JMIR Publications

ABSTRACT

Background:

Despite numerous research examining the digital divide in the context of eHealth, studies specifically targeting inpatients remains limited. In comparison with the general population, inpatients typically undergo a progression from outpatient consultations to inpatient treatment and subsequent out-of-hospital rehabilitation. This sequential process gives rise to requirements across nearly all usage scenarios of eHealth services. Therefore, this study focuses on inpatients with potential interest in eHealth as the research subjects.

Objective:

This study aims to analyze the digital divide in the awareness in, want for, and adoption of diverse eHealth services, and further explore factors influencing these disparities among inpatients.

Methods:

A cross-sectional study was conducted in 2023, involving 1,322 inpatients aged 15 and older from three tertiary hospitals in Jinan, China. Data were collected through a face-to-face questionnaire survey. eHealth services were categorized into three types, including information-based, treatment intermediary, and treatment eHealth services. The adoption gap ratio is used to explore the gap between eHealth services’ adoption and awareness or want. The awareness, want, and adoption (AWAG) segment matrix was employed to further analyze the digital divide in eHealth services and categorize inpatients into four groups, including opened, perception-deficiency, desire-deficiency, and closed group, each of which was further divided into four subcategories (strong, generic, want-bias, and awareness-bias). Binary logistic regression was used to explore potential influencing factors of awareness, want, and adoption across diverse eHealth services.

Results:

The results showed that 1204 out of 1322 inpatients (91.1%) have awareness of eHealth services, 88.4% (1169/1322) of them have want for eHealth services, and 847 out of 1322 inpatients (64.1%) adopted one or more of these services. Digital divides were observed in information-based eHealth, treatment intermediary, and treatment eHealth services, with adoption gap ratios reaching 32.1%, 34.1%, and 66.5%, respectively. Notably, all three eHealth services fell into the opened group. Among three services, information-based eHealth services were located in the want-bias subgroup, treatment services belonged to the generic subgroup, and treatment intermediary services fell into the strong group. Binary logistic regression revealed that the influence of age, place of residence, educational attainment, income, self-rated health, chronic disease, eHealth literacy, perceived usefulness, and perceived ease of use on the awareness of, want for, and adoption of eHealth services, showed notable difference, differed significantly depending on the types of eHealth services.

Conclusions:

This study provides empirical evidence on the existence of digital divide in awareness, want, and adoption across diverse eHealth services among inpatients in Jinan, China. Given the promise and opportunities that eHealth services increase access to healthcare, future digital interventions should both address or bridge the digital divide in various eHealth services and consider the implementation differentiated marketing strategies for diverse eHealth services.