In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
eHeal h and mHeal h De elopmen in Spain: P omise o Reali y?
XoséMahou 1, B an Ba al 2,Ángela Fe nández 1, Ramón Bouzas-Lo enzo 2and And és Ce nadas 2,*
Ci a ion: Mahou, X.; Ba al, B.;
Fe nández, Á.; Bouzas-Lo enzo, R.;
Ce nadas, A. eHeal h and mHeal h
De elopmen in Spain: P omise o
Reali y?. In . J. En i on. Res. Public
Heal h 2021,18, 13055. h ps://
doi.o g/10.3390/ije ph182413055
Academic Edi o s: Geo ge C ooks
and Paul B. Tchounwou
Recei ed: 29 Oc obe 2021
Accep ed: 8 Decembe 2021
Published: 10 Decembe 2021
Publishe ’s No e: MDPI s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a il-
ia ions.
Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
1Depa men o Poli ical Science and Sociology, Facul y o Social Sciences and Communica ion,
Uni e si y o Vigo, 36005 Pon e ed a, Spain; xmahou@u igo.es (X.M.); angela e nandez.dasil [email protected] (Á.F.)
2
Depa men o Poli ical Science and Sociology, Facul y o Poli ical and Social Sciences, Uni e si y o San iago
de Compos ela, 15782 San iago de Compos ela, Spain; [email p o ec ed] (B.B.);
[email p o ec ed] (R.B.-L.)
*Co espondence: and [email p o ec ed]
Abs ac :
In he las decades, he use o In o ma ion and Communica ion Technologies (ICTs) has
p og essi ely sp ead o socie y and public adminis a ion. Heal h is one o he a eas in which he
use o ICTs has mo e in ensi ely de eloped h ough wha is now known as eHeal h. Tha a ea
has ecen ly included mHeal h. Spanish heal h sys em has s ood ou as one o he benchma ks
o his echnological e olu ion. The de elopmen o ICTs applied o heal h, especially since he
ou b eak o he pandemic caused by SARS Co -2, has inc eased he ange o heal h se ices deli e ed
h ough sma phones and he de elopmen o subsequen specialized apps. Based on he da a o a
Su ey on Use and A i udes ega ding eHeal h in Spain, he aim o his esea ch was o conduc a
compa a i e analysis o he di e en eHeal h and mHeal h use p o iles. The esul s show ha he
use p o ile o eHeal h an mHeal h se ices in Spain is no in a majo i y. Weaknesses a e de ec ed
bo h in he knowledge and use o eHeal h se ices among he gene al popula ion and in he usabili y
o de elopmen o hei mobile e sion. Sma phones can be a democ a izing ec o , as o now,
access o eHeal h se ices is only a ailable o weal hy people, widening inequali y.
Keywo ds:
eHeal h; mHeal h; elemedicine; Spanish na ional heal h sys em; heal h policy; heal h
equi y; public policy; heal hca e dispa i ies
1. In oduc ion
1.1. How he Na ional Heal h Sys em Wo ks
In he la e 1970s, heal hca e in Spain ansi ioned om a social insu ance sys em
ha imi a ed hose o cen al Eu opean coun ies such as Ge many o Belgium o a na-
ional heal h sys em (NHS) ha was uni e sal in na u e and unded exclusi ely h ough
s a e axes.
In andem wi h his, he Cons i u ion o 1978 decen alized he Spanish s a e in o 17
Au onomous Communi ies (ACs). These we e endowed wi h nume ous compe ences,
including managemen o heal hca e se ices, while he s a e e ained compe ence o e
non-domes ic heal hca e and gene al coo dina ion o he heal hca e sys em.
