JMIR Publications

ABSTRACT

Background:

Broadband Internet plays an increasingly important role in supporting healthcare delivery and enhancing access to care and health information. Although access to broadband has the potential to alleviate inequities in healthcare, the digital divide negatively impacts cancer across the continuum, from access to prevention information, to early diagnostics and treatment, and survival outcomes. While subscription to broadband services has been previously assessed, satisfaction with individual at-home internet connection is a lesser known, important indicator of access to health information online and digital health technology use.

Objective:

To assess disparities in perceptions of the quality of at-home Internet connection and its association to cancer health information-seeking experiences and use of digital health technologies in a nationally representative sample of US adults.

Methods:

Secondary analysis of data from NCI’s Health Information National Trends Survey 2022 (HINTS 6, n= 6,252) was employed in this study. The primary predictor, satisfaction with at-home Internet, a novel item on HINTS 6, was dichotomized into “high” (extremely satisfied, very satisfied) and “low” (somewhat satisfied, not very satisfied, not at all satisfied) satisfaction. Outcomes variables included four items of cancer information-seeking experiences and 2 items on access to telehealth appointments and patient portals over the past 12 months. Adjusted logistic regression models (P<0.05) were performed, and included the following variables: age, gender, race/ethnicity, educational attainment, annual household income, health insurance access and geography.

Results:

Those reporting low satisfaction with their home Internet had higher odds of agreeing that searching for cancer information took a lot of effort (OR 1.77, 95% CI 1.31-2.37) and that they felt frustrated (OR 1.63, 95% CI 1.25-2.12). Additionally, those reporting lower satisfaction had higher odds of agreeing that they were concerned about the quality (OR 1.60, 95% CI 1.20-2.13) and had difficulty understanding (OR 1.56, 95% CI 1.13-2.15) cancer information they searched for. Respondents reporting lower satisfaction with their home Internet had lower odds of accessing their online medical portal at least once (OR 0.69, 95% CI 0.50-0.95) and of receiving care from a healthcare provider using telehealth over the past 12 months (OR 0.73, 95% CI 0.58- 0.92). Younger age, lower educational attainment and identifying as a racial/ethnic minority (NH-Asian/NH-Other) were associated with more challenges in their cancer information-seeking experiences. Lower education and household income were associated with lower odds of accessing patient portals, while younger age and lacking health insurance were associated with decreased odds of having a telehealth appointment.

Conclusions:

Satisfaction with at-home Internet connection, a novel HINTS 6 item, is directly correlated with cancer information-seeking experiences and utilization of widely available health technology. These findings underscore the value of widespread, high quality internet services towards the successful implementation of healthcare technology and better patients experiences in health information-seeking.