Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May 2;15(5):e93.
doi: 10.2196/jmir.2645.

The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use

Namkee G Choi  1 , Diana M Dinitto
Affiliations

The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use

Namkee G Choi et al. J Med Internet Res. .

Abstract

Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults' Internet use, none focused on these most vulnerable older adults.

Objective: This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts-homebound adults under age 60.

Methods: Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78% were age 60 years and older and 22% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models.

Results: Only 34% of the under-60 group and 17% of the 60 years and older group currently used the Internet, and 35% and 16% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language.

Conclusions: This study is the first to describe in detail low-income disabled and homebound adults' and older adults' Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided.

Keywords: Internet; attitudes toward Internet; eHealth literacy; homebound older adults; housebound older adults.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. United States Census Bureau Statistical Table Based on data from the 2009 American Community Survey. 2009. [2013-04-01]. Table 35, Persons 65 Years and Over - Living Arrangements and Disability Status http://www.census.gov/compendia/statab/2012/tables/12s0035.pdf.
    1. Centers for Medicare and Medicaid Services Table 7.2, Persons Served, Visits, Total Charges, Visit Charges, and Program Payments for Medicare Home Health Agency Services: Calendar Year 2011. 2012. [2013-04-01]. Medicare and Medicaid Supplemental Statistics http://cms.hhs.gov/Research-Statistics-Data-and-Systems/Statistics-Trend....
    1. Barrett A, Schimmel J. Issue Brief No 2. Mathematica Policy Research, Inc; 2012. Aug, [2013-04-24]. 6G7am0QLA OAA Title III services target the most vulnerable elderly in the United States http://www.nanasp.org/pdf/vulnerableseniors_ib2.pdf.
    1. Altchuler N, Schimmel J. Issue Brief No. 1. Mathematica Policy Research, Inc; 2010. [2013-04-24]. 6G7asrlAm Aging in place: Do Older Americans Act Title III services reach those most likely to enter nursing homes? http://www.aoa.gov/aoaroot/program_results/docs/AoA-issue1_Nursing%20Hom....
    1. Colello KJ. Congressional Research Service Report for Congress. 2011. Jun 17, [2013-04-24]. Older Americans Act Title III Nutrition Services Program http://www.aging.senate.gov/crs/nutrition1.pdf.