The new sys em ma e ialized in 1986 wi h he Ley Gene al de Sanidad (LGS, Gene al
Heal h Law), which exp essed he poli ical will o make he igh o heal h p o ec ion
e ec i e, as ecognized in A icle 43 o he Cons i u ion o 1978. The law es ablished wo
undamen al p inciples: (1) ha “All Spania ds and o eign ci izens wi h esidence es ab-
lished in he na ional e i o y ha e he igh o heal h p o ec ion and medical a en ion”
(A . 1.2. LGS); and (2) ha access o heal hca e will occu in condi ions o e ec i e equali y,
and ha his policy will be o ien ed owa ds o e coming social imbalances (A . 3.2 and
3.3 LGS), acco ding o he maxim o “equal access o equal need” [1].
1.2. eHeal h
In ecen yea s, Spain has been consolida ing he applica ion o new in o ma ion and
communica ion echnologies (ICTs) o public adminis a ion. Many se ices unde s ood as
In . J. En i on. Res. Public Heal h 2021,18, 13055. h ps://doi.o g/10.3390/ije ph182413055 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2021,18, 13055 2 o 17
basic ci izen igh s ha e been digi alized h ough eGo e nmen p og ams. Heal hca e was
one o he i s se ices o in oduce ICTs.
Though educing cos s was he ini ial mo i a ion, wi h ICTs adminis a i e p ocesses
ha ing been au oma ed, a emp s ha e been made o imp o e quali y o se ice, o ensu e
p o essionals and use s enjoy g ea e secu i y, and o ensu e ha he sys em can be accessed
using he in e ne [
2
]. Howe e , in es men has s agna ed in Spain, in con as wi h e o s
o o he Eu opean coun ies, o apply ICTs o public se ices and adminis a ion [3].
The in eg a ion o ICTs in o heal h se ices and hei use in di e se asks ela ed o
heal hca e and li es yle managemen is known as digi al heal h o eHeal h. Recen esea ch
has in oduced elemen s in o he de ini ion o eHeal h ha include he po en ial o ICTs o
imp o ing access o heal hca e; inc easing e iciency, e icacy, and he quali y o clinical
p ocesses; and imp o ing managemen o all ac o s in ol ed [4–6].
Accessing he in e ne o in o ma ion, along wi h new o ms o communica ion,
de ices and applica ions ha allow use s g ea e con ol and moni o ing o hei heal h
has been epo ed o con ibu e signi ican ly o hei empowe men [
7
]. These possibili ies
mo i a e use s o ake g ea e in e es in hei heal h [
8
], gi ing ise o ePa ien s: mo e
p oac i e and in o med indi iduals who seek o pa icipa e in decisions ha a ec hei
heal h [9].
Some eHeal h se ices o e ed in Spain ha e been well ecei ed and a e comple ely
es ablished, such as he use o elec onic p esc ip ions, making appoin men s using he
in e ne , o accessing Elec onic Medical Reco ds (EMRs) [
10
]. Howe e , se ices such as
elemedicine o ac i i ies ela ed o digi al imaging exhibi he need o g ea e in es men
and de elopmen o a ain sa is ac o y le els o use. Se e al pilo p og ams [
11
–
13
] ha e
o e ed posi i e p elimina y esul s ( educed cos s h ough ele-assis ance o eleca e) bu
lack su icien con inui y o become es ablished.
In ela ion o eHeal h, bo h he s a e as coo dina o o he NHS, and he egional AC
heal h se ices a e adap ing hei web po als o acili a e access o se ices ia mobile
phones. To keep pace wi h he g owing use o hese de ices, apps a e being de eloped ha
allow use s o in e ac wi h medical pe sonnel o moni o ac i i ies o beha io s.
This p o ision o heal h se ices ia sma phones is commonly known as mHeal h.
Some au ho s ha e indica ed [
14
,
15
] ha i could gi e a signi ican impulse o eHeal h in
gene al and elemedicine in pa icula [14,15].
1.3. mHeal h
The e m mHeal h can be de ined as “medical o public heal h p ac ices ha use
mobile de ices such as sma phones, pe sonal digi al assis an s (PDAs), able s and wea -
ables” [
15
]. The use o hese de ices is linked o speci ic echnical equi emen s and
unc ionali ies ha include oice o ex messaging, hi d, ou h, o i h gene a ion mobile
elecommunica ions (3G, 4G, 5G), and Blue oo h o global posi ioning sys ems (GPS).
