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. 2018 Feb;34 Suppl 1(Suppl 1):s30-s38.
doi: 10.1111/jrh.12228. Epub 2017 Jan 11.

Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States

Alexandra J Greenberg  1   2 , Danielle Haney  3 , Kelly D Blake  2 , Richard P Moser  2 , Bradford W Hesse  2
Affiliations

Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States

Alexandra J Greenberg et al. J Rural Health. 2018 Feb.

Abstract

Purpose: The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency.

Methods: Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics.

Findings: In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77).

Conclusions: The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.

Keywords: access to care; health disparities; health services research; technology; utilization of health services.

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Figures

Figure 1
Figure 1
Predicted marginals of having regular Internet access by urban-rural categorization across the 7 administrations of the Health Information National Trends Survey (HINTS) from 2003–2014, weighted to data from the 2010 US Census and controlling for age, sex, race/ethnicity, education, income level, and survey year.
Figure 2
Figure 2
Predicted marginals of reporting that health care providers maintained electronic health records by urban-rural categorization across 5 administrations of the Health Information National Trends Survey (HINTS) from 2008–2014, weighted to data from the 2010 US Census and controlling for age, sex, race/ethnicity, education, income level, and survey year.
Figure 3
Figure 3
Predicted marginals of having managed personal health information online in the past 12 months by urban-rural categorization across 3 administrations of the Health Information National Trends Survey (HINTS) from 2008–2014, weighted to data from the 2010 US Census and controlling for age, sex, race/ethnicity, education, income level, and survey year.
Figure 4
Figure 4
Predicted marginals of having emailed a health care provider in the past 12 months by urban-rural categorization across 5 administrations of the Health Information National Trends Survey (HINTS) from 2003–2013, weighted to data from the 2010 US Census and controlling for age, sex, race/ethnicity, education, income level, and survey year.
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