Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to a lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of individuals’ electronic health records (EHR): motivations, intentions and physical access to patients EHR.
Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). First, exploratory factor analysis was performed to group items derived from the UTAUT model. Next, we applied linear and logistic regressions controlling for country-level heterogeneity, health and sociodemographic factors.
Results: A total of 829 individuals aged over 18 completed the questionnaire. We found evidence of socioeconomic inequalities in the access to and use of EHR. Education and income played a significant role in individual’s desire to access their EHR. Being older than 65 years, and migrant, were negatively related to the desire to access EHR. An income gradient was found in having a physical access to EHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use EHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived EHRs to be useful and had the necessary digital skills were more inclined to use their EHR regularly. Social support and lack of anxiety in using technology were strong predictors of regular use of EHR.
Conclusion: The findings highlight the importance of considering all stages in the use of EHR (desire, physical access, and regular use), while paying special attention to migrants and people with lower socioeconomic backgrounds who may not be able to exploit the potential of EHRs. As EHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could lead to increases in health equity.