Internet use and health: a mixed methods analysis using spatial microsimulation and interviews

Internet use is considered a lever for empowering patients, levelling inequalities and reducing healthcare expenditure. However, with digital inclusion, health provision quality and health system efficiency high on the UK and EU policy agendas, we need to better understand the relationship between Internet use and health outcomes to assess potential benefits and adverse effects. This research addresses the question of how Internet use influences individuals’ health service use and their perceived health in the context of England. Focusing on health information-seeking, it analyses variations across different kinds of users, mechanisms between Internet use and both health outcomes, and the role of individual and contextual factors in this relationship. To answer this question, this research uses a mixed methods approach. Quantitative data from the Oxford Internet Surveys (OxIS), the English census and Hospital Episode Statistics (HES) was connected through spatial microsimulation based on output areas. Qualitative data was collected through semi-structured, face-to-face interviews, primarily with former OxIS participants from output areas in the quantitative strand. The quantitative data was revisited based on emerging interview themes. The results indicate that Internet use influences perceived health and health service use via various mechanisms based on the Internet’s content, mediation and connection affordances. However, the boundaries between users and non-users are blurry and outcomes vary for different types of individuals, classified here as learners, pragmatists, sceptics, worriers, delegators and adigitals. Age, education, socioeconomic status, long-term health conditions, and geographic context influence Internet use and health outcomes separately, while the social context shapes their relationship too. These findings advance the theoretical understanding of Internet-based health outcomes, and provide practical implications for health professionals and policymakers with insights down to the local level. Moreover, this research demonstrates how novel insights for public wellbeing can be derived from qualitatively enriched secondary data in privacy-preserving and cost-effective ways.