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Internet medical services (IMS) expanded rapidly in China during the COVID-19 pandemic. Unfortunately, disparities in internet medical services utilization (IMSU) have marginalized disadvantaged groups of Chinese patients from digital health benefits. The extent and nature of these disparities remain poorly understood, with no research comprehensively addressing how unfavorable predictors, including demographic, socioeconomic, and health-related factors, shape IMSU status, patterns, and preferences in China after the COVID-19 pandemic. This study aims to gain a deeper understanding of the disparities and unfavorable predictors that limit IMSU among Chinese adult patients following the COVID-19 pandemic, providing key reference points for advancing equitable IMSU. This cross-sectional study used a triangular approach, combining data from a provincial field survey conducted in July 2023 and a national online survey conducted in March 2024. Participants were Chinese adult outpatients aged 18 years or older. Descriptive and comparative analyses were used to examine disparities in IMSU status, patterns, and preferences across different demographic, socioeconomic, and health status-related factors. Binary logistic regression models were applied to assess the associations between unfavorable predictors (constructed from selected demographic, socioeconomic, and health status-related factors) and IMSU status, patterns, and preferences. Of the 2011 eligible participants in the Jiangsu provincial field survey, 787 (39.13%) reported using IMS at least once in the previous 12 months. Among the 1611 eligible participants in the national online survey, all reported accessing IMS during the same period; however, only 481 (29.86%) reported high-frequency use (defined as usage in the third quartile or above, ie, ≥6 times). Overall, participants with unfavorable predictors were less likely to engage in IMSU, deep IMS were used less frequently than shallow IMS, and participants with 6 or more cumulative unfavorable predictors had the lowest total of IMSU preference score (mean 48.98 and 57.37 in the provincial field and national online surveys, respectively). Based on combined data from the provincial field and national online surveys, significantly negative associations were observed between unfavorable predictors and IMSU status, patterns, and preferences. In particular, participants aged 60 years or above (odds ratio [OR] 0.40, 95% CI 0.25-0.63, P<.001) and those without everyday internet access (OR 0.54, 95% CI 0.41-0.71, P<.001) were the least likely to use IMS at a medium-to-high frequency. Participants without private health insurance (OR 0.59, 95% CI 0.44-0.79, P<.001) were the least likely to utilize deep IMS. Moreover, participants aged 60 years or above (OR 0.45, 95% CI 0.33-0.63, P<.001) and those with a high school education or less (OR 0.67, 95% CI 0.55-0.82, P<.001) were the least likely to prefer IMS to a moderate-to-strong degree. Widespread disparities in IMSU status, patterns, and preferences persisted among Chinese adult patients after the COVID-19 pandemic. More pro-disadvantaged patient policies may be warranted to narrow these disparities in IMSU, such as reimbursement for IMSU, to promote digital health equity in China.

Background The global aging trend has intensified chronic disease burdens, widened healthcare access disparities, and exacerbated unmet care needs. Internet‑based Healthcare Services (IHS) present a promising strategy to address these challenges. This study investigates the prevalence and determinants of IHS use, as well as the primary motivations and barriers to adoption among adults aged 50 years and older in mainland China. Methods An online cross-sectional survey was conducted in March 2021 among adults aged 50 years and older in mainland China. Participants ( N  = 560) were recruited through random sampling on an online platform. Logistic regression models were used to identify predisposing, need, and enabling factors associated with IHS use. Results Only 17.14% of respondents reported using IHS, with online medical consultation being the most common (38.5%). Respondents aged between 50 and 59 years (AOR = 4,975 [95% CI 1.224–19.608]), urban residents (AOR = 6.056 [95% CI 1.689–21.713]), higher income (AOR = 3.862 [95% CI 1.822–8.186]), chronic conditions (AOR = 5.567 [95% CI 2.167–14.301]), delays in seeking healthcare (AOR = 5.323 [95% CI 2.866–9.888]), mobility difficulties (AOR = 9.802 [95% CI 4.005–23.993]), positive attitude (AOR = 3.038 [95% CI 1.039–8.884]) were more likely to use IHS, after adjusting for other variables. The main barriers to IHS use included distrust and uncertainty about describing symptoms online. Conclusion Low levels of IHS use were observed among middle-aged and elderly populations in mainland China. Although IHS can benefit individuals with high healthcare needs or mobility limitations, income-related and urban–rural inequalities in IHS use persist. Addressing trust issues and enhancing digital literacy among the elderly are essential for the widespread and effective development of IHS.

Background Chronic diseases pose substantial healthcare burdens globally, notably in aging nations like China. Internet Medical Services (IMS) demonstrate significant potential to mitigate healthcare challenges in chronic disease management through optimized resource allocation and enhanced remote care capabilities. However, persistent adoption disparities and the “high demand–low penetration” paradox highlight persistent barriers stemming from the digital divide. This study aims to investigate factors influencing IMS utilization among chronic disease patients, examining their effects across specific IMS domains and acceptance pathways, thereby offering new insights for optimizing chronic disease management. Methods This study extended the Technology Acceptance Model (TAM) by integrating eHealth literacy and Technology anxiety to evaluate the utilization of IMS among 520 patients with chronic diseases in Jinan, China. IMS was categorized by functional domains (Information Access, Convenience Services, Online Health) and utilization stages (Awareness, Want, Adoption). The dual-method analysis: Awareness-Want-Adoption Gap (AWAG) matrix for service-specific disparity mapping and Structural Equation Modeling (SEM) to quantify perceptual drivers, providing a panoramic perspective to deconstruct the complex utilization. Results Information Access IMS showed the highest acceptance, while Online Health exhibited severe Want-to-Adoption collapse (71.43% gap). Affluent patients demonstrated paradoxical rejection of Online Health despite high Awareness. SEM confirmed Perceived Usefulness (β = 0.338–0.423, P  < 0.001) and eHealth literacy (β = 0.184–0.395, P  < 0.001) are significant and direct drivers of IMS utilization, with stage-specificity observed across the utilization process. Matrix analysis identified critical barriers for vulnerable subgroups: rural residents, elders (≥ 70 years), and low-education (≤ 9 years) patients. Conclusions IMS adoption is governed by multidimensional determinants beyond access, including cognitive, socio-economic, and other factors. Counterintuitive patterns (e.g., affluent patients’ rejection of Online Health) necessitate tiered interventions, such as eHealth literacy programs for vulnerable groups, service standardization to mitigate distrust, and regulatory frameworks to ensure data security. This study’s dual-method framework (matrix analysis and SEM) critically delineated barrier typologies through staged decomposition, establishing an evidence-based scaffold for optimizing digital health equity.

