JMIR Publications

ABSTRACT

Background:

Expanding use of the Internet contributes to more effective searches for health-related information and opens up opportunities for direct communication online with health care professionals online. However, less is known about how users’ characteristics on the demand side influence health-related Internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users’ characteristics and their impacts on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies.

Objective:

Our aim in this study was to assess the prevalence of health-related Internet use and to identify its determinants in a remote province in China.

Methods:

We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in the northwestern China. Households were selected by multi-stage random sampling and households’ key formants were interviewed face-to-face at the respondents’ home. Dependent variables were whether the households’ use of online health services or not. Independent variables were chosen based on the Andersen’s Behavioral Model. Socio-demographic characteristics were compared between households used health-related online services with non-users. We applied logistic regression models to evaluate multivariate associations between respondents’ characteristics and their usage of online health services, and obtained odds ratios (ORs) with 95% confidence intervals.

Results:

A total of 1,354 respondents from rural households were interviewed, of whom 707 (52.22%) were men. The mean age of the respondents was 44.54 years (SD = 10.22). Almost half of the surveyed households (640 out of 1,354 or 47.27%) reported using one or more online health care services, whereas 37.8%(502/1,354) reported using the Internet to obtain health-related information, 15.51%(210/1,354) used the Internet to communicate with professionals about health issues, and 7.24% (98/1,354) had engaged in online consultations in last year. After controlling for potential confounders, Households engaged in health-related Internet use were found to be richer, have higher health demands, and have less geographic access to high-quality health care compared with other households.

Conclusions:

Internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households’ health-related Internet use in rural and remote areas in China. Those who belong to older age groups, have low incomes, and whose education levels do not extend beyond primary school education are significantly less likely to use online health care services and to benefit from online health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, online and offline health care providers, family members, and the government. Clinical Trial: none