Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors: An Analysis of the Health Information National Trends Survey (Preprint)

BACKGROUND Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges to accessing digital devices and tools that have not yet been described. This study aims to utilize a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and use of technology for health in this population. OBJECTIVE To examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included: (1) internet access and use for health-related activities, (2) digital device ownership and utilization as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. METHODS A cross-sectional analysis of the National Cancer Institute’s Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. RESULTS Overall, 17% (n=125/710) of the sample lived in a rural area of the United States and the mean sample age was 73.0 (± 8.2) years. Older cancer survivors, regardless of rural-urban status, reported high prevalence of internet usage (79.9%), digital device ownership (94.9%), and social media use (66.6%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio OR: 0.56; p=0.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR: 2.64; p=0.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services via telehealth in the previous year. CONCLUSIONS Regardless of residential status, older cancer survivors report high internet and technology utilization for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors.