The paper reviewed here is ‘Internet Use and Self-Rated Health Among Older People: A National Survey’ by Enrique Gracia and Juan Herrero and freely available here. The internet has had a profound effect on culture and in this study the researchers look at the possible health effects of the internet on the older adult population.
Aims: Quoting from the abstract
‘The aim of this study was to examine the association between internet use and self-rated health among older people and determine whether this association holds independently of socioeconomic position‘
Method: Data from a 2008 survey was analysed. The latter survey investigated the ‘digital divide and quality of life among older people in Spain‘. The researchers explain the sampling methods in more detail. The subjects were recruited from both non-internet users and internet users. Internet users were sampled from 50,000 people that were included in a survey database. There is a general description of the sampling method for inclusion in this database – targetted advertising is used to recruit subjects. Non-internet users were sampled by random dialling of home telephone numbers. The former group received a small financial incentive while the latter group did not. The researchers state that the final sample was representative of the Spanish population in terms of factors such as internet usage. Several measures including demographic factors were used for the quantitative analysis
- 5-point likert scale health measure
- User v Non-Internet User status
- Social class determined by educational and occupational status of main income earner – with a five-point stratification
The researchers used a binomial logistic regression models to determine the odds ratio of being in the poor health category adding additional variables into successive models. Four models were used with the most basic assessing the relationship between internet use and self-rated health.
Results: 709 subjects were included in the study. The authors found no evidence to support a relationship between internet use and self-rated health in their older adult sample. A significant relationship identified between internet use and health became non-significant on adjusting for socioeconomic status.
Discussion: In the first instance, I would have been interested to see an examination of the relationship between illness and internet use. Health is a little more difficult to define whereas illness can be investigated using proxy markers such as contacts with health services, active illness with assessment or change in treatment or measures of pain as examples. The difficulty with assessing health in this study comes with the tool that is used which is essentially a 5-point likert statement. I wasn’t clear on whether this had been devised specifically for the study and whether this question has reliability and validity. Further the perception of health is a different construct to actual health. Thus it is possible for someone to have very poor health but perceive themselves as being in good health and vice versa. This is another reason to have a standardised measure of actual health although admittedly there may be a number of outcome measures that could be justified in this regards. Also the internet use is a binary measure whereas this could also be represented along a continuous distribution or could be more finely graded to more closely represent realistic use of the internet. I’m not sure how the difference in financial incentives might influence the results. The final result was clear – that there was no significant relationship between self-rated health and internet use. I’m not sure what to make of this. In terms of a relationship between internet use and health, the obvious factors to look at are sedentary activity and exercise as both have important relationships with health or else factors such as the use of health related information and social networking. Examining such factors as these in the ‘early’ years of the internet might be more helpful in understanding the relationship between health and internet use.
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