JMIR Publications

ABSTRACT

Background:

Online health information seeking behavior (OHISB) has become a central component of contemporary health management. Yet substantial disparities persist in who seeks health information online and which populations benefit from digital health resources. While previous research has largely focused on individual-level determinants, cross-national evidence on how structural factors shape OHISB remains limited.

Objective:

This study investigates how much variation in OHISB can be attributed to individual characteristics versus national context. It examines the relative contributions of sociodemographic, health-related, and motivational factors alongside macro-level indicators of socioeconomic development, healthcare capacity, digital infrastructure, public health, and cultural values.

Methods:

Data were drawn from the Health and Health Care II module of the International Social Survey Programme (ISSP 2021–2024; N = 35,592; 32 countries). OHISB was measured as any use of the internet to search for health-related information in the past 12 months. Multilevel mixed-effects logistic regression models estimated individual-level effects, macro-level effects, and cross-level interactions. Country-level indicators were reduced via principal component analysis into four composite indices. All analyses included robustness checks excluding respondents without internet access and using design weights.

Results:

OHISB varied substantially across countries (intraclass correlation coefficient = 0.177). At the individual level, younger age, higher education, female gender, recent health problems, doctor visits, unmet medical needs, and perceived usefulness of the internet were strong predictors of OHISB (all P<.001). At the macro level, the Socioeconomic & Health Development Index was the dominant contextual predictor (OR=1.52 per SD, P=.003), explaining more than half of the between-country variance. Cultural hierarchy–individualism showed a weaker contextual effect. Two cross-level interactions were significant: the gender gap in OHISB widened with higher national development (OR=1.17, P=.009), and the effect of perceived usefulness was stronger in more developed contexts (OR=1.09, P<.001).

Conclusions:

OHISB is shaped by both individual characteristics and broader structural conditions. Socioeconomic and health development emerged as the primary contextual driver of cross-national differences, confirming that digital health engagement is embedded in structural opportunity. Development not only increases overall OHISB but amplifies gender and motivational differences. Effective digital health strategies must therefore address both individual readiness and structural inequalities to promote equitable digital participation.