Previously submitted to: JMIR Aging (no longer under consideration since Jun 12, 2026)
Date Submitted: Apr 29, 2026
Open Peer Review Period: Apr 30, 2026 - Jun 25, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Health Engagement Among Older Adults: Health Status, Multimorbidity, and Cross-Survey Differences Across HINTS and NHIS
ABSTRACT
Background:
Digital health use among older adults is increasing, yet engagement varies by health status and socioeconomic factors. Comparative analyses across nationally representative surveys can clarify these differences and inform strategies to improve engagement.
Objective:
To compare digital health engagement among older adults in the Health Information National Trends Survey and the National Health Interview Survey, determine important predictors related to information seeking, communication with a healthcare provider, and access to test results, and evaluate how variations in survey design and participant composition affect observed associations.
Methods:
We analyzed 2024 data from NHIS (N=8,818) and HINTS (N=2,120) using weighted descriptive statistics and multivariable logistic regression. Outcomes included (1) seeking health information online, (2) communicating with providers digitally, and (3) viewing test results. Models adjusted for sociodemographic characteristics, health conditions, physical activity, and living arrangements. Multimorbidity-stratified analyses were conducted by estimating models separately for participants with 0–1 conditions and those with 2 or more conditions. To examine how differences in participant composition and survey design influence findings, we conducted an additional subset analysis restricted to comparable demographic groups across surveys.
Results:
HINTS consistently had higher levels of digital health engagement than NHIS across all outcomes (e.g., seeking health information: 78.5% vs. 57.8%; contacting providers: 60.5% vs. 42.2%). In NHIS, lower self-rated health was associated with greater information seeking and provider communication, whereas these correlations were smaller and less consistent in HINTS. Depression was a consistent predictor of increased digital health use in both surveys. Higher education, income, and female sex were all associated with increased use, whereas living alone was associated with reduced participation. Multimorbidity-stratified analyses showed stronger associations between poorer perceived health and digital engagement among individuals with multiple chronic conditions in NHIS, while patterns in HINTS were less consistent and more variable across outcomes. Subset analyses showed weaker relationships in HINTS and more consistent results in NHIS, suggesting that differences in survey design and measurement influence observed relationships.
Conclusions:
Older adults' digital health engagement reflects their health needs and inequality, rather than equitable access. Its association with depression suggests ways to incorporate behavioral health and digital navigation support into patient portals. Disparities in education, income, and living alone emphasize the importance of targeted digital literacy and social support. Differences between NHIS and HINTS show that survey design influences observed relationships, and combining evidence from multiple surveys can help inform equitable digital health policy.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.