Murray, Bernard Lo, Lance Pollack … (2003)
          Use of the Internet for health information continues to grow rapidly, but its impact on health care is unclear. Concerns include whether patients' access to large volumes of information will improve their health; whether the variable quality of the information will have a deleterious effect; the effect on health disparities; and whether the physician-patient relationship will be improved as patients become more equal partners, or be damaged if physicians have difficulty adjusting to a new role. Telephone survey of nationally representative sample of the American public, with oversample of people in poor health. Of the 3209 respondents, 31% had looked for health information on the Internet in the past 12 months, 16% had found health information relevant to themselves and 8% had taken information from the Internet to their physician. Looking for information on the Internet showed a strong digital divide; however, once information had been looked for, socioeconomic factors did not predict other outcomes. Most (71%) people who took information to the physician wanted the physician's opinion, rather than a specific intervention. The effect of taking information to the physician on the physician-patient relationship was likely to be positive as long as the physician had adequate communication skills, and did not appear challenged by the patient bringing in information. For health information on the Internet to achieve its potential as a force for equity and patient well-being, actions are required to overcome the digital divide; assist the public in developing searching and appraisal skills; and ensure physicians have adequate communication skills.
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            Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective.

            Lila Finney Rutten, Kelly D Blake, Alexandra J. Greenberg‐Worisek … (2019)
            During the past decade, the availability of health information online has increased dramatically. We assessed progress toward the Healthy People 2020 (HP2020) health communication and health information technology objective of increasing the proportion of health information seekers who easily access health information online.
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              Is Open Access

              Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review

              Grazia Orizio, Anna Merla, Peter J. Schulz … (2011)
              Background Online pharmacies are companies that sell pharmaceutical preparations, including prescription-only drugs, on the Internet. Very little is known about this phenomenon because many online pharmacies operate from remote countries, where legal bases and business practices are largely inaccessible to international research. Objective The aim of the study was to perform an up-to-date and comprehensive review of the scientific literature focusing on the broader picture of online pharmacies by scanning several scientific and institutional databases, with no publication time limits. Methods We searched 4 electronic databases up to January 2011 and the gray literature on the Internet using the Google search engine and its tool Google Scholar. We also investigated the official websites of institutional agencies (World Health Organization, and US and European centers for disease control and drug regulation authorities). We focused specifically on online pharmacies offering prescription-only drugs. We decided to analyze and report only articles with original data, in order to review all the available data regarding online pharmacies and their usage. Results We selected 193 relevant articles: 76 articles with original data, and 117 articles without original data (editorials, regulation articles, or the like) including 5 reviews. The articles with original data cover samples of online pharmacies in 47 cases, online drug purchases in 13, consumer characteristics in 15, and case reports on adverse effects of online drugs in 12. The studies show that random samples with no specific limits to prescription requirements found that at least some websites sold drugs without a prescription and that an online questionnaire was a frequent tool to replace prescription. Data about geographical characteristics show that this information can be concealed in many websites. The analysis of drug offer showed that online a consumer can get virtually everything. Regarding quality of drugs, researchers very often found inappropriate packaging and labeling, whereas the chemical composition usually was not as expected in a minority of the studies’ samples. Regarding consumers, the majority of studies found that not more than 6% of the samples had bought drugs online. Conclusions Online pharmacies are an important phenomenon that is continuing to spread, despite partial regulation, due to intrinsic difficulties linked to the impalpable and evanescent nature of the Web and its global dimension. To enhance the benefits and minimize the risks of online pharmacies, a 2-level approach could be adopted. The first level should focus on policy, with laws regulating the phenomenon at an international level. The second level needs to focus on the individual. This approach should aim to increase health literacy, required for making appropriate health choices, recognizing risks and making the most of the multitude of opportunities offered by the world of medicine 2.0.
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                Author and article information

                Contributors
                Naleef Fareed: Naleef.Fareed@osumc.edu
                Christine M. Swoboda: Christine.Swoboda@osumc.edu
                Pallavi Jonnalagadda: Pallavi.Jonnalagadda@osumc.edu
                Timothy R. Huerta: Timothy.Huerta@osumc.edu
                Journal
                Journal ID (nlm-ta): J Cancer Surviv
                Journal ID (iso-abbrev): J Cancer Surviv
                Title: Journal of Cancer Survivorship
                Publisher: Springer US (New York )
                ISSN (Print): 1932-2259
                ISSN (Electronic): 1932-2267
                Publication date (Electronic): 15 July 2020
                Pages: 1-12
                Affiliations
                [1 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, , The Ohio State University, ; 460 Medical Center Drive, Columbus, OH 43210 USA
                [2 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Department of Biomedical Informatics, College of Medicine, , The Ohio State University, ; 1585 Neil Avenue, Columbus, OH 43210 USA
                [3 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Department of Family Medicine, College of Medicine, , The Ohio State University, ; 2231 North High Street, Columbus, OH 43201 USA
                Article
                Publisher ID: 913
                DOI: 10.1007/s11764-020-00913-8
                PMC ID: 7360998
                PubMed ID: 32671557
                SO-VID: 90298bb7-f926-44f2-aebc-1400283ea7e1
                Copyright © © Springer Science+Business Media, LLC, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 11 March 2020
                Date accepted : 7 July 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: internet,cancer survivors,disparities,health information,information sources,health communication,health promotion
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: internet, cancer survivors, disparities, health information, information sources, health communication, health promotion

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