Heal h apps a e on he ise. A s udy by Resea ch2guidance epo ed mo e han 300,000
o hem, mainly o he wo g ea ope a ing sys ems, Apple and And oid [
16
]. Mos o hese
a e o ien ed o i ness o gene al wellbeing. The Ins i u e o Heal hca e In o ma ics [
17
]
p o ides concu ing da a, indica ing ha he majo i y o such apps cen e on li es yle (die ,
physical exe cise, s ess, and way o li e), ollowed by hose ha add ess speci ic aspec s o
heal h such as p egnancy, men al heal h, diabe es, o medica ion [18].
Simila ly, a e iew o he ele an li e a u e demons a es ha mHeal h is mainly
used in p e en a i e heal h. The mos equen ly add essed opics a e amily planning,
p egnancy, AIDS p e en ion, diagnosis, in o ma ion abou addic ions o ea men , and
ollow-up o medica ions and pa hologies [
19
,
20
]. Being a good ool [
21
,
22
], i is belie ed
ha mHeal h could also ha e g ea po en ial o moni o ing pa ien s and ch onic illnesses
o condi ions such as as hma, ch onic pulmona y diseases, hea ailu e symp oms, blood
suga le els, and blood p essu e. This app oach is also highly use ul o p omo ing heal h
and ga he ing da a o imp o e medical assis ance and he sys em i sel [23].
In . J. En i on. Res. Public Heal h 2021,18, 13055 3 o 17
Though he e is consensus abou he con enience and ease o hese echnologies o
p o essionals [
24
] and use s, each o hese ac o s has hei own se o expec a ions and
conce ns. Heal hca e p o essionals alue mHeal h e y posi i ely and a e conce ned wi h
he s abili y o he p og ams, he po en ial use ulness o mHeal h o hei p o essional
ac i i y, and he secu i y o eliabili y o da a and in e ne connec ions [
25
,
26
]. Pa ien s a e
conce ned wi h usabili y and medical a en ion, he ongoing ailu e o de ices o ca y ou
many o he ac ions equi ed o digi al in e ac ion o da e, and app incompa ibili ies. They
also exp ess lack o con idence in secu i y measu es. Bo h g oups clea ly conside mHeal h
o be a good ool, bu he e a e disc epancies abou how speci ic u ili ies, such as access o
digi al medical eco ds, should be de eloped [27].
The li e a u e e iew e ealed ha esea ch has cen e ed mainly a ound s udying—
bu e y li le on achie ing—da a usabili y, accessibili y, and quali y [
28
,
29
]. Signi ican
in e ope abili y issues de i ed om he incompa ibili y o ga he ed da a a e belie ed o
pe sis [
30
]; he wo ldwide web is s ill conside ed insecu e and lacking in in es men [
31
];
ins i u ional ba ie s ha e been de ec ed [
32
]; and he lack o i s -language in o ma ion on
he in e ne is accompanied by in o ma ion eliabili y issues [
33
]. All hese issues oge he
c ea e an impo an obs acle o he de elopmen o mHeal h.
S udies seem o indica e ha eHeal h and mHeal h do no gene a e social and heal h
changes di ec ly. Mo eo e , gi en ha he echnology inco po a es o ms o powe , in-
e es s, and ela ionships be ween ac o s ha a e no always conco dan [
34
], heal hca e
sys ems also equi e adap a ion.
In his a ea, he ou b eak o he SARS-CoV-2 i us ha unleashed he global COVID-19
pandemic in 2020 has enli ened he deba e abou he po en ial o eHeal h and mHeal h
as use ul ools o con olling pandemics [
35
–
37
]. How use s in e ac wi h heal hca e
p o essionals has changed signi ican ly, as ci cums ances ha e accele a ed he adop ion o
digi al ools such as elemedicine and i ual ca e [32,38–42].
