Electronic Theses and Dissertations

Farah Faizah

Date

2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Public Health

Committee Chair

Marian Levy

Committee Member

Alex Parkhouse

Committee Member

Shafi Bhuiyan

Committee Member

Xichen Mou

Abstract

The rapid integration of digital technologies into health systems has transformed the way individuals’ access, manage, and utilize health information. Yet, persistent inequities in e-health engagement highlight the role of social determinants of health (SDoH) in shaping access and utilization. This dissertation examines how demographic, socioeconomic, and geographic determinants influence three domains of e-health utilization—cancer information seeking, internet use, and wellness application/wearable device adoption—using nationally representative data from the 2022 cycle of the National Cancer Institute’s Health Information National Trends Survey (HINTS). The study further investigates whether these determinants vary by cancer status and across racial/ethnic groups, providing a multidimensional understanding of disparities in digital health engagement. Weighted descriptive, bivariate, and multivariable logistic regression analyses were conducted to identify the most influential SDoH variables and their independent effects on e-health utilization. Stratified analyses compared determinants between cancer and non-cancer populations, as well as across racial subgroups (White, Black, and other races). Analyses were adjusted for complex survey design and replicate weights to ensure nationally representative estimates. Findings reveal that education and income were the most consistent and powerful predictors of e-health engagement across all outcomes. Respondents with postgraduate education and higher household income (≥$75,000) were significantly more likely to seek cancer information, use wellness applications, and access the internet. Conversely, individuals with a high school education or less demonstrated markedly lower engagement across all digital health domains, underscoring education as a central axis of digital inequity. Age also played a significant role: older adults (≥65 years) exhibited substantially reduced use of wellness applications and internet technologies, although middle-aged adults demonstrated higher odds of cancer information seeking. Gender disparities emerged, with men less likely than women to seek cancer information or use wellness apps, though no significant differences were observed for internet use overall. Stratified analyses by cancer status highlighted both commonalities and divergences. Among cancer survivors, higher education and income remained the strongest facilitators of digital engagement. However, racial disparities were pronounced in this subgroup: White cancer survivors were more likely to use the internet, whereas survivors from other racial categories were more likely to seek cancer information. Among non-cancer respondents, patterns mirrored those of the overall sample, with strong gradients by education, income, and age. Racial/ethnic analyses revealed additional heterogeneity. White respondents were more likely than Black or other racial groups to seek cancer information and use the internet, while Black respondents showed a pronounced age-related digital divide, particularly in internet use. For other racial groups, income played a critical role, with higher-income respondents exhibiting significantly greater odds of digital health utilization. This dissertation contributes to the growing body of evidence on digital health equity by demonstrating that structural determinants—particularly education, income, and race/ethnicity—remain pivotal in shaping e-health utilization. These findings have critical implications for public health practice and policy. Targeted interventions are needed to enhance digital literacy, expand broadband access, and provide culturally tailored resources for populations disproportionately disadvantaged by educational and socioeconomic barriers. Cancer survivors, older adults, and racial/ethnic minorities may particularly benefit from inclusive digital health initiatives designed to mitigate disparities and promote equitable engagement. In conclusion, while digital health tools hold significant promise for improving access to care, health communication, and self-management, their benefits are inequitably distributed. Addressing the underlying social determinants that shape digital engagement is essential for ensuring that e-health technologies serve as vehicles for health equity rather than amplifiers of existing disparities.

Comments

Data is provided by the student.”

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Embargoed until 05-18-2026

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Available for download on Monday, May 18, 2026

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