Characterizing the Digital Health Citizen: Mixed-Methods Study Deriving a New Typology (Preprint)

Abstract

BackgroundA key challenge for health systems harnessing digital tools and services is that of digital inclusion. Typically, digital inequalities are conceptualised in relation to unequal access or usage. However, these differences do not fully explain the differing health outcomes individuals obtain through health-related internet use. ObjectiveTo derive a new typology of health internet users based on their antecedent motivations and enablers, to explain how the different orientations of individuals influence the health outcomes they achieve through health-related internet use. MethodsA mixed methods design using qualitative data from 43 semi-structured interviews about individuals' general and health-related internet use, and how this influenced their health perception and their help-seeking decisions, and quantitative data from the Oxford Internet Survey (OxIS), a household survey of 2,150 adults in England about their internet use and other characteristics. The interview data were used to identify constructs which described motivations and enablers affecting how internet use shaped their health perception and health service use. These constructs were then used to 1 identify variables in OxIS which provided a quantitative measure of these constructs. A hierarchical cluster analysis of these constructs was then undertaken using the numerical variables, to derive a proposed typology of health information-seekers. ResultsBoth the qualitative findings and the subsequent cluster analysis suggested there exist six different types of individuals, categorised as learners, pragmatists, sceptics, worriers, delegators and adigitals. The learners have a strong desire to understand health better, and use the internet to make decisions about whether they need to see a professional, and to learn about their and others' health. The pragmatists primarily used the internet to decide whether it was worth seeing a doctor. The sceptics are sceptical of physicians and the medical system and value the Internet for solving health problems that doctors may not be able to deal with. The worriers found it difficult to interpret health information online, describing health information-seeking online as frightening, and reporting a critical attitude towards it despite doing so frequently. The delegators are composed of non-users and users valuing the internet as an information-source, but not necessarily wanting or being able to use the internet themselves. The last group of adigitals comprises many non-users, but also users, who do not see the internet as a useful information tool and presented strong views on its low suitability for healthcare. ConclusionsThis research supports a shift in the understanding of the digital divide in health, away from only access and usage issues, towards also conceptualising an "outcomes divide", 2 whereby different types of internet user derive differing benefits from their use. This new typology can be used to inform digital inclusion policies in health systems.[442 words]