Determinants of Frequent Internet Use in an Urban Kidney Transplant Population in the United States: Characterizing the Digital Divide

Lockwood, Mark B.; Saunders, Milda R.; Josephson, Michelle A.; Becker, Yolanda T.; Lee, Christopher S.

doi:10.7182/pit2015957

Cited by 9 publications

(14 citation statements)

References 41 publications

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“…The sample characteristics and methods of the 2012 technology survey were like the 2016 survey and can be found elsewhere. 13 , 14 All participants provided informed consent before participation in the study. Both studies were approved by the University of Chicago Institutional Review Board before the administration of the study survey and conducted in adherence with the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…Our previous work characterizing device ownership trends and attitudes related to ICT in prekidney and postkidney transplant patients represented a narrow window into the many nuances of technology use in this chronically ill population. 13 , 14 In our 2012 technology survey of prekidney and postkidney transplant patients, we found a significant disparity among racial/ethnic minorities particularly with regard to frequent Internet use, defined as using the Internet more than 5 hours per week. 13 In addition, we found that device ownership and frequency of technology use were less in our prekidney and postkidney transplant population than what had been previously reported in an earlier national survey of people with one or more chronic health conditions in the United States.…”

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confidence: 90%

“… 13 , 14 In our 2012 technology survey of prekidney and postkidney transplant patients, we found a significant disparity among racial/ethnic minorities particularly with regard to frequent Internet use, defined as using the Internet more than 5 hours per week. 13 In addition, we found that device ownership and frequency of technology use were less in our prekidney and postkidney transplant population than what had been previously reported in an earlier national survey of people with one or more chronic health conditions in the United States. 15 Thus, because we expect technology use will change over time, continued assessments related to technology use is warranted in at-risk populations with chronic illness including racial/ethnic minorities, patients with lower socioeconomic status (SES), and those over 40 years of age.…”

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confidence: 90%

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Frequency of In-Home Internet Use Among Prekidney and Postkidney Transplant Patients—Facilitators and Barriers to Use and Trends Over Time

Lockwood

Dunn-Lopez

Burke

et al. 2017

Transplantation Direct

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BackgroundAs health-related communications become digitized, strategies to increase adoption of these Web-based platforms are needed. The purpose of this study was to assess facilitators and barriers to in-home Internet use among prekidney and postkidney transplant patients.MethodsA single center, cross-sectional survey of 240 consecutive patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The Patient Information and Technology Assessment consists of 6 demographic questions, 3 disease-related questions, and 8 technology-related questions.ResultsMuch of the sample was African American, male with a mean age of 51 years, and median income of $53 800/year. Logistic regression analysis was undertaken, and after adjusting for covariates, we found Smartphone ownership (odds ratio [OR], 4.94; 95% confidence interval [CI], 2.32-10.52), a higher number of Internet users in the home (OR, 2.00; 95% CI, 1.11-3.62), and having college education and beyond (OR, 4.88; 95% CI, 2.03-11.74) increased the likelihood of being a frequent Internet user. African American or Hispanic/Latino patients were less likely to be frequent Internet users compared with white patients (OR, 0.26 and 0.24, respectively, compared with whites, all P < 0.05). As the total number of people in the household increased, frequent Internet use decreased (OR, 0.52; 95% CI, 0.29-0.92). As age increased, reports of frequent Internet use decreased.ConclusionsLower rates of Internet use among African Americans and Hispanic/Latinos in urban areas in the United States remains a problem despite a significant increase in access to the Internet and Smartphone ownership. The finding that Internet use increases as the number of Internet users in the household increases indicates that leveraging the patient’s social support network and/or the development of patient information champion programs may aid with patient’s adoption of health technology and patient engagement in self-care.

