Sue Ziebland*, University of Oxford, Oxford, United Kingdom Helen Atherton, University of Oxford, Oxford, United Kingdom John Powell*, University of Oxford, Oxford, United Kingdom Track: Research Presentation Topic: Health information on the web: Supply and Demand Presentation Type: Rapid-Fire Presentation Submission Type: Single Presentation Building: Sol Principe Room: C - Almudaina Date: 2014-10-10 09:45 AM – 10:30 AM Last modified: 2014-09-10

If you are the presenter of this abstract (or if you cite this abstract in a talk or on a poster), please show the QR code in your slide or poster (QR code contains this URL).

Background
Studies examining the existence and impact of a ‘digital divide’ have largely focused on general population based observations, examining specific demographic groups; most commonly by age, ethnicity and socioeconomic status. There is an observable divide in use of the internet to access healthcare and health information within these groups. Large surveys typically show that older people, ethnic minorities and those in lower socioeconomic groups are less likely to have access to the internet, or to access the internet for health information seeking purposes. This has contributed to concerns about the consequences of digital exclusion for those who are likely to be in greatest need. Yet, there are also reasons to believe that the internet could help to ameliorate some of the health effects of social inequalities.
Objectives
To consider the evidence about whether the internet may be (or become) a means of levelling, rather than deepening, health inequalities.
Methods
A literature review to identify mechanisms through which the internet may help to level health inequalities. We included studies using quantitative and qualitative methods, as well as opinion pieces and the wider literature. Relevant content was analysed using thematic methods with constant comparison.
Results
Becoming ill oneself, or caring for someone else who is facing a health problem, is a major motivator to use the internet – there is a different picture of the ‘digital divide’ if we look at motivations and access among people facing health problems, rather than the general population. The internet may act as a leveller by helping patients to self-manage, learn about their condition , prepare for decisions, check medical terms and identify treatment options. We used thematic analysis to classify the mechanisms through which the internet could reduce inequalities according to macro (infrastructure and health policy), organisational (access in hospitals, staff behaviour, health coaching) and micro level (patient clinician interactions) factors. The wide variety of media formats on websites means that patients should be able to find the level and style of information they prefer and understand. Access to information about how a health system works is now at least potentially available to everyone (in a way that access to private care is not). There is potential to shift stereotypes about the type of patient who is likely to be ‘activated’. Patients’ agency is thus supported at a time when many people feel a strong urge to take some control.
Conclusion
We need to be realistic: even when the internet is universally accessed via mobile devices it cannot be expected to solve deeply embedded structural inequalities in health or access to good care. However, in this paper we suggest ways that health and care systems could concentrate efforts to support changes at the macro, organisational and micro level that have real potential to ameliorate some of the health related consequences of inequalities.