1.4. Objec i es
This wo k p o ides an analysis o he use and ecen e olu ion o eHeal h in Spain,
and mHeal h in pa icula , based on he esul s o a su ey in ol ing a s a is ically signi i-
can sample o he popula ion. The scien i ic li e a u e was also e iewed, and ele an
seconda y sou ces we e consul ed om o ganisms ha e alua e eHeal h access and use,
including he epo s o he Obse a o io Nacional de Tecnología y Sociedad de la In o -
mación (ONTSI, Na ional Obse a o y on Technology and he In o ma ion Socie y) o he
Ins i u o Nacional de Es adís ica (INE, Na ional S a is ics Ins i u e), bo h o icial esea ch
Spanish ins i u ions.
Mo i a ed by he gap in he li e a u e conce ning he de ini ion o an mHeal h use
p o ile [
43
–
45
], his wo k a emp s o desc ibe he le els o mHeal h use and accep ance
in Spain along wi h u u e pe spec i es. Speci ically, he idea was o con as use s who
op o manage and consul heal h- ela ed issues om a mobile de ice (mHeal h) and hose
who access eHeal h h ough o he de ices.
The s udy o indi iduals who use hei mobile de ice (he ea e MobU) as an access
poin o eHeal h se ices and hose who use o he de ices, mainly compu e s, (he ea e
WebU) o access he same se ices p o ides a e e ence o de ec ing simila i ies and
di e ences in access and use o he online heal hca e sys em and de e mining he deg ee o
Heal h and mHeal h pene a ion.
Acco dingly, he esul s we e con igu ed and compa ed based on de ice use o each
use p o ile (MobU, WebU) and a ings and opinions om bo h g oups. In addi ion o
he compa a i e aspec , he a ious su ey ques ion blocks made i possible o compile a
pano amic pic u e o he s a e o eHeal h se ices in 2018. I p o ides much mo e de ail
abou uses and use p o iles han wha is o e ed in o he seconda y da a sou ces.
In . J. En i on. Res. Public Heal h 2021,18, 13055 4 o 17
2. Ma e ials and Me hods
Up- o-da e in o ma ion on he use o eHeal h and mHeal h se ices was ga he ed
om he Encues a de Uso y Ac i udes an e la eSalud en España (Su ey on Use and A i udes
ega ding eHeal h in Spain), he ea e e e ed o as he eHeal h Su ey.
2.1. Design o he eHeal h Su ey
This su ey was conduc ed by means o elephone calls and Compu e -Assis ed
Telephone In e iews (CATI). Du ing he su ey, opinions we e eques ed abou ques-
ions ela ed o he accessibili y o he main se ices o e ed on AC heal h web po als:
scheduling a medical appoin men , accessing digi al medical eco ds, managing elec onic
p esc ip ions, digi al imaging, and elemedicine. O he i ems we e included conce ning
use o de ices, he pe cei ed po en ial o new echnologies, p io i ies o se ices, means o
accessing in e ne , and pe cei ed p io i ies abou eHeal h and mHeal h se ices.
The a e age du a ion o he in e iew was 9.0 min, wi h a ange o 5.7 o 12.3 min.
The ampli ude o he ange was condi ioned by il e ques ions, on he basis o which no
all in o man s had o espond o he en i e su ey. The ieldwo k was done om 24 May
2018 o 21 June 2018 h oughou he en i e Spanish e i o y, wi h he excep ion o he
au onomous A ican ci ies o Ceu a and Melilla.
2.2. Popula ion
A sample o 1695 adul s legally esiding in Spain we e in e iewed. Phone calls we e
andomly gene a ed om he In obel elephone di ec o y a di e en imes o day and days
o he week. To gua an ee adequa e ep esen a i eness, sociodemog aphic p o ile ea u es
we e included in he case selec ion p ocess. Quo as we e es ablished o sex, age, and
habi a , wi h a con idence le el o 95% and a ma gin o e o o 2.45 o he en i e sample.
2.3. Analysis and In e p e a ion
The in o ma ion ga he ed was s o ed in a codi ied da a base acco ding o he su ey
design and objec i es. The p elimina y esul s we e co ec ed, s anda dized, and ecodi ied
in o a iables o acili a e s a is ical ea men . Weigh ing was applied wi h a en ion o
he quo as men ioned ea lie , o ensu e ep esen a i eness a he na ional le el. Finally,
he da a we e ho oughly analyzed using SPSSTM and STATATM so wa e packs. F om
hese, gene al opinions we e ex ac ed and ca ego ized o he se o in o man s, whose
con ibu ion o he esea ch objec i es was hen assessed.
