{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:06:58Z","timestamp":1785535618403,"version":"3.56.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objective Communication inequalities deepen health disparities even when internet access is achieved. The goal of this study is to understand how a range of barriers may inhibit individuals from low socioeconomic position (SEP) from engaging with online health information even when it is freely available.<\/jats:p><jats:p>Materials and methods Detailed data were collected from 118 low-SEP individuals from a randomized controlled trial providing internet access. Measures triangulated the health-seeking experience through internet use tracked in real-time, call log data, and self-reported barriers. Negative binomial regression models were fitted with technology and perceived predictors, and our outcome, health information seeking, and then stratified by medical status.<\/jats:p><jats:p>Results Participants experienced a median of two computer issues (median 6 days) and two internet issues (median 6.5 days). Duration of internet problems was associated with a decrease in the rate of internet health information seeking by a factor of 0.990 ( P = .03) for each additional day. Participants with a medical problem who were frustrated in their search for health information had half the rate of health information seeking of those who were not frustrated (incidence rate ratio = 0.395, P = .030).<\/jats:p><jats:p>Discussion Despite IT support, participants still experienced internet connectivity issues that negatively impacted their health information seeking. Frustration in their search to find information may serve as an additional barrier to those who have medical issues.<\/jats:p><jats:p>Conclusion After initial internet access, a second-level digital divide emerged due to connectivity issues, highlighting the need to understand the complex network of barriers experienced by low-SEP internet users.<\/jats:p>","DOI":"10.1093\/jamia\/ocv204","type":"journal-article","created":{"date-parts":[[2016,10,19]],"date-time":"2016-10-19T07:09:37Z","timestamp":1476860977000},"page":"1053-1059","source":"Crossref","is-referenced-by-count":131,"title":["Beyond access: barriers to internet health information seeking among the urban poor"],"prefix":"10.1093","volume":"23","author":[{"given":"Rachel F","family":"McCloud","sequence":"first","affiliation":[{"name":"Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra A","family":"Okechukwu","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glorian","family":"Sorensen","sequence":"additional","affiliation":[{"name":"Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Viswanath","sequence":"additional","affiliation":[{"name":"Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA"},{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,5,20]]},"reference":[{"key":"2020110612384313900_ocv204-B1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1146\/annurev.publhealth.18.1.341","article-title":"Measuring social class in US public health research: concepts, methodologies, and guidelines","volume":"18","author":"Krieger","year":"1997","journal-title":"Annu Rev Public Health."},{"issue":"Winter","key":"2020110612384313900_ocv204-B2","first-page":"1f","article-title":"Use of health information technology among racial and ethnic underserved communities","volume":"8","author":"Gibbons","year":"2011","journal-title":"Perspect Health Inf Manag."},{"key":"2020110612384313900_ocv204-B3","article-title":"Public communications and its role in reducing and eliminating health disparities","volume-title":"Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business","author":"Viswanath","year":"2006"},{"issue":"1","key":"2020110612384313900_ocv204-B4","doi-asserted-by":"crossref","first-page":"e14550","DOI":"10.1371\/journal.pone.0014550","article-title":"Race, ethnicity, language, social class, and health communication inequalities: a nationally-representative cross-sectional study","volume":"6","author":"Viswanath","year":"2011","journal-title":"PLoS One"},{"issue":"3","key":"2020110612384313900_ocv204-B5","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.2196\/jmir.3992","article-title":"eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults","volume":"17","author":"Tennant","year":"2015","journal-title":"J Med Internet Res."},{"issue":"4","key":"2020110612384313900_ocv204-B6","doi-asserted-by":"crossref","DOI":"10.5210\/fm.v7i4.942","article-title":"Second-level digital divide: differences in people\u2019s online skills","volume":"7","author":"Hargittai","year":"2002","journal-title":"First Monday."},{"key":"2020110612384313900_ocv204-B7","first-page":"123","article-title":"Online and on point: Broadband usage in Canada and the United States","volume":"3","author":"McConnaughey","year":"2013","journal-title":"J Inf Pol."