JMIR Publications

ABSTRACT

Background:

The prevalence of diabetes and the use of eHealth are increasing. People with diabetes need frequent monitoring and follow-up of health parameters and eHealth services can be of great significance. However, little is known about the use of eHealth in different socio-economic groups among people with diabetes.

Objective:

The objectives of this study was to investigate the use of four different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socio-economic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively).

Methods:

We used e-mail survey data from 1,250 members of The Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1,056 respondents who reported to have type 1 (n=523) and/or type 2 (n=541) diabetes themselves. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health.

Results:

We found that 87% (447/514) of people with T1D and 77.7% (421/542) of people with T2D had used one or more forms of eHealth sometimes or often during the previous year. The proportion using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between the use of search engines and an increasing level of education, whereas we found no educational differences for the use of apps, social media, or video services. In both diagnostic groups, the use of apps was more likely among those with high income, compared to those with low income, whereas we found a higher probability of using video services in T1D patients with lower income. Men in both diagnostic groups used social media less than women did. In people with T1D, the use of apps and search engines decreased with higher age. Except for the use of apps, the use of eHealth, and in particular the use of social media, increased significantly in T1D groups reporting poorer health. The probability of using search engines was significantly higher among people with T2D with bad/very bad health, compared with those in excellent health.

Conclusions:

This study indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media and video services showed no educational differences indicate that adequate communication strategies for different educational target groups should be a focus in future efforts to reduce inequalities in health outcomes.