Identifying Barriers Preventing Latina Women from Accessing WIC Online Health Information

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a program for low-income women and children under age five. The purpose of this study was to identify barriers to accessing online WIC resources among Latina WIC clients. Five focus groups were conducted with Spanish-speaking participants recruited from a single WIC clinic. Two key themes emerged relating to barriers in accessing WIC’s online resources. The first theme, access issues, included three subthemes: lack of computer/Internet resources; family barriers to computer use; and computer literacy. The second theme, perceived value of the website, included three subthemes: limited time savings; preference for on-site education; and knowledge about the website. This is the first study to evaluate barriers to accessing online resources among Latina women in the WIC program. WIC sites attempting to increase utilization of online resources may be more successful if they serve clients with easy access to a computer with Internet access. They may also consider strategies to increase the value of the online resources, as compared to their current services offered to clients in a face-to-face setting.     

Internet use among Chinese-American breast cancer survivors

This study describes information seeking behaviors and patient characteristics associated with Internet use by 72 Chinese-American breast cancer survivors diagnosed in the past 5 years and living in Houston, Texas. Face-to-face interviews showed that only 56% used the Internet for health information; only 9% used e-mail or visited a website to communicate with a doctor's office or get online provider advice. Results indicate that health providers who want to reach breast cancer patients with limited English skills need to take into account this low use of Internet resources and web-based information. Particularly important is the need to develop and make available culturally effective and appropriate health information in the native languages of the patients to promote greater health literacy.     

The Next 50 Years—Reducing the Continued Harm From Tobacco Use

Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.     

Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of the Cognitive-Social Health Information Processing (C-SHIP) model

Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.     

Barriers to patient interest in internet-based cognitive behavioral therapy: Informing e-health policies through quantitative analysis

ObjectiveThere is growing interest in expanding patient access to Internet-Based Cognitive Behavioral Therapy (ICBT). In order to inform policies to improve ICBT access, this study explored attitudinal (e.g., stigma), structural (e.g., access to care) and ICBT specific (e.g., computer anxiety) barriers to rural and urban patient interest in ICBT.MethodsThis cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, nine barriers to ICBT, demographics, and depression and anxiety symptoms.ResultsMultivariable linear regression analyses were conducted and revealed that participants with lower self-stigma of seeking help and higher perceived need for mental health treatment (attitudinal barriers), and participants with lower access to care (structural barrier) and lower computer anxiety (ICBT-specific barrier) showed significantly greater interest in ICBT. Participants with financial concerns, life chaos, and participants who reported greater preference for autonomy (attitudinal barrier) did not report significant interest in ICBT.ConclusionsTo increase uptake of ICBT, the findings point towards several policy implications, including aligning ICBT towards individuals with lower access to care and higher perceived needs, and allocating resources for strategies to decrease computer anxiety and self-stigma of seeking help.     

Internet Access and Online Cancer Information Seeking Among Latino Immigrants From Safety Net Clinics

Internet use is widespread, but little is known about Internet use for cancer information among Latinos, especially those who rely on safety net clinics. The authors investigated access to and intended use of the Internet for cancer information among low income, immigrant Latinos predominately from Central and South America. A cross-sectional study of 1,273 Latinos 21 years and older attending safety net clinics or health fairs was conducted from June 2007 to November 2008. The authors used logistic regression models to evaluate associations of age, acculturation, psychosocial factors and other covariates with Internet access and intended use of the Internet for cancer information among those with access. Of the sample, 44% reported Internet access. Higher information self-efficacy and greater trust in the Internet were independently associated with Internet access (p = .05 and p < .001, respectively). Among those with access, 53.8% reported they intended to seek cancer help online if they needed information. Those with younger age and higher acculturation, education and self-efficacy had higher odds of intended Internet use for cancer information, considering covariates. In addition, those with high (vs. low) perceived risk of cancer (OR = 1.76; 95% CI [1.14, 2.73]; p = .01) and higher levels of trust in online health information (OR = 1.47 per one-point increase; 95% [CI 1.19, 1.82]; p = .0004) were more likely to intend to seek cancer information online. These findings that Internet access is fairly high in the immigrant Latino population and that the Internet is a trusted source of cancer information suggest that the Internet may be a channel for cancer control interventions.     

