Date of Award

5-2020

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Policy

First Advisor

Edward Alan Miller

Second Advisor

Michael Ahn

Third Advisor

Amit Patel

Abstract

The use of email and other Information and Communication Technologies (ICT) in health care has grown considerably over the last two decades, in part, due to widespread claims that electronically mediated communication between providers and patients promotes increased access to quality communication and quality health care. The access and usage of Internet, email, and other ICT, however, has been associated with unequal opportunities that lead to a “digital divide,” based on age, gender, education, income, race and ethnicity, and geographic location. To better understand how and whether electronically mediated communication between providers and patients may contribute to a digital divide, this dissertation sought: (i) to examine trends in email use in doctor-patient communication from 2003 to 2014; (ii) to identify the determinants of email use in doctor-patient communication and changes in those determinants over time; (iii) to examine the role of and extent to which a person’s capability for email and Internet communication mediates the relationship between email use and individual characteristics associated with the digital divide, including age, gender, education, income, race and ethnicity, and geographic location; and (iv) to examine the effects of email use on the perceived quality of doctor-patient communication. This study used publicly available data from four rounds of the Health Information National Trends Surveys (2003, 2007, 2011, 2014), a nationally representative survey funded by the National Cancer Institute which asked respondents about their health, experiences in obtaining health care, and their use of health information technology. The results show that email use in doctor-patient communication increased from 7.6% in 2003 to 28.3% in 2014. The key findings show disparities in email use in doctor-patient communication related to patients’ education, income, region, and urban versus rural residence that have persisted over the study period. Stronger personal capability for email and Internet communication was also associated with increased email use. The quality of doctor-patient communication rating increased with age, better self-rated health, having a primary care provider, and with better experience searching for health information; however, using email to communicate with doctor was only significantly associated with quality rating in 2003 and 2011, but, contrary to expectations, the association was negative, as the use of email decreased likelihood of high-quality rating. This research is the first to comprehensively examine national trends in email use in doctor-patient communication, and the effects of that use on the quality of doctor-patient communication, over a period of one decade. The implications of study findings for research, policy, and practice are discussed, and recommendations are proposed to improve the effectiveness of email use in doctor-patient communication.

Comments

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