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Study shows significant digital divide in China

First national-level study on eHealth behaviors in a middle- and low-income country shows health care infrastructure building in underserved communities should be priority

The use of mobile technologies and internet in health care, known as eHealth, promises increased access to quality care; however, the quality and quantity of eHealth programs in use havebeen found lacking, especially in middle- and low-income countries like China. To build evidence-based policies around eHealth in China, researchers and policymakers need a better understanding of eHealth behaviors and the factors associated with them.

A research team led by Alicia Hong, PhD, associate professor in the Health Promotion and Community Health Sciences Department and co-director of the Program on Global Health Research at the Texas A&M School of Public Health, sought to answer questions about eHealth use in China, a nation with more than 700 million internet users and more than a billion mobile phone users. The study, published in the journal Frontiers in Public Health, reported results from a nationally representative survey of more than 4,000 Chinese adults. This survey, a collaborative project of Texas A&M University and Southwest University of Finance and Economics of China, aimed to understand health behaviors and communications in contemporary China.

In the study, Hong and colleagues measured whether the general population has used the internet to search for health information, buy medication online, communicate with health care providers online and make doctor’s appointments online. They also collected data on age, gender, education, employment, income, health insurance status, rural or urban residence and self-reported health status.

Hong and colleagues found that half of the study’s participants used the internet, with a third searching for health information online and 10 percent using online tools for health care communication. They also found that these low rates of usage were even lower for participants who were older, had lower levels of education or income, or lived in rural areas. The overall eHealth adoption rates were much lower in China than in the United States. Also, the economic and social inequality with regard to access to, use of or impact of information and communication technologies—known as the digital divide—was consistent with previous research there.

These findings point to a need to address this digital divide before pouring more resources into eHealth initiatives in China, especially in resource-poor settings where the priority should be access to basic health services.

“Research from high income countries has found that lower rates of eHealth use by the groups of low socio-economic status due to a digital divide could aggregate already documented health disparities,” Hong said. “Rather than pouring limited resources into advanced eHealth technologies that are used by only a small group, policymakers should give priority to health care infrastructure building in underserved communities and focus on reducing the digital divide first.”

Despite limitations such as the self-reported nature of the data and a focus on only five eHealth behaviors, this research marks the first national level study on eHealth behaviors in a middle- and low-income country.

Media contact: Dee Dee Grays,, 979.436.0611

Rae Lynn Mitchell

SPH - Director of Communications and Alumni Affairs

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