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Section: Methodsmentioning

confidence: 99%

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confidence: 90%

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confidence: 90%

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Frequency of In-Home Internet Use Among Prekidney and Postkidney Transplant Patients—Facilitators and Barriers to Use and Trends Over Time

Lockwood

Dunn-Lopez

Burke

et al. 2017

Transplantation Direct

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“…This inequality leads to disparities in the outcomes from the IT investments and their use, called 'digital outcome divide' [12]. In the healthcare literature, disparities in patients' access to or use of IT has been repeatedly reported in various clinical contexts including transplant [31,32,33,34,35]. African-American patients register for the use of a web portal less frequently than other ethnic groups [33], and patients with a higher education level (college or higher) use a patient portal more frequently than those with a lower education level [35].…”

Section: Expected Impacts Of Patient Portalsmentioning

confidence: 99%

“…This phenomenon called the 'Digital Divide,' has been repeatedly reported by research studying health IT. The difference in the distribution of patients' Internet use and access is attributed to ethnicity and level of education [32,31]. Despite the high Internet accessibility, African-American patients enroll in a patient portal less frequently than white patients [33,34], and patients with a college degree or higher use a patient portal more frequently than those with a high school degree or lower [35].…”

Section: Stratified Analysis By Ethnicity and Educationmentioning

confidence: 99%

Repairing the Digital Divide Can Increase the Service Divide: The Effects of Patient Portals on Kidney Allocation

Kim

Ayvaci

Raghunathan

et al. 2019

Proceedings of the Annual Hawaii International Conference on System Sciences

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The severe shortage of organs combined with increasing demand for them characterize the outcomes for the kidney allocation process. Despite the efforts to improve the allocation of kidneys, notable inefficiencies and unequal access to available organs persist across patient populations. The goal of this study is to examine (i) whether the adoption of a patient-oriented information technology (IT), namely the patient portals, can mitigate inefficiencies in the allocation of these scarce resources (kidneys) in general; (ii) whether the adoption of patient portals magnify or alleviate the disparity issues around access to transplants. Using a rich dataset of all the kidney transplant records in the U.S. from 2011 to 2014, we show that the likelihood that the patient receives deceased donor transplant at a given point in time increases in the presence of patient portals. However, the varying impact of IT across sub-populations may indicate that the efforts to bridge the digital divide may benefit some groups of patients at the expense of other groups, leading to further disparities.

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If you build it, they may not come: modifiable barriers to patient portal use among pre- and post-kidney transplant patients

et al. 2018

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Background Patient access to health information using electronic patient portals is increasingly common. Portal use has the potential to improve patients’ engagement with their health and is particularly important for patients with chronic illness; however, patients’ abilities, attitudes, and use of portals are poorly understood. Methods A single-center, cross-sectional survey was conducted of 240 consecutive pre- and post-kidney transplant patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The investigator-developed Patient Information and Technology Assessment-Patient Portal was used to assess patients’ attitudes towards the use of patient portals. Results Most patients surveyed did not use the patient portal (n = 176, 73%). Patients were more likely to use the patient portal if they were White, highly educated, in the post-transplant period, more comfortable with technology, and reported being a frequent internet user (P < .05). The most common reasons for not using the patient portal included: (1) preference for traditional communication, (2) not being aware of the portal, (3) low technological proficiency, and (4) poor interoperability between the portal at the transplant center and the patient’s primary care center. Conclusions We identified several modifiable barriers to patient portal use. Some barriers can be addressed by patient education and training on portal use, and federal initiatives are underway to improve interoperability; however, a preference for traditional communications represents the most prominent barrier. Additional strategies are needed to improve portal adoption by encouraging acceptance of technologies as a way of clinical communication.

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Determinants of Frequent Internet Use in an Urban Kidney Transplant Population in the United States: Characterizing the Digital Divide

Abstract: Alternatives to electronic information sources and/or additional resources should be considered for those who may fall in the so-called digital divide.

Cited by 9 publications

References 41 publications

Frequency of In-Home Internet Use Among Prekidney and Postkidney Transplant Patients—Facilitators and Barriers to Use and Trends Over Time

Frequency of In-Home Internet Use Among Prekidney and Postkidney Transplant Patients—Facilitators and Barriers to Use and Trends Over Time

Repairing the Digital Divide Can Increase the Service Divide: The Effects of Patient Portals on Kidney Allocation

If you build it, they may not come: modifiable barriers to patient portal use among pre- and post-kidney transplant patients

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