# Digital Divide in Awareness, Want, and Adoption Across Diverse eHealth Services: Cross-Sectional Survey of Inpatients in Jinan, China

## TL;DR

This study explores the digital divide in eHealth service awareness, interest, and adoption among hospitalized patients in China, finding significant gaps and differences based on factors like age and education.

## Contribution

The study provides empirical evidence of the digital divide in eHealth services among inpatients, a group rarely studied in this context.

## Key findings

- 91.1% of inpatients were aware of eHealth services, but only 64.1% adopted them.
- Adoption gap ratios reached 32.1%, 34.1%, and 66.5% for information-based, treatment intermediary, and treatment eHealth services, respectively.
- Factors like age, education, and eHealth literacy significantly influenced awareness, want, and adoption of eHealth services.

## Abstract

Despite numerous research studies examining the digital divide in the context of eHealth, studies specifically targeting inpatients remain limited. In comparison with the general population, inpatients typically undergo a progression from outpatient consultations to inpatient treatment and subsequent out-of-hospital rehabilitation. This sequential process gives rise to requirements across nearly all usage scenarios of eHealth services. Therefore, this study focuses on inpatients with potential interest in eHealth as the research subjects.

This study aimed to analyze the digital divide in the awareness of, want for, and adoption of diverse eHealth services and further explore factors influencing these disparities among inpatients.

A cross-sectional study was conducted in 2023, involving 1322 inpatients aged ≥15 years from 3 tertiary hospitals in Jinan, China. Data were collected through a face-to-face questionnaire survey. eHealth services were categorized into 3 types (ie, information-based, treatment intermediary, and treatment eHealth services). The adoption gap ratio is used to explore the gap between eHealth services’ adoption and awareness or want. The awareness, want, and adoption gap segment matrix was used to further analyze the digital divide in eHealth services and categorize inpatients into 4 groups (ie, opened, perception deficiency, desire deficiency, and closed group), each of which was further divided into 4 subcategories (ie, strong, generic, want-bias, and awareness-bias). Binary logistic regression was used to explore potential influencing factors of awareness, want, and adoption across diverse eHealth services.

The results showed that of 1322 inpatients, 1204 (91.1%) have awareness of eHealth services, 1169 (88.4%) have want for eHealth services, and 847 (64.1%) have adopted 1 or more of these services. Digital divides were observed in information-based eHealth, treatment intermediary, and treatment eHealth services, with adoption gap ratios reaching 32.1%, 34.1%, and 66.5%, respectively. Notably, all 3 eHealth services fell into the opened group. Among the 3 services, information-based eHealth services were located in the want-bias subgroup, treatment services belonged to the generic subgroup, and treatment intermediary services fell into the strong group. Binary logistic regression revealed that the influence of age, place of residence, educational attainment, income, self-rated health, chronic disease, eHealth literacy, perceived usefulness, and perceived ease of use on the awareness of, want for, and adoption of eHealth services showed notable difference and differed significantly depending on the types of eHealth services.

This study provides empirical evidence on the existence of a digital divide in awareness, want, and adoption across diverse eHealth services among inpatients in Jinan, China. Given the promise and opportunities that eHealth services increase access to health care, future digital interventions should both address or bridge the digital divide in various eHealth services and consider the implementation of differentiated marketing strategies for diverse eHealth services.