The analysis has been ca ied ou wi h he aim o con as ing use p o iles acco ding o
hei use o heal h web po als on compu e o mobile pla o ms. Heal h web po als ha e
been he main o only ga eway o eHeal h se ices in Spain, and he e o e, his cen alized
all access o hem.
Based on his i s selec ion o cases, a p o ile o each ypology was c ea ed wi h
he aim o de e mining he main di e ences and simila i ies be ween hem. In addi ion,
some indica o s we e buil wi h he pu pose o weighing and es ima ing he a e age use o
se ices, hus de ining he p io i ies o each p o ile. The ope a ions ca ied ou o pe o m
hese analyses a e desc ibed along wi h he esul s in o de o ease i s unde s anding.
This ea men p o ided us wi h a desc ip ion o he gene al si ua ion o eHeal h in
Spain and made i possible o con as he habi s and expec a ions o wo use p o iles:
MobU, indica ing hose who use a mobile de ice o access se ices, and WebU, indica ing
hose who use compu e s o any o he de ice o he same pu pose.
3. Resul s
3.1. Dimension o Each P o ile
As pa o he WebU p o ile, he MobU con ingen ep esen ed 24.4% o all hose who
in e ac ed wi h eHeal h se ices.
In . J. En i on. Res. Public Heal h 2021,18, 13055 5 o 17
WebU comp ised 49.91% o he Spanish popula ion. This indica es ha al hough he
numbe o people who access eHeal h se ices is conside able a nea ly 50%, ha use o
eHeal h is by no means gene alized.
Wi h his in mind, he wo p o iles as well as hei use and expec a ions o eHeal h
and mHeal h in Spain a e desc ibed in he ollowing sec ions.
3.2. Heal h S a us and F equency o Medical Visi s
Mobile use s (MobU) gene ally made g ea e use o in-pe son heal h se ices han web
use s (WebU). Al hough 59.4% o WebU wen o he doc o be ween 0 and 3 imes pe yea
compa ed o 52.3% o MobU, he in e se si ua ion was obse ed o he esponse ca ego y
o 4 o mo e isi s pe yea . In o al, 47.7% o MobU made in-pe son isi s compa ed o
40.6% o WebU.
Thus, MobU used heal hca e se ices mo e equen ly han WebU. Is his because he
heal h s a us o MobU is wo se o does i simply mani es hei g ea e conce n o hei
heal h? The ollowing da a on heal h s a us and he p esence o ch onic illnesses will help
o cla i y his ques ion.
MobU and WebU sel -assessed hei heal h s a us almos iden ically (means and
medians we e ex emely simila and ho e ed a ound 2, “Good”). MobU cases we e highe
a bo h ends o he dis ibu ion (especially in he “Ve y good” ca ego y bu also in “Bad”
o “Ve y bad”), bu no no ably highe han WebU (less han 2%).
Fo ch onici y, he simila i y con inued: 35.7% o WebU decla ed a ch onic condi ion
compa ed o 33.3% o MobU.
3.3. Use o In e ne (Gene al and Speci ic o he Medical Con ex )
When asked abou how hey connec ed o he in e ne , MobU indica ed ha hei
main de ice was he mobile phone: 85.6% used i e e y day and 93.2% used i equen ly.
A e ha , and o a much lesse deg ee, o he de ices named included desk op compu e s,
lap ops, and able s, which 20% epo ed using daily and 30–45% epo ed using equen ly.
The WebU g oup also used hei mobile phones as hei main ool o accessing
he in e ne , bu he numbe s we e lowe han MobU; in ac , abou 10% less o WebU
epo ed equen use (83.8%). Desk ops and lap ops illed he gap in simila numbe s,
hough sligh ly highe o desk ops: o e 30% indica ed daily use and nea ly 50% epo ed
equen use.
