Digital Technology Ownership, Usage, and Factors Predicting Downloading Health Apps Among Caucasian, Filipino, Korean, and Latino Americans: The Digital Link to Health Survey
Open accessAbstract
BACKGROUND: Interventions using mobile health (mHealth) apps have been effective in promoting healthy lifestyle behavior change and hold promise in improving health outcomes to thereby reduce health disparities among diverse racial/ethnic populations, particularly Latino and Asian American subgroups (Filipinos and Koreans) at high risk for diabetes and cardiovascular disease. Latinos and Asian Americans are avid digital technology owners and users. However, limited datasets exist regarding digital technology ownership and use, especially among specific racial/ethnic subgroups. Such information is needed to inform development of culturally tailored mHealth tools for use with lifestyle interventions promoting healthy behaviors for these at-risk racial/ethnic populations. OBJECTIVE: The intent of the study was to examine (1) digital technology ownership and usage, and (2) factors predicting downloading health apps for Caucasian, Filipino, Korean, and Latino American subgroups. METHODS: A cross-sectional survey conducted in August 2013 through December 2013 recruited 904 participants (Caucasians n=172, Filipinos n=250, Koreans n=234, and Latinos n=248), age >18 years, from California community events, clinics, churches, and online. English, Spanish, and Korean surveys were administered via paper or online. Descriptive statistics characterized the sociodemographics and digital technology ownership/usage of the 904 participants. Differences among groups in categorical variables were examined using chi-square statistics. Logistic regression was used to determine factors predicting downloading health apps. RESULTS: Overall, mean age was 44 years (SD 16.1), with 64.3% (581/904) female. Only 44.7% (404/904) of all participants reported English as their primary language (Caucasian 98.3%, 169/172; Filipino 67.6%, 169/250; Korean 9.4%, 22/234, and Latino 17.7%, 44/248. Overall, mobile phone ownership was 92.8% (839/904). Compared to all groups, Koreans were more likely to own a mobile phone (82.8%, 194/234), computer (91.4%, 214/234), or tablet (55.2%, 129/234), whereas Latinos (67.5%, 167/248; 65.3%, 162/248; 24.4%, 61/248, respectively) were least likely. Internet access via mobile phones (90.5%, 818/904) was higher than computers (78.6%, 711/904). Odds of downloading health apps increased with college (OR 2.62, 95% CI 1.44-4.80) or graduate school (OR 2.93, 95% CI 1.43-6.00) compared to some high school; and family history of heart attack (OR 2.02, 95% CI 1.16-3.51). Odds of downloading health apps were reduced with: race/ethnicity, Latino (OR 0.37, 95% CI 0.20-0.69), and Korean (OR 0.52, 95% CI 0.31-0.88) compared to Caucasians; increasing age (OR 0.96, 95% CI 0.95-0.97); and completing paper surveys (OR 0.50, 95% CI 0.34-0.75). CONCLUSIONS: This survey study uniquely targeted specific racial/ethnic subgroups. Results indicated that despite a narrowing racial/ethnic "digital divide", some disparities still exist, particularly among racial/ethnic groups with less education and whose primary language is not English. Findings will be used to inform development and evaluation of culturally tailored mHealth apps for use with interventions promoting healthy behavior change for Filipinos, Koreans, and Latinos.
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In one study conducted on Latino and Asian subgroups in the United States, the odds of downloading a health app was twice as high for those who had a family history of heart attack (odds ratio 2.02, 95% CI 1.16-3.51) compared with those who did not.
“One study conducted on Latino and Asian subgroups in the United States found that the odds of downloading a health app was twice as high for those who had a family history of heart attack (odds ratio 2.02, 95% CI 1.16-3.51), compared with those who did not [41].”
From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [41]
The Results (Factors Predicting Health App Downloads) report an adjusted OR of 2.02 (95% CI 1.16–3.51) for participants with a family member who had a myocardial infarction. However, the Methods (Analysis) show that the study included Caucasian, Filipino, Korean, and Latino participants; the reported estimate is from the overall model, not an analysis limited to Latino and Asian subgroups. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHaving a better education level, such as high school education or higher and college degree or higher, was associated with better engagement with health and well-being apps.
“Living in an urban area [42,44,55]; having a better education level, such as having high school education or higher [41,42,44,64] and college degree or higher [41,53]; and having a higher income [44] were also associated with better engagement with health and well-being apps.”
From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [41]
The Results (Factors Predicting Health App Downloads, Table 3) associate some college or more and graduate school with greater odds of downloading a health app. They do not establish an association for high school education or higher: high school or some high school is the reference group. The study measures downloads, not broader engagement with apps. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBeing younger than 44 years was associated with a higher level of uptake and engagement than older adults.
“Being younger than 44 years was associated with a higher level of uptake and engagement [38,41,42,44,49,53,55,63,64] than older adults.”
From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [41]
The Results section, “Factors Predicting Health App Downloads” (page not provided), reports that each additional year of age was associated with 4% lower odds of downloading a health app, supporting greater uptake among younger participants. The paper gives 44 years as the sample’s mean age, not a cutoff for comparison, and does not establish higher engagement among people younger than 44. (LLM, conf=0.88)
Experimental — accuracy not yet measuredApps were more frequently downloaded by women than men, with the percentage ranging from 59% to 74%.
“Apps were more frequently downloaded by women than men, with the percentage ranging from 59% to 74% [38,41,49,53,55,63], although 1 study found that being male was associated with using an app to manage alcohol consumption [65].”
From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [41]
The Results (Digital Technology Usage; page unavailable) report app-download rates by race and ethnicity, not by gender. The Results (Factors Predicting Health App Downloads; page unavailable) do not identify gender as a factor in the final model. A search for female and male download rates found no passage supporting the claimed 59%–74% range or the comparison between women and men. (LLM, conf=0.74)
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- Authors
- Bender, M. S., Choi, J., Arai, S., Paul, S. M., Gonzalez, P., & Fukuoka, Y.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Bender, Melinda S
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2014-10-22
- Volume
- 2
- Issue
- 4
- Pages
- e43
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC4259923
- OpenAlex
- W2133666939
- Cited by
- 106
- References
- 27
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 14 · 2019: 11 · 2018: 16 · 2017: 12 · 2016: 9 · 2015: 7
- FWCI
- 16.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- University of California, San Francisco
- National Heart, Lung, and Blood Institute (R01HL104147)
- National Institute of Nursing Research (T32NR 07088, T32NR007088)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
- Keywords
- mobile health apps, mobile phone ownership, smartphone ownership, racial and ethnic differences, Hispanic Americans, Filipino Americans, Korean Americans, White Americans, health disparities, culturally tailored interventions, diabetes prevention, cardiovascular disease prevention, lifestyle intervention, health behavior change, California, multigenerational families, low-income households
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