The Digital Divide Among Low-Income Homebound Older Adults: Internet Use Patterns, eHealth Literacy, and Attitudes Toward Computer/Internet Use

By N. Choi, D. DiNitto. Journal of Medical Internet Research, 2013

809 citations recorded by the source corpus.

Background Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts—homebound adults under age 60. Methods Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78% were age 60 years and older and 22% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models. Results Only 34% of the under-60 group and 17% of the 60 years and older group currently used the Internet, and 35% and 16% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language. Conclusions This study is the first to describe in detail low-income disabled and homebound adults’ and older adults’ Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided.

Subfields: Demography, General Health Professions, Occupational Therapy

View Paper: https://www.semanticscholar.org/paper/ac946a54b120cbe610f137b04bf71435b86cfb97

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Citations in the corpus

Measurement of Digital Literacy Among Older Adults: Systematic Review (2020, methodology): “94 (ease of use) [52], adapted by Choi and DiNitto [29] 10 5-point Likert questions Interview (semistructured) X X X X O Attitudes Toward Computer/Internet Questionnaire (ATC/IQ)”
From internet access to internet skills: digital inequality among older adults (2019, background): “Beyond age and socioeconomic factors, disability status and health issues are also related to Internet adoption rates [10, 13, 19, 26, 27, 44].”
eHealth Literacy and Web 2.0 Health Information Seeking Behaviors Among Baby Boomers and Older Adults (2015, neutral): “Preliminary research suggests that eHealth literacy is negatively associated with age among low income homebound adults above 60 years of age [31], but the literature is not definitive regarding relationships between social determinants, sociodemographic variables, eHealth literacy, and use of…”
Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies (2016, neutral): “In addition, as very few of the included studies in our review involved people over sixty years of age and other literature on usability points to older adults having more difficulties with digital health [60, 61], it would be wise to explore in more depth why this population do or do not engage wit”
Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (2017, background): “The poor may also have less rich social networks, less reliable access to broadband, lower digital literacy, and greater likelihood of having problems such as debt or unsuitable housing [77,78].”
Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills (2017, background): “Further research needs to consider the instrument’s application to other subgroups for which these skills might be less obvious (such as the elderly and less-educated people) due to less computer experience [7,42].”
"Who over 65 is online?" Older adults' dispositions toward information communication technology (2015, background): “This latter group poses a personal rationale, often age related for non-use (Braun, 2013; Choi & DiNitto, 2013; Fausett et al., 2013), which acts as a barrier to their receptivity to using ICT in the future.”
Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States (2016, methodology): “Elderly populations were targeted in four of the studies (38,43,45,51).”