The Sociodemographic Digital Divide in Mobile Health App Use Among Clients at Outpatient Departments in Inner Mongolia, China: Cross-sectional Survey Study

Background: Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital divide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers. Objective: The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade. Methods: A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated. Results: Of 2115 participants, the beta coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (beta=-0.38 and beta=-0.41), as were less educated subgroups (beta=-0.24 and beta=-0.27), and these two factors had nonsignificant direct effects on mHealth use. Conclusions: To overcome the mHealth use divide, it is important to improve digital access and digital use among older adults and less educated groups.