Do Older Hispanic Diabetics Use the Internet for Health-Related Information?

Tuesday, 10 November 2015: 8:50 AM

Kathleen Nokes, RN, PhD, FAAN
Hunter-Bellevue School of Nursing, Hunter College (retired), New York, NY, USA
Judith Aponte, RN, PhD, CDE, CCM, APHN-BC
Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, NY, USA

Diabetes is a major cause of morbidity and mortality and a growing public health concern.  In 2012, Hispanics comprised 16.9% of the total 313.9 million US population; and 12.8% had diabetes.  Persons with diabetes and limited health literacy have worse health outcomes since they have less knowledge about their diabetes, difficulty in reading medication labels, and a poor understanding on ways to better management their health.  Health literacy influences a person’s ability to engage in self- management and the internet can be a resource for providing diabetes-related information for people to self-manage their diabetes more effectively. 

The purpose of this mixed methods descriptive study was to provide insight about older Hispanics’ with type 2 diabetes use of the internet to access diabetes-related information.  Inclusion criteria included: 1) residing in East Harlem, a New York City community characterized by poverty and a large Hispanic population; 2) able to access the internet; 3) aged 60 or older; 4) either English or Spanish speaking; and 5) diagnosed with type 2 diabetes. 

A convenience sample of 20 Hispanics participated in both phases of the research; the sample was equally divided between men and women; the average participant was 74 years; born in Puerto Rico;  preferred to speak in Spanish; lived with diabetes an average of 17 years and took medications to manage their diabetes.  Since access to the internet could be an issue, respondents were asked if they had a smart phone with internet access and the average participant had a smart phone for 3 years; made or received 3 calls daily; texted less than once daily; and 75% were either very or somewhat concerned with privacy and texting.   

 During the quantitative phase, participants completed a demographic (i.e., age, gender, country of origin), diabetes-related information, and smart phone use to access the internet survey along with the E-Health Literacy Scale (e-Heals) which measures comfort and skill in using internet technology for health information.  They then participated in the qualitative phase which was a focus group with questions framed around the E-Health literacy items using a diabetes orientation.

The mean score on e-Heals was computed as 22.35 (SD=12.96) with a range from 8 to 40; respondents reported the most difficulty with knowing how to use the Internet to answer questions about their health.   Recognizing the small sample size and the descriptive purpose of the research, univariate exploratory analysis were conducted to determine if there were differences in electronic health literacy based on age or gender.  No significant differences were found based on age (F=.76, p.=.66) but an independent sample t-test found highly significant differences based on gender (t=-2.67, df=18, p=.015) in that the e-Heals scores of men were significantly lower than those of women (means=13.85 (9.69) and 25.77 (10.22) respectively).

Using applied thematic analysis, five themes were identified from the responses provided by focus group participants who were asked about their experiences with the internet as a source of health-related information n.  The five themes were:  Useful information source; Family and friends help; Complex and confusing; Type words and get information; and Improved self-management.

This research identified significant barriers in accessing the internet for health-related information about their diabetes self-management although all had a smart phone which provided internet access.  Older Hispanic men seemed to rely on family and friends rather than search the internet independently.  Use of different venues by culturally diverse groups and subpopulations within relatively homogeneous groups based on demographic variables such as gender – and perhaps gender roles – need to be explored in order to optimize the use of technology in populations who could benefit from enhanced self-management strategies but who may lack the technical skills to use available information.