Use o able s o access he in e ne was almos iden ical be ween p o iles, wi h nea ly
20% epo ing daily use and sligh ly mo e han 30% epo ing equen use.
Finally, 34% o bo h use p o iles accessed he in e ne wi h hei ele ision o some
deg ee, wi h o e 10% indica ing ha hey go online daily wi h his de ice. These igu es di -
e en ia e he access p o iles o he wo g oups h ough in as uc u al o
echnological means
.
When asked abou he physical space o loca ion om which hey usually connec ed
o he in e ne , he MobU g oup was less es ic ed o a speci ic loca ion. Nea ly one- hi d
o MobU connec ed om anywhe e, and nowhe e in pa icula , compa ed o 18% o WebU.
In ha g oup, domes ic/home spaces eme ged as clea ly p edominan places o in e ne
connec ion in 70% o he cases, compa ed o 62.1% o MobU.
Finally, he hi d mos ele an op ion o connec ing om he wo kplace was epo ed
by 10.6% o WebU and 7.6% o MobU.
Despi e he di e ences, connec ion om home emained p edominan . This may be
associa ed wi h consump ion and ee- ime habi s, despi e he signi ican numbe s o
“ ee” access (no p e e ence o a speci ic loca ion), especially among people who access
he in e ne om hei mobile phones.
Fo gene al online ac i i ies, bo h p o iles displayed he same p io i ies and o de in
equency o use, bu wi h clea di e ences in he in ensi y o ask comple ion.
As he ollowing g aph illus a es (Figu e 1), MobU pe sis en ly ended owa d mo e
equen use, while WebU displayed mo e di e si ied use and lacked use o knowledge o
se e al i ems.
In . J. En i on. Res. Public Heal h 2021,18, 13055 6 o 17
In . J. En i on. Res. Public Heal h 2021, 18, 13055 6 o 17
“ ee” access (no p e e ence o a speci ic loca ion), especially among people who access
he in e ne om hei mobile phones.
Fo gene al online ac i i ies, bo h p o iles displayed he same p io i ies and o de in
equency o use, bu wi h clea di e ences in he in ensi y o ask comple ion.
As he ollowing g aph illus a es (Figu e 1), MobU pe sis en ly ended owa d mo e
equen use, while WebU displayed mo e di e si ied use and lacked use o knowledge
o se e al i ems.
Figu e 1. Basic online ac i i ies (by use p o ile).
In he a ea o heal hca e, when in o man s we e asked abou sea ch c i e ia and p i-
o i ies o online heal h que ies, a simila beha io pa e n eme ged. Table 1 shows ha
al hough consul a ion sou ces and p io i y o access o hem we e equal, MobU had
highe consul a ion in ensi y and equency.
Table 1. F equency o accessing heal h in o ma ion sou ces (by use p o ile).
When You Look Fo In o ma ion abou Heal h, How O en o You Go o he Following Web-
si es?
F equency o Access
E e y Day
F equen ly
Occasionally
Almos
Ne e
Ne e
Use P o ile
WebU
MobU
WebU
MobU
WebU
MobU
WebU
MobU
WebU
Mob
U
My Au onomous Communi y’s
public heal h se ice
0.92
0.00
11.58
18.94
43.20
39.39
19.49
18.18
23.48
24.82
Ano he ins i u ion such as he
Wo ld Heal h O ganiza ion o
he Minis y o Heal h
0.18
0.00
3.31
6.82
19.12
18.18
17.65
18.94
56.06
59.74
Businesses ha p o ide
heal hca e se ices (insu ance
companies o wo kplace mu u-
als)
0.00
0.00
2.94
3.03
17.28
17.42
14.89
12.88
66.67
64.89
Pa ien associa ions
0.18
0.00
2.21
3.82
11.23
6.87
15.47
16.79
72.52
70.90
Heal h blogs o o ums
0.37
0.76
4.97
8.40
23.57
23.66
19.71
19.08
48.09
51.38
Sou ce: au ho s’ own da a. Highes and lowes equencies/sco es a e showed in di e en colo s.
