Gordon Nancy P, Hornbrook Mark C
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Center for Health Research, Kaiser Permanente Northwest Region, 3800 North Interstate Avenue, Portland, OR, 97227, USA.
BMC Health Serv Res. 2018 Mar 27;18(1):220. doi: 10.1186/s12913-018-2986-0.
This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools.
A mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65-79 years. Respondent data were weighted to the study population for the cross-sectional analyses.
Older seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities.
The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.
本研究调查了大型健康计划中老年人获取数字技术的情况、技能和经验，以及使用基于网络和其他数字技术获取健康信息和建议的偏好。一个主要目的是评估种族/族裔和年龄组造成的数字鸿沟在多大程度上可能影响很大一部分老年人，尤其是弱势群体中的老年人参与在线健康信息和建议模式（电子健康信息访问，eHIA）以及移动健康（mHealth）监测工具的能力。
对年龄和性别分层的随机样本进行邮寄调查，样本来自加利福尼亚州北部凯撒医疗集团65至79岁说英语的非西班牙裔白人、非裔美国人/黑人（黑人）、西班牙裔/拉丁裔（拉丁裔）、菲律宾裔美国人（菲律宾人）和华裔美国人（华裔）会员。在横断面分析中，对受访者数据进行加权处理以匹配研究人群。
与年轻的非西班牙裔白人老年人相比，年龄较大的老年人以及黑人、拉丁裔和菲律宾裔老年人获取数字工具的机会更少，进行各种在线任务的经验更少，并且不太相信自己有能力上网获取健康信息和建议。因此，他们对使用电子健康信息访问模式也不太感兴趣。
先前已表明慢性病患病率较高且医疗保健获取困难较大的同一亚组老年人，采用电子健康信息访问和移动健康监测技术的可能性也较小。在患者群体层面，在规划健康信息和慢性病管理项目时，考虑这种数字鸿沟很重要。在个体患者层面，为了提供以患者为中心的优质护理，在推荐使用基于网络的资源和移动健康工具之前，医疗服务提供者评估而非假设患者的数字访问能力、电子健康技能和偏好非常重要。
