Exploring the Social Determinants of Technology Use on Digital Access to Health Information Among African Americans in Alabama

Background and Purpose: The literature consistently demonstrates rural health disparities, highlighting that individuals living in rural areas in the U.S. are at a higher risk of experiencing poorer health outcomes compared to those in urban areas. Considering the challenges associated with rural settings, such as geographic barriers to healthcare access and longer travel distances, researchers have focused on digital access to health information as a vital resource for enhancing both individual and community health outcomes; yet factors associated with this access have been underexplored, especially within rural communities of the Deep South. Guided by the digital divide theory, this study aims to explore the social determinants of technology use (SDT) associated with digital access to health information among rural residents in Alabama.

Methods: Using a cross-sectional survey design, a convenience sampling strategy was employed to select 191 African Americans aged 18 or older residing in the Black Belt area of Alabama. The dependent variable, digital access to health information, was calculated by summing responses to 12 items regarding internet use for health-related purposes. Higher scores on this scale indicate greater digital access to health information. We included nine SDTs including social isolation, social media access, transportation access, three factors related to economic stability, education, health literacy, and media literacy; and two demographic factors. A multiple linear regression model was performed to examine the associations between demographic factors/social determinants and digital access to health information.

Results: The participants reported a low level of digital access to health information. Most participants were 55 years or older (60.8%) and female (68.1%). Participants reported a moderate level of social isolation. They used social media once a week on average and showed a low need (i.e., M=.42, range=0-3) of access to transportation. Regarding economic stability, most participants were unemployed (58.2%) and earned an income annually less than $25,000 (60.9%). About 93% of the participants graduated high school. They showed medium levels of health and media literacy. Our regression model (R²=.52) revealed participants who were less socially isolated had less digital access to health information (p<.01). Those who had more access to social media had more digital access to health information (p<.001). Participants with employment (p<.05), higher education (p<.001), and increased health literacy (p<.05) exhibited significantly greater digital access to health information.

Conclusion/Implications: The findings of this study hold critical implications for healthcare practice and policy, particularly within rural communities in the Deep South. Policies should prioritize the expansion of digital literacy programs and ensure the availability of reliable internet services, especially as social media emerges as a significant tool for health information. Healthcare providers should be aware of these dynamics and potentially incorporate social media platforms into their outreach strategies to connect with and educate rural communities. Additionally, employment and education initiatives could be integrated with health promotion efforts, leveraging work and learning environments as points of intervention for improving digital health literacy and access.