Florence Nightingale School of Nursing & Midwifery
The internet, the ‘digital divide’ and effect of place : patterns of
health information seeking amongst families with children
under five years of age in one Inner London area
Dr Mary Malone
Professor Alison While
Dr Julia Roberts
April 2011
Overview
• This presentation is based on a doctoral study
conducted within the field of child and family public
health
• A survey of 224 individuals using SureStart services
within an inner-London area
• Qualitative data from individual interviews and focus
groups with parents and health and social care providers
in the same area
Overview
•
Descriptive and multivariate statistics were used to identify and describe
discrete geographical districts with differing patterns of health information
seeking.
•
A geographically defined ‘information hungry’/ ‘on line’ health information
seekers was identified
•
This group contrasted with others who acquired information through
‘assimilation’ or ‘off-line’ information seekers
•
Qualitative data revealed the processes underpinning these characteristics
and also professional attitudes towards the internet as a source of health
information.
Background to the study
• SureStart was a Government project based on
developing health and social care resources
within geographically bound local communities
• SureStart aimed to provide access for all, but
most especially for the most vulnerable families,
to new sorts of health care
• The internet has the potential to contribute to
improved access and greater equity of service
provision
Key concepts : the ‘digital divide’
and ‘effect of place’
• ‘Effect of place’ (Macintyre et al 2002) the concept
that ‘place’, or location, can have an effect on health
which is independent of individual personal
characteristics.
The ‘digital divide’
• The ‘digital divide’ (Eng et al 1998; Eysenbach 2000)
• The division between those who use new technologies
for health information and those who do not
• Possibly the modern manifestation of the inverse care
law
• The associated fear that the ‘digital divide’ may
exacerbate the effect of inequalities on health
Methods
• Within one SureStart area five districts (n of respondents
=202) were identified
• Three of the districts had dominant and distinctive
characteristics and these were analysed in depth
• Two of the districts were very small (n=22) and had
disparate characteristics and these were excluded from
the final analysis
The three districts : North East,
West and Central
• North East : part of one of the most deprived boroughs in
the UK
• West formed the other half of the same electoral ward as
North East but differed from it historically, geographically
and culturally
• Central was different again
• Although there were associations between the three
districts and Local Authority electoral wards they were by
no means co-terminous with these
Health information seeking
behaviours
• No significant differences between the districts in terms of age,
ethnicity or gender
• In comparison with respondents in Central and North East , the
West showed significantly lower levels of information-seeking
behaviour across all available information sources
• The West had the highest proportion of internet use at locations
other than the home
Qualitative data
• Qualitative data from focus groups
identified three conceptual themes :
• (i) information hunger
• (ii) information assimilation
• (iii) power and control
The three districts
• In Central and North qualitative data revealed a form of
‘information hunger’
• ‘…I look everywhere for information’
• The West was characterised by a more passive form of
‘information assimilation’
• ‘…It’s just information that you know. It’s out there and
you just get it.’
Health information and the
Internet
• ‘on-line’ health information seekers were more likely to have a
computer, to use it at home and at work and to use the internet for a
range of information in relation to health.
• ‘on-line health information seekers also actively sought health
information from a variety of other (i.e. non-internet) sources
• ‘off-line’ health information seekers used more traditional sources of
health information and they used fewer of them.
• For multivariate analysis all those variables showing a significant
association with internet use for health information were entered
simultaneously into a logisitc regression analysis
Multi-variate analysis
• For multivariate analysis all those variables showing a significant
association with internet use for health information were entered
simultaneously into a logistic regression analysis
• There was a strong association between Internet use for child health
and being an on-line user (OR 45.3)
• Using the internet at home increased the potential to be an on-line
health information seeker by nearly six fold
• To control for the influence of demographic variables in the
multivariate model the analysis was run again using them as covariates but there was no change in the result
Internet users
• Internet use for child health information was strongly correlated with
Internet use for information on :
• adult health
• lifestyle
• health services
•
•
•
•
•
Internet use at home was strongly associated with :
frequency of use
having a computer at home
using the computer to access a broad range of health information
Being ‘information hungry’
Health professionals and the
internet
• GPs associated the internet with issues of ‘power and control’ in
health care
• Power and control within the primary care consultation
• Felt that patients used the internet to check up on them (i.e. the
GPs) especially regarding medication
• Patients used the internet as a means of creating a favourable
impression during the consultation
• For GPs the internet promoted patient autonomy but that this was an
autonomy for which boundaries must be drawn.
A ‘digital divide’ ?
• Districts of equal deprivation have very different patterns of health
information-seeking and of internet use
• Possibly two digital divides
• One structural
• The second interpersonal and psychodynamic
• The effect of the internet on health information seeking behaviour
has possibly been imposed on other, possibly older, patterns of
health information seeking
• Which in turn are predicated on social, cultural and economic
divisions