},{"key":"2020110612384313900_ocv204-B8","first-page":"187","article-title":"The knowledge gap hypothesis: 25 years in review","volume-title":"Communication Yearbook 19","author":"Viswanath","year":"1996"},{"issue":"1","key":"2020110612384313900_ocv204-B9","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1002\/asi.22793","article-title":"Four levels of outcomes of information-seeking: a mixed methods study in primary healthcare","volume":"64","author":"Pluye","year":"2013","journal-title":"J Assoc Inf Sci Technol."},{"key":"2020110612384313900_ocv204-B10","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/j.socscimed.2012.07.022","article-title":"How does searching for health information on the internet affect individuals\u2019 demand for health care services?","volume":"75","author":"Suziedelyte","year":"2012","journal-title":"Soc Sci Med."},{"key":"2020110612384313900_ocv204-B11","author":"Fox"},{"issue":"1","key":"2020110612384313900_ocv204-B12","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/j.1475-682X.2009.00317.x","article-title":"Digital na(t)ives? variation in Internet skills and uses among members of the \u201cnet generation.\u201d","volume":"80","author":"Hargittai","year":"2010","journal-title":"Sociol Inq."},{"issue":"7","key":"2020110612384313900_ocv204-B13","first-page":"e172","article-title":"Predictors of eHealth usage: Insights on the digital divide from the Health Information National Trends Survey 2012","volume":"16","author":"Kontos","year":"2014","journal-title":"JMIR."},{"issue":"10","key":"2020110612384313900_ocv204-B14","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1158\/1055-9965.EPI-12-0852","article-title":"The communications revolution and health inequalities in the 21 st century: Implications for cancer control","volume":"21","author":"Viswanath","year":"2012","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"2020110612384313900_ocv204-B15","doi-asserted-by":"crossref","first-page":"S131","DOI":"10.1016\/j.amepre.2007.02.012","article-title":"Health disparities, communication inequalities, and eHealth","volume":"32","author":"Viswanath","year":"2007","journal-title":"Am J Prev Med."},{"key":"2020110612384313900_ocv204-B16","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1197\/jamia.M3150","article-title":"Profiling characteristics of internet medical information users","volume":"16","author":"Weaver","year":"2009","journal-title":"J Am Med Inform Assoc."},{"issue":"1","key":"2020110612384313900_ocv204-B17","first-page":"e19","article-title":"eHealth literacy: extending the digital divide to the realm of health information","volume":"14","author":"Neter","year":"2012","journal-title":"JMIR."},{"key":"2020110612384313900_ocv204-B18","author":"Fox"},{"key":"2020110612384313900_ocv204-B19","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/j.1083-6101.2009.01513.x","article-title":"Reducing the health and digital divides: a model for using community-based participatory research approach to e-health interventions in low-income Hispanic communities","volume":"15","author":"Ginossar","year":"2010","journal-title":"J Comput Mediat Commun."},{"issue":"5S2","key":"2020110612384313900_ocv204-B20","doi-asserted-by":"crossref","first-page":"S245","DOI":"10.1016\/j.amepre.2011.02.005","article-title":"Cyberinfrastructure: an extraordinary opportunity to bridge health and communication inequalities?","volume":"40","author":"Viswanath","year":"2011","journal-title":"Am J Prev Med."},{"key":"2020110612384313900_ocv204-B21","author":"DiMaggio"},{"key":"2020110612384313900_ocv204-B22","first-page":"355","article-title":"Digital inequality: from unequal access to differentiated use","volume-title":"Soc Inequality","author":"DiMaggio","year":"2004"},{"issue":"5","key":"2020110612384313900_ocv204-B23","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1177\/0093650208321782","article-title":"Digital inequality: Differences in young adult\u2019 use of the Internet","volume":"35","author":"Hargittai","year":"2008","journal-title":"Commun Res."},{"issue":"2","key":"2020110612384313900_ocv204-B24","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1080\/15295036.2014.922207","article-title":"The US digital divide: a call for a new philosophy","volume":"31","author":"Strover","year":"2014","journal-title":"Crit Stud Mass Commun."},{"key":"2020110612384313900_ocv204-B25","doi-asserted-by":"crossref","DOI":"10.7551\/mitpress\/6699.001.0001","volume-title":"Technology and Social Inclusion","author":"Warschauer","year":"2003"},{"issue":"3","key":"2020110612384313900_ocv204-B26","first-page":"e75","article-title":"Internet use and eHealth literacy of low-income parents whose children have special health care needs","volume":"13","author":"Knapp","year":"2011","journal-title":"JMIR."