OncoLink

Abstract

OncoLink is the first multimedia cancer information resource on the Internet that offers state of the art, quality information about cancer. Developed at the University of Pennsylvania Medical Center and the University of Pennsylvania Cancer Center, OncoLink (http://www.oncolink.upenn.edu) has been online since March 1994. The major goals for OncoLink are to provide quality, original content for cancer patients and health care professionals and to provide well-organized, consistent access to cancer resources on the Internet. It is a free service that is available 24 hours each day to people around the globe.     

A study of Internet use by doctors and patients in Poland.

We evaluated Internet use in Poland in the field of obstetrics and gynaecology. Questionnaires were sent to 33 hospital departments of obstetrics and gynaecology; 25 replied (76%). The 25 departments contained a total of 275 doctors, 70% of whom (n=193) returned the questionnaire. We also invited 3054 people visiting a gynaecological Website for patients to complete an online form; 161 replied, a response rate of 5.3%. While 84% of the 102 doctors using the Internet were satisfied with Internet medical resources, only 24% of patients were. Patients searched for medical information less frequently than professionals and were younger. About half of the doctors and patients had only modem access to the Internet. The most popular services for professionals were databases and information services; patients were most interested in information on pregnancy, contraceptives, physiology and general female health. Most of the 45% of patients who said that they did not receive sufficient information from doctors could not usually find it on the Internet either.     

Digital Disparities

ABSTRACT

There is a vast amount of health information on the Internet, although certain underserved U.S. populations still lack equal access to this information. This digital divide pertains not only to computer and Internet access, but also to issues related to appropriate content. Some view the Internet as one solution to eliminating health disparities, although barriers such as education, income and cost, age, location, literacy, and content contribute to a persistent digital divide. Many solutions to this problem have been proposed, but the situation still warrants further study before eHealth strategies and interventions can be effectively implemented to a wider community.     

Exploring factors influencing the use of an eHealth intervention for families of children with hearing loss: An application of the COM-B model

BackgroundPrior to developing a successful eHealth intervention, it is important that we explore stakeholders’ capacity to adapt to eHealth.ObjectiveTo explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention.MethodsA qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation.ResultsThe COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals’ and families’ preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families’ and professionals’ confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions.ConclusionFindings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders’ capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services.     

Health and information disparities among non-adopters of smartphones

ObjectivesMobile health technologies have gained increasing popularity in the healthcare industry, even though inequity in their adoptions has been documented. This study aimed to describe sociodemographic and clinical vulnerabilities among non-adopters of smartphones, identify their alternative ways of seeking health information, and explore potential outreach venues to these individuals.MethodsSmartphone users, basic cell phone users, and nonusers of mobile devices were identified from the 2019 Health Information National Trends Survey (HINTS). The three groups were compared on sociodemographic and clinical characteristics. Their health information seeking outcomes were compared in latent factor models, path models, and multinomial regression models.ResultsCompared to smartphone users, the nonusers were more likely to be older, less educated, have lower income, speak English less well, have a chronic condition, report poorer health, have lower self-care efficacy, and less likely to have family and friends to talk about their health. In the covariate adjusted models for health information seeking characteristics, compared to smartphone users, basic cell phone users and nonusers of mobile devices showed persistent disparities (less tendency) in search of health information with technology (p’s<.001) and access to online medical records (p’s <.01). Nonusers of smartphones were more likely to report no internet access and feeling uncomfortable with computers as the reasons not to access online medical records.ConclusionmHealth technologies may create additional barriers to health equity in the absence of equitable distributions of socioeconomic resources and access to mobile devices and the Internet. Education and training are warranted to make technology beneficial to the vulnerable population.     

