Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey (Preprint)

Abstract

BACKGROUND The digital divide refers to technological disparities based on demographic characteristics (e.g., race and ethnicity). Specifically, the lack of physical access to the Internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Digital divide literature has adopted a multi-dimensional conceptualization of access by examining device and context of use, whereas OHIS literature has explored how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context-device pairings operate differently across intersectional identities – particularly racial and ethnic groups – in the domain of OHIS. OBJECTIVE This study examines how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships between predisposing characteristics (i.e., age, sex, education, income), internet access (home-computer, public-computer, work-computer, and mobile), health need, and OHIS. METHODS Using data from the 2019 Health Information National Trends Survey (HINTS), participant responses (N = 5,247) were analyzed using structural equation modeling (SEM) of a theoretical model of OHIS to explicate the roles of internet access and health need for racial and ethnic minority groups’ OHIS. Three separate group SEM models were specified based on Black/African American, Latino/a/x or Hispanic, and White self-categorizations. RESULTS In general, predisposing characteristics (i.e., age, sex, education, income) were associated with internet access, health need, and OHIS, internet access was associated with OHIS, and health need was associated with OHIS. In exploring our research questions, we disaggregated internet access and found that home-computer and mobile access were most consistently associated with OHIS. When disaggregating by racial and ethnic minority groups, we found several notable linkages between predisposing characteristics and internet access that differed for Black/African American and Latino/a/x or Hispanic individuals. Older racial and ethnic minorities tended to access the Internet on home and public computers less frequently, home-computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals. CONCLUSIONS Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, impacts specific racial and ethnic groups and their OHIS. We find support for prior work on the digital divide, but also surface new insights, including distinct impacts of context-device pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide.