Health-Related Internet Use in Hard-to-Reach Populations: Empirical Findings From a Survey in a Remote and Mountainous Province in China

BACKGROUND: The expanding use of the internet contributes to more effective searches for health-related information and opens up opportunities for direct Web-based communication with health care professionals. However, little is known about how users’ characteristics on the demand side influence health-related internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users’ characteristics and their impact on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies. OBJECTIVE: The aim of this study was to assess the prevalence of health-related internet use and to identify its determinants in a remote province in China. METHODS: We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in northwestern China. Rural households were selected by multistage random sampling, and households’ key members were interviewed face-to-face at the respondents’ home. Dependent variables were whether the households use Web health services or not. Independent variables were chosen based on the Andersen behavioral model. Sociodemographic characteristics were compared between households that used health-related Web services with nonusers. We applied logistic regression models to evaluate multivariate associations between respondents’ characteristics and their usage of Web-based health services and obtained odds ratios with 95% CI. RESULTS: A total of 1354 respondents from rural households were interviewed, of whom 707 (52.22%) were men. The mean age of the respondents was 44.54 years (SD 10.22). Almost half of the surveyed households (640/1354, 47.27%) reported using 1 or more Web-based health care services, whereas 37.8% (502/1354) reported using the internet to obtain health-related information, 15.51% (210/1354) used the internet to communicate with professionals about health issues, and 7.24% (98/1354) had engaged in Web-based consultations in the last year. After controlling for potential confounders, households engaged in health-related internet use were found to be wealthier, have higher health demands, and have less geographic access to high-quality health care compared with other households. CONCLUSIONS: The internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households’ health-related internet use in rural and remote areas in China. Those who belong to older age groups, have low income, and whose education levels do not extend beyond primary school education are significantly less likely to use Web-based health care services and to benefit from Web-based health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, Web-based and other health care providers, family members, and the government is needed.