Virtual Medical Care: How Are Our Patients Using Online Health Information?

An increasing percentage of Internet users are seeking health information online. The purpose of our study was to determine the extent of Internet access and online health-seeking and the feasibility of implementing Internet services for our urban, residency-based practice. Using a self-administered survey, we obtained information on use of the Internet, demographics and socioeconomic profile, presence of a chronic medical condition and self-rated health from 300 consecutive patients. Complete surveys were obtained by 203 (68 percent). Responses were compared based on demographic, socioeconomic, and medical variables using Chi-square analysis. Results showed that our sample population tended to be under age 50, female, non-Hispanic Black, low income, and healthy. Seventy-seven percent of respondents had accessed the Internet at least once, 79 percent had used the Internet to find health-related information, 73 percent used the online information to make a health-related decision, 50 percent shared the information with their provider. In conclusion, we confirmed a high rate of Internet usage in our specific patient population, characterized by low socioeconomic status, low education level, and high minority percentages. Our patients not only access online health information, but also make changes based on this information, with only about half of all patients sharing this information with their physicians. It is unclear how this system of ‘virtual medical care’ influences overall patient health.Heather A. Liszka and Terrence E. Steyer are Assistant Professors of Family Medicine, William J. Hueston is Professor and Department Chair of Family Medicine, all at the Medical University of South Carolina, Charleston, SC.     

Adolescent Access to Online Health Services: Perils and Promise

PurposeMany health care institutions provide online health services to adult patients and proxy access to parents of young children. Many of the benefits and barriers to providing such services to adolescent patients remain unclear.MethodsThe present work is based on a literature review and expert opinion synthesis.ResultsPotential benefits of providing online health services to adolescents include improved health care access, health literacy, and ongoing care. Potential barriers include information complexity, confidentiality concerns, legal issues, and management priorities.ConclusionsAlthough barriers exist to implementing adolescent access to online health services, the potential benefits are significant. Overcoming these barriers will involve invoking legal and policy strategies and refocusing priorities on adolescent health.     

Assessment of low-income adults' access to technology: implications for nutrition education

ObjectiveThe main objective of this study was to investigate access and use of technologies such as the Internet among Indiana's low-income population. The secondary objective was to determine whether access and use of computers significantly differed by age, race, and/or education level.MethodsData were collected from low-income adult Supplemental Nutrition Assistance Program Education participants for a 2-year period using a cross-sectional questionnaire about access and use of technology.ResultsApproximately 50% of the total respondents (n = 1,620) indicated that they had a working computer in their home, and of those, the majority (78%) had a high-speed Internet connection. Chi-square analysis revealed that younger adults who were white and had more education were more likely to have a computer (P < .001) and Internet.Conclusions and ImplicationsThe results of this study provide evidence that using Internet-based nutrition education in a low-income population is a viable and possibly cost-effective option.     

Nutritional Status and Information Needs of Medical Oncology Patients Receiving Treatment at an Australian Public Hospital

This study aimed to identify 1) the prevalence of malnutrition according to the scored Patient Generated-Subjective Global Assessment (PG-SGA), 2) utilization of available nutrition resources, 3) patient nutrition information needs, and 4) external sources of nutrition information. An observational, cross-sectional study was undertaken at an Australian public hospital on 191 patients receiving oncology services. According to PG-SGA, 49% of patients were malnourished, and 46% required improved symptom management and/or nutrition intervention. Commonly reported nutrition-impact symptoms included peculiar tastes (31%), no appetite (24%), and nausea (24%). External sources of nutrition information were accessed by 37%, with popular choices being media/Internet ( n = 19) and family/friends ( n = 13). In a subsample ( n = 65), 32 patients were aware of the available nutrition resources, 23 thought the information sufficient, and 19 patients had actually read them. Additional information on supplements and modifying side effects was requested by 26 patients. Malnutrition is common in oncology patients receiving treatment at an Australian public hospital, and almost half require improved symptom management and/or nutrition intervention. Patients who read the available nutrition information found it useful; however, awareness of these nutrition resources and the provision of information on supplementation and managing symptoms requires attention.     

Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey

BackgroundDespite being motivated to improve nutrition and physical activity behaviors, cancer survivors are still burdened by suboptimal dietary intake and low levels of physical activity.ObjectiveThe aim of this study was to assess changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, barriers to eating a healthy diet and staying physically active, and sources for seeking nutrition advice reported by breast cancer survivors.DesignThis was a cross-sectional study.Participants/settingThe study included 315 survivors of breast cancer who were recruited through social media and provided completed responses to an online exploratory survey.Main outcome measuresSelf-reported changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, perceived barriers to healthy eating and physical activity, and sources of nutrition advice were measured.Statistical analysisFrequency distribution of nutrition and physical activity behaviors and changes, barriers to healthy eating and physical activity, and sources of nutrition advice were estimated.ResultsAbout 84.4% of the breast cancer survivors reported at least 1 positive behavior for improving nutrition and physical activity after cancer diagnosis or treatment. Fatigue was the top barrier to both making healthy food choices (72.1%) and staying physically active (65.7%), followed by stress (69.5%) and treatment-related changes in eating habits (eg, change in tastes, loss of appetite, and craving unhealthy food) (31.4% to 48.6%) as barriers to healthy eating, and pain or discomfort (53.7%) as barriers to being physically active. Internet search (74.9%) was the primary source for seeking nutrition advice. Fewer than half reported seeking nutrition advice from health care providers.ConclusionsDespite making positive changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, breast cancer survivors experience treatment-related barriers to eating a healthy diet and staying physically active. Our results reinforce the need for developing tailored intervention programs and integrating nutrition into oncology care.     

How older adults self-manage distress – does the internet have a role? A qualitative study

Background

Anxiety and depression are common in older adults, but often under-recognised by GPs. Rather than perceiving themselves as suffering from anxiety or depression, older adults are more likely to self-identify as experiencing low mood, stress or distress. Older people may also feel responsible for managing their own mood problems. The Internet has the potential to support the self-management of distress through accessing health information or social support.

Methods

This study was approved by Keele University’s ethical review panel. Older adults who self-identified as experiencing distress were recruited from community groups in the West Midlands, England. To generate data, ‘think-aloud’ methods (including storyboards and an extract from an online forum) were embedded within semi-structured interviews. Thematic analysis, incorporating constant comparison methods, were used for data analysis.

Results

Data saturation was achieved after 18 interviews. All participants reported having access to the Internet, but only a few described using the Internet to obtain general information or to conduct online purchases. Most participants described barriers to Internet use which included: a lack of interest, knowledge and confidence, a fear of technology and no trust in social media sites. Facilitators of Internet use included family encouragement and attending community groups which taught computer use. Female participants reported valuing the social contact provided by attending such groups. The Internet was seen as a source of health information once a GP had diagnosed a physical problem, but was not considered a source of information about distress or mood problems. Participants did not use the Internet to access social support and described a preference for face-to-face communication.

Conclusions

GPs need to understand how an individual patient utilises the Internet. GPs should explore the self-management strategies already employed by older adults experiencing distress and understand that directing these older people to online support might not be acceptable. Encouraging distressed older adults to attend computer group classes might be useful as this permits face-to-face social contact, and may help to facilitate Internet use in the future.

     

Know Your Search Engine

Abstract

Over the past decade, the Internet has become a vital part of our society, playing a significant role in bridging the traditionally extensive gap between knowledge seekers and knowledge providers and creating an opportunity for consumers in rural communities to access health information previously either unavailable or available through very limited sources. This exploratory study was conducted to examine utilization of the Internet for health information retrieval by rural West Virginia consumers. Surprisingly, the researchers discovered that more West Virginia rural respondents had access to the Internet than the national average for rural consumers and that health care professionals in rural West Virginia rarely suggest the Internet to their patients as a secondary source of health information.     