},{"issue":"1","key":"2020110612384313900_ocv204-B27","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1471-1842.2011.00971.x","article-title":"Assessing internet access and use in a medically underserved population: implications for providing advanced health information services","volume":"29","author":"Zach","year":"2012","journal-title":"Health Inf Lib J."},{"issue":"3","key":"2020110612384313900_ocv204-B28","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1363459307077547","article-title":"Chronic illness and health-seeking information on the internet","volume":"11","author":"Ayers","year":"2007","journal-title":"Health."},{"issue":"7","key":"2020110612384313900_ocv204-B29","doi-asserted-by":"crossref","first-page":"e176","DOI":"10.2196\/jmir.3499","article-title":"Online health information seeking behaviors of Hispanics in New York City: a cross-sectional study","volume":"16","author":"Lee","year":"2014","journal-title":"J Med Internet Res."},{"key":"2020110612384313900_ocv204-B30","author":"Neogi"},{"key":"2020110612384313900_ocv204-B31","author":"Clark"},{"issue":"4","key":"2020110612384313900_ocv204-B32","first-page":"e31","article-title":"Barriers and facilitators to home computer and Internet access among urban novice computer users of low socioeconomic position","volume":"9","author":"Kontos","year":"2007","journal-title":"JMIR."},{"issue":"47","key":"2020110612384313900_ocv204-B33","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1093\/jncimonographs\/lgt029","article-title":"Internet use, browsing, and the urban poor: implications for cancer control","author":"Viswanath","year":"2013","journal-title":"JNCI Monograph."},{"issue":"3","key":"2020110612384313900_ocv204-B34","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1258\/jhsrp.2010.009155","article-title":"The poor may always be with us but we don't know how many or where they are","volume":"15","author":"Carr-Hill","year":"2010","journal-title":"J Health Serv Res Policy."},{"issue":"4","key":"2020110612384313900_ocv204-B35","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1177\/1524839909342849","article-title":"Integrating cell phones and mobile technologies into public health practice: a social marketing perspective","volume":"10","author":"Lefebvre","year":"2009","journal-title":"Health Promot Pract."},{"issue":"1","key":"2020110612384313900_ocv204-B36","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/jcom.12008","article-title":"Recruitment and retention for community-based eHealth interventions with populations of low socioeconomic position: strategies and challenges","volume":"63","author":"Nagler","year":"2013","journal-title":"J Commun."},{"issue":"5-6","key":"2020110612384313900_ocv204-B37","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.intcom.2009.06.005","article-title":"Using the Internet: Skill related problems in users\u2019 online behavior","volume":"21","author":"van Deursen","year":"2009","journal-title":"Interact Comput."},{"issue":"1","key":"2020110612384313900_ocv204-B38","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/iwc\/iwu027","article-title":"Modeling traditional literacy, internet skills and internet usage: An empirical study","volume":"28","author":"Van Deursen","year":"2014","journal-title":"Interact Comput."},{"key":"2020110612384313900_ocv204-B39","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0738-3991(01)00170-7","article-title":"Barriers to information access, perceived health competence, and psychosocial health outcomes: test of a mediation model in a breast cancer sample","volume":"47","author":"Arora","year":"2002","journal-title":"Patient Educ Couns."},{"key":"2020110612384313900_ocv204-B40","volume-title":"Regression Models for Categorical Dependent Variables Using Stata: Revised Edition","author":"Long","year":"2003"},{"key":"2020110612384313900_ocv204-B41","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s12114-014-9185-y","article-title":"Assets and African Americans: attempting to capitalize on hopes for children through college savings accounts","volume":"41","author":"Shanks","year":"2014","journal-title":"Rev Black Polit Econ."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/23\/6\/1053\/34147724\/ocv204.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/23\/6\/1053\/34147724\/ocv204.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T14:18:57Z","timestamp":1692541137000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/23\/6\/1053\/2399232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,20]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,5,20]]},"published-print":{"date-parts":[[2016,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocv204","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2016,11]]},"published":{"date-parts":[[2016,5,20]]}}}