Socioeconomic and behavioural factors associated with access to and use of Personal Health Records

Ivana Paccoud,Benoît Pétré,Louis Chauvel,Philip Böhme,Mareike Breinbauer,Etienne Le Bihan,Anja K Leist,Michèle Baumann

doi:10.1186/s12911-020-01383-9

Abstract

BackgroundAccess to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR.MethodsA cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors.ResultsA total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use.ConclusionThe findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.

Highlights

Access to and use of digital technology are more common among people of more advantaged socioeconomic status
Desire to access Personal Health Records (PHR) After controlling for country fixed effects and demographic variables, the results indicate that a higher educational level (OR = 2.35, 95% CI = 1.36–4.05) and living comfortably on income (OR = 1.87, 95% CI = 1.11–3.13) are positively associated with the desire to have access to their PHR in the expected direction
Having physical access to PHR Exploring the association between those who have physical access to their PHR and the different demographic and socioeconomic variables, we found that those born outside of the Greater Region and those who reported that they are living comfortably or coping on present income were more likely to have physical access to their PHR (OR = 2.59, 95% CI = 1.087–6.158), (OR = 2.56, 95% CI = 1.060–6.188), respectively

Summary

Introduction

Access to and use of digital technology are more common among people of more advantaged socioeconomic status. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. It has been noted that the provision of PHRs will further help with self-care, facilitate the better coordination of healthcare services and improve health outcomes [3, 4]. In this context, the European Commission supports the adoption of PHR within and between its member states, with a strong emphasis on the safety and the security of patients’ health data. Most countries within the European Union, with the exception of Germany, have developed and to some extent implemented PHRs [1]

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