Evidence of Geospatial and Socioeconomic Disparities in Access to Online Grocery Shopping for Fresh and Frozen Produce in North Carolina

BackgroundOnline grocery shopping is a rapidly growing food procurement approach in the United States with the potential to improve food access. Limited research has focused on understanding differential access to online grocery shopping that provides healthier items such as fresh or frozen fruits and vegetables.ObjectiveThe study aim was to understand geospatial, socioeconomic, and racial disparities in the availability of healthy online grocery shopping and online Supplemental Nutrition Assistance Program (SNAP) acceptance in North Carolina.DesignA cross-sectional study was conducted during spring 2021.Participants/settingA listing of grocery stores with online shopping was generated using a systematic search strategy. Stores were geocoded and spatially joined to relevant contextual (rural/urban [based on US Department of Agriculture Rural Urban Continuum codes]), broadband Internet availability, socioeconomic variables (ie, percent poverty and Social Vulnerability Index), and demographic variables (ie, percent racial minority) in geographic information systems software.Main outcome measuresPrevalence rate ratios (PRRs) of healthy online grocery shopping (availability of curbside pickup or home delivery of fresh and frozen produce), and online SNAP acceptance (ie, availability of online SNAP), at the census tract level (n = 2,162).Statistical analyses performedPRRs for availability of healthy online grocery shopping and SNAP online acceptance at the census tract level (n = 2,162) were modeled using Poisson regression with robust standard errors.ResultsThis study found disparities in access to healthy online grocery shopping and SNAP online shopping availability in North Carolina. Healthy online shopping availability rates were higher in urban census tracts (PRR 1.68, 95% CI 1.47 to 1.92), areas with lower Social Vulnerability Index scores (PRR 0.99, 95% CI 0.98 to 0.99), higher Internet Availability Index scores (PRR 1.21, 95% CI 1.17 to 1.25), and lower percent poverty (PRR 0.94, 95% CI 0.90 to 0.98). SNAP online shopping availability rates were higher in urban census tracts (PRR 1.41, 95% CI 1.16 to 1.65), areas with higher Social Vulnerability Index scores (PRR 1.02, 95% CI 1.01 to 1.04), higher Internet Availability Index scores (PRR 1.15, 95% CI 1.10 to 1.20), and higher percent minority (PRR 1.02, 95% CI 1.0001 to 1.03). SNAP online shopping availability rates were lower in areas with higher percent poverty (PRR 0.90, 95% CI 0.85 to 0.95).ConclusionsThis study found disparities in access to healthy online grocery shopping and SNAP online shopping for rural areas, and areas with higher poverty, and lower broadband Internet access in North Carolina. Further research is needed to identify effective strategies for addressing these disparities.     

Exploring e-Health usage and interest among cancer information service users: the need for personalized interactions and multiple channels remains

Since searching for health information is among the most popular uses of the Internet, we analyzed a survey of 6,019 callers to the National Cancer Institute's (NCI's) Cancer Information Service (CIS) to assess Internet usage and interest in technologies to access health and cancer information. Findings suggest that about 40% of CIS callers used the Internet to obtain cancer information and, of these, only about 20% found all the information they sought. Nearly 33% of Internet users called the CIS to discuss information found on the Internet; most (>90%) reported that the CIS was helpful. Those who sought cancer information on the Internet were more likely to call the CIS about this information if they found all or most of the information they were seeking, compared with those who found some or little of the information. New communication services endorsed by most CIS callers included e-mails from an information specialist and telephone support from the CIS while on the Internet. The survey results indicate the importance of multiple access points, both traditional and technology based, and that there is still a need for more traditional, personalized forms of health communication. A crucial question is how best to harness and integrate these new technologies within the current generation of mediated health information systems.