Examining the Impact of Selected Sociodemographic Factors and Cancer-related Fatalistic Beliefs on Patient Engagement via Health Information Technology among Older Adults - A Cross-Sectional Analysis.

Abstract

Despite the role of Health Information Technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults, with a high burden of chronic diseases like cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT usage for patient engagement in adults 65 or older. We controlled cancer diagnosis to account for its potential influence on patient engagement. This study has two aims 1- To investigate the role of sociodemographic factors of race, education, poverty index, and psychosocial factor of cancer fatalistic beliefs on accessing and utilizing HIT in older adults. 2- To examine the association of access and utilization of HIT to the self-management domain of patient activation that serves as a precursor to patient engagement. This is a secondary data analysis of a subset of the Health Information National Trend Survey (HINTS 4, Cycle 3). The subset includes individuals 65 and older with and without a cancer diagnosis. The relationships between access to and utilization of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic regression and linear regression models were fit to study these associations. In this study, the total number of individuals over 65 years of age with a cancer diagnosis was 180 and without a diagnosis was 398. This analysis indicated that having less than a college education level, being nonwhite, and living in poverty were significantly associated with decreased access to HIT. Reduced HIT utilization was associated with less than a college education level and poverty. This analysis also indicated that cancer fatalistic beliefs were significantly associated with lower HIT utilization. Specifically, a one-point increase in cancer fatalistic belief score is associated with a 36% decrease in HIT utilization. We found that controlling for cancer diagnosis did not affect the outcome for sociodemographic variables. However, the self-management domain of patient activation was significantly associated with the higher utilization of HIT and patients with a prior cancer diagnosis. Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and utilization in older adults, regardless of prior cancer diagnosis. HIT users among older adults report higher self-management, essential for patient activation and engagement.