Background With the rapid digitalization of healthcare and an aging population, understanding the factors influencing older adults' sustained adoption of Internet medical services is critical. However, existing research often oversimplifies these factors by relying on linear models. This study integrates Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to explore the complex pathways driving continued use. Methods A survey of 1,920 older adults (60–75 years) in China assessed satisfaction, e-health literacy, self-efficacy, social support, social influence, social participation, and willingness to use Internet medical services. PLS-SEM examined the relationships between variables, while fsQCA identified multiple configurations leading to sustained use. Results PLS-SEM identified satisfaction as the strongest predictor of sustained use (β = 0.281, p < 0.001), acting as both a direct determinant and a mediator for e-health literacy and social participation. Social influence (β = 0.189, p < 0.001) and social support (β = 0.172, p < 0.001) also contributed significantly. FsQCA revealed six distinct configurations, with satisfaction and e-health literacy as core conditions across most pathways. Conclusions By integrating linear and configurational approaches, this study provides a nuanced understanding of older adults' digital healthcare behaviors. Enhancing satisfaction, digital literacy, and social engagement is key to fostering sustained adoption. Tailored interventions based on distinct configurations can maximize the effectiveness of digital health programs. Implications This research bridges gaps in understanding complex behaviors and provides actionable insights for policymakers and healthcare providers, highlighting the critical role of digital literacy and social support.

Background The increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved. Methods A multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity. Results On average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P  = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P  < 0.01), while income (β = 0.0370, P  < 0.001) and marital status (β = 0.2039, P  < 0.001) have negative moderating effects. Conclusions By focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

Currently, internet services are developing rapidly, and the relationship between specific types of internet services and the well-being of older adults is still unclear. This study took a total of 353 urban older adults aged 60 years and above as research objects to explore the impact of the use behavior toward internet-based medical services (IBMS) on their well-being through an online questionnaire. This study integrated well-being theory and peer support theory, constructed an extended structural equation model of technology acceptance based on the technology acceptance model (TAM), and analyzed the variable path relationship. The results confirm the proposed model: older adults improved their eudaimonic well-being through using IBMS; perceived usefulness significantly affected the older adults’ attitudes towards IBMS; perceived ease of use significantly affected the use of IBMS through mediation; peer support significantly affected older adults’ attitudes, willingness, actual use, and well-being in the process. This study proposes that facilitating IBMS use for older adults in the development and design of internet technology programs should be considered in order to provide them with benefits. Moreover, paying attention to peer support among older adults plays an important role in the acceptance of new technologies and improving their well-being. The “peer support” of this study expanded and contributed to the research on the impact on older adults’ well-being and the construction of a technology acceptance model. The peer support in this study extended the influence factor of eudaimonic well-being and contributed to the further development of the TAM.

This study examines the impact of a COVID-19 pandemic-derived online medical service on cardiovascular patient visits and assesses whether these services can ease the strain on medical resources. This study investigated the impact of the COVID-19 pandemic on cardiology services and hospital operations. We analyzed key primary medical indicators in cardiology, including outpatient visits, inpatient improvement rates, cure rates, and mortality rates, over three years from 2019 to 2021. Furthermore, the study assessed the influence of the development of Internet-based medical services on the treatment of cardiovascular disease. Specifically, we compared the changes in the number of outpatient visits in four categories of offline outpatient clinics in the Department of Cardiology during two phases: Phase I (1 February 2019 to 28 February 2020) and Phase II (1 March 2020 to 28 February 2021). Compared to the period before online services (T1), the second stage (T2) saw a significant decrease in total offline and general clinic visits. After the establishment of the online clinic, the third period (P3) showed a significant reduction in total offline, general, and senior clinic visits compared to the first period (P1), while vice-senior and VIP/international clinic visits increased. The number of online clinic visits and VIP/international clinic visits continued to rise. Online consultations had the highest proportion (55.9%), while prescriptions and examinations had the lowest (3.3%), although they showed a gradually increasing trend. After the implementation of the online clinic, the improvement rate of patients' conditions increased and the mortality rate decreased. Since the advent of online medical services, cardiovascular patients have increasingly opted for online diagnosis and treatment. Since March 2021, the online outpatient service has driven the overall growth in hospital outpatient numbers while maintaining medical quality. The primary use of the online medical service is for consultations, which shortens medical time and reduces implicit costs for patients.

At a time when lesbian, gay, bisexual, and transgender individuals-often referred to under the umbrella acronym LGBT-are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

The Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.

With the world's population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults' online health information seeking (OHIS) behavior is still underway. This systematic scoping review aims to understand older adults' OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults' OHIS? (3) What are the barriers to older adults' OHIS? (4) How can we intervene and support older adults' OHIS? A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults' OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults' OHIS. Although OHIS has become increasingly common among older adults, the review reveals that older adults' OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults' OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults' OHIS; (4) facilitating older adults' OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults.