Seckin Gul, Hughes Susan
Department of Sociology, University of North Texas, Denton, TX, United States.
Department of Sociology, Ouachita Baptist University, Arkadelphia, AR, United States.
JMIR Aging. 2021 Nov 24;4(4):e16006. doi: 10.2196/16006.
The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.
We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.
Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.
Age (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).
This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.
互联网的迅速普及降低了消费者对医疗保健提供者获取健康信息的依赖，并增强了患者掌控自身健康的能力。然而，关于老年人使用与健康相关互联网的影响的实证证据有限，而且网上健康和医学信息来源众多，其科学准确性存疑，这使得情况变得复杂。
我们探讨与健康相关的互联网使用、教育程度和电子健康素养对医疗就诊及患者报告结局的影响。患者报告结局分为两个维度：（1）自我报告的健康问题；（2）因获取的信息而产生的情感困扰（感到担忧和焦虑）。我们特别感兴趣的是教育程度和电子健康素养是否会调节医疗就诊中感知到的压力与患者报告结局之间的关联。
我们的研究样本由将互联网用作健康信息资源来源的在线小组成员组成，这些成员是从最大的基于概率的在线研究小组之一中随机抽取的。本文具体报告了老年小组成员（年龄≥60岁：n = 194）的研究结果。首先，我们检查了描述性统计和双变量关联（皮尔逊相关性和独立样本t检验）。我们通过对每个患者报告结局进行单独回归，使用分层普通最小二乘法回归分析。在模型1中，我们纳入了主效应。在模型2中，纳入了技术和医疗就诊变量。模型3添加了统计交互项。
年龄（β = -0.17；P = 0.02）、性别（β = -0.22；P = 0.01）和医疗满意度（β = -0.28；P = 0.01）是自我报告健康问题的显著预测因素。情感困扰的正向预测因素是性别（β = 0.13；P = 0.05）和对医疗就诊的满意度（β = 0.34；P < 0.001），而负向预测因素是教育程度（β = -0.18；P = 0.03）和电子健康素养（β = -0.32；P = 0.01）。在教育程度较低的受访者中，与健康相关的互联网使用所导致的健康问题与对紧张医疗就诊的感知之间的关联更大（β = -0.55；P = 0.04）。在预测情感困扰水平方面，教育程度和电子健康素养之间也存在显著的交互作用（β = -0.60；P = 0.05），这表明尽管电子健康素养较低，但较高的教育程度预示着较低的焦虑和担忧平均水平。老年女性报告的情感困扰平均水平较高（β = 0.13；P = 0.05），而老年男性报告的自我报告健康问题平均水平较高（β = -0.22；P = 0.01）。
本研究为与健康相关的互联网使用对患者报告结局的影响提供了证据，这对医疗就诊具有启示意义。研究结果可用于指导针对老年人的教育和电子健康素养干预措施。