5.30
4.25
58.33
55.54
75.00
66.48
58.33
58.56
26.52
23.20
0.00
0.18
25.76
21.81
34.85
34.87
15.91
15.10
24.24
21.73
19.70
20.26
21.97
16.21
52.27
50.65
6.06
8.49
5.30
7.37
13.64
14.00
35.61
29.65
46.21
47.33
9.09
10.72
0.76
0.37
1.52
3.50
2.27
3.31
6.82
11.42
12.12
12.89
7.58
12.57 0.00
0.74
2.27
7.55
1.52
2.39
11.36
15.47
19.70
23.39
0.0 20.0 40.0 60.0 80.0 100.0
MobU-Online adminis a i e p ocedu es (wi h Public Adminis a ions o businesses)
WebU-Online adminis a i e p ocedu es (wi h Public Adminis a ions o businesses)
MobU-Look o in o ma ion on sea ch engines
WebU-Look o in o ma ion on sea ch engines
MobU-Use social media
WebU-Use social media
MobU-Use eMail
WebU-Use eMail
MobU-Wa ch, lis en o, download o sha e iles
WebU-Wa ch, lis en o, download o sha e iles
MobU-Buy p oduc s o se ices
WebU-Buy p oduc s o se ices
E e y day F equen ly Occasionally Almos ne e Ne e
Figu e 1. Basic online ac i i ies (by use p o ile).
In he a ea o heal hca e, when in o man s we e asked abou sea ch c i e ia and
p io i ies o online heal h que ies, a simila beha io pa e n eme ged. Table 1shows ha
al hough consul a ion sou ces and p io i y o access o hem we e equal, MobU had highe
consul a ion in ensi y and equency.
Table 1. F equency o accessing heal h in o ma ion sou ces (by use p o ile).
When You Look Fo In o ma ion abou Heal h, How O en o You Go o he Following Websi es?
F equency o Access E e y Day F equen ly Occasionally Almos Ne e Ne e
Use P o ile WebU MobU WebU MobU WebU MobU WebU MobU WebU MobU
My Au onomous
Communi y’s public
heal h se ice
0.92 0.00 11.58 18.94 43.20 39.39 19.49 18.18 23.48 24.82
Ano he ins i u ion such as
he Wo ld Heal h
O ganiza ion o he
Minis y o Heal h
0.18 0.00 3.31 6.82 19.12 18.18 17.65 18.94 56.06 59.74
Businesses ha p o ide
heal hca e se ices
(insu ance companies o
wo kplace mu uals)
0.00 0.00 2.94 3.03 17.28 17.42 14.89 12.88 66.67 64.89
Pa ien associa ions 0.18 0.00 2.21 3.82 11.23 6.87 15.47 16.79 72.52 70.90
Heal h blogs o o ums 0.37 0.76 4.97 8.40 23.57 23.66 19.71 19.08 48.09 51.38
Sou ce: au ho s’ own da a. Highes and lowes equencies/sco es a e showed in di e en colo s.
3.4. Value and Use o Au onomous Communi y Websi es
The i s i em o add ess in assessing he AC heal h se ices websi es was how use s
accessed knowledge o hei exis ence.
The g ea di e ence be ween he wo p o iles esided in how hey knew abou he
exis ence o hese websi es. In he WebU g oup, 37.2% epo ed ha his in o ma ion
was p o ided by he AC public heal h sys em, i s pe sonnel, o ano he adminis a ion
(
e.g., municipal
), compa ed o 31.8% in he MobU g oup. Fo MobU, he mos common
way o accessing his knowledge was by in e ne sea ch (38.6%), while o WebU, he
In . J. En i on. Res. Public Heal h 2021,18, 13055 7 o 17
pe cen age was lowe (31.2%). This s ikes a con as be ween a mo e ins i u ional and
adi ional access p o ile and a mo e in o mal and up-do-da e one.
Tu ning he spo ligh o equency o access, we ound ha MobU accessed heal h
websi es conside ably mo e o en: 52.7% decla ed o ha e accessed such a si e “in he las
mon h” compa ed o 36.1% o WebU. The la e g oup also p esen ed mo e spo adic access
by decla ing highe equency o access supe io o 3 mon hs.
