Dr Mary Malone Professor Alison While Dr Julia Roberts April 2011

1. Florence Nightingale School of Nursing & Midwifery The internet, the ‘digital divide’ and effect of place : patterns ofhealth 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

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. 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

9. Health information seeking behaviours • No significant differences between thedistricts 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

10. Qualitative data • Qualitative data from focus groups identified three conceptual themes : • (i) information hunger • (ii) information assimilation • (iii) power and control

11. 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.’

12. 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

13. 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 co-variates but there was no change in the result

14. 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’

15. 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.

16. 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