Socio-demographic and socio-economic determinants for the utilization of digital patient portals in hospitals: Systematic review and meta-analysis on the digital divide. (Preprint)
Authors: Goldberg Nina , Herrmann Christin , di Gion Paola , Hautsch Volker , Hefter Klara , Langebartels Georg , Holger Pfaff , Ansmann Lena , Karbach Ute , Wurster Florian 
Published: November 2024

BACKGROUND

Digital patient portals (PP) are platforms that enhance patient engagement and promote active involvement in healthcare by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by socio-demographic and socio-economic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze socio-demographic and socio-economic determinants affecting digital patient portal utilization, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities.

OBJECTIVE

Conducting a meta-analysis of the socio-demographic and socio-economic factors contributing to the digital divide in the utilization of digital patient portals.

METHODS

A systematic review with meta-analysis was conducted using PRISMA guidelines in the databases PubMed, Web of Science Core Collection and EBSCOHost. Screening involved three reviewers with consensus meetings to resolve discrepancies. Data on socio-demographic and socio-economic factors and statistical outcomes were extracted, and study quality was assessed using the MMAT tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias.

RESULTS

A total of 2,225 studies were identified through a systematic review and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (under 65 years) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 17% higher likelihood of utilizing the digital PP compared to men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37% greater likelihood of using the digital PP in the meta-analysis. Additionally, employed patients were 23% more likely to use the digital PP while married patients had a 13% higher likelihood of using it compared to unmarried patients.

CONCLUSIONS

The review confirms that socio-demographic and socio-economic factors significantly influence the utilization of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22% more likely to utilize digital PPs. Overall, socio-demographic factors, like marital status, primarily affect usage patterns, while socio-economic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in healthcare.

CLINICALTRIAL

The research project MAiBest is listed in the German register of clinical trials (DRKS00033125, https://drks.de/search/de/trial/DRKS00033125).