Le els o sa is ac ion wi h websi es showed he g ea es di e ences a “mode a e” and
“high” le els. Among WebU, 44.1% epo ed mode a e sa is ac ion, compa ed o 36.4% o
MobU. In con as , 54.5% o MobU indica ed “high” sa is ac ion, while only 48.4% o WebU
decla ed he same. A gene al eading, hus, con i ms a medium-high le el o sa is ac ion
in bo h p o iles ha is sligh ly highe among mobile use s.
Conce ning accomplishing he objec i es o which hey accessed he websi es, he e
we e no g ea di e ences: mo e han 9 ou o 10 (92.4% o MobU and 90.8% o WebU)
decla ed o ha e ul illed he in ended pu pose o hei isi .
The da a compiled abou he ype o consul a ions on heal hca e websi es indica e
ha he in o ma ion mos commonly sough by bo h use g oups was “loca ing medical
cen e s, opening hou s and con ac in o ma ion”. Howe e , di e ences appea ed o o he
ypes o in o ma ion: MobU sea ched o “p e en ion p og ams” ( accina ions, ad ice on
heal hy habi s
. . .
) and “In o ma ion on he AC public heal h sys em” mo e equen ly
han WebU. Di e ences o o he ypes o in o ma ion, such as “Illnesses, he apies and
medica ions”, we e smalle .
As o equency, MobU used he websi es mo e ( he e we e ewe “ne e ” esponses)
and mo e in ensi ely (mo e equen han occasional) han WebU.
Fo eHeal h se ices, he pa e n became mo e accen ua ed. Fi s o all, he mos
equen se ice accessed—by 83.3% o MobU and 72.5% o WebU—was online schedul-
ing (changing, canceling) o appoin men s. The se ice mos o en accessed a e ha ,
hough o a lesse ex en (34.1% MobU, 28.0% WebU), was managemen o he medical
iden i ica ion ca d.
Mo e speci ically, di e ences ound in he equency o seeking online se ices indica e
ha 33% o MobU used he se ices men ioned on some occasion, compa ed o 28.8% o
WebU. The e was a di e ence o 10.9% be ween he wo g oups o online scheduling o
appoin men s (16.7% o MobU had ne e used his se ice, compa ed o 27.5% o WebU).
Apa om hese wo se ices, MobU epo ed using an a e age o 21.6% o a ailable
eHeal h se ices ( ange 15–23%) and WebU used an a e age o 18% ( ange 13–20%).
Again, he e we e no g ea di e ences in he impo ance a ibu ed o each eHeal h
se ice, al hough MobU ended o assign hem mo e alue and impo ance. The e we e
ewe in ha g oup who esponded ha hese se ices had “No impo ance” (7.3% com-
pa ed o 10.1% o WebU) and 66.2% o MobU conside ed all he se ices “ e y impo an ”,
compa ed o 63.2% o WebU.
Figu e 2shows he main di e ences among eHeal h se ices and he p ominence o
se ices ela ed o scheduling appoin men s and consul ing/ ecei ing medical epo s
o esul s.
Rega ding ease o use o eHeal h se ices, ha dly any di e ences appea ed, and bo h
p o iles conside ed hem easy o use (88.3% o MobU; 88.1% o WebU). When asked o
a gene al opinion o he AC websi es, he opinions o bo h p o iles we e eco ded along
wi h MobU esponses o a speci ic ques ion abou using hose websi es om a mobile
de ice. Table 2shows he compa ison o opinions ega ding AC public heal h websi es by
use p o ile.
In . J. En i on. Res. Public Heal h 2021,18, 13055 8 o 17
In . J. En i on. Res. Public Heal h 2021, 18, 13055 8 o 17
Figu e 2. Ranking o he impo ance o heal h se ices (by use p o ile).
Rega ding ease o use o eHeal h se ices, ha dly any di e ences appea ed, and bo h
p o iles conside ed hem easy o use (88.3% o MobU; 88.1% o WebU). When asked o a
gene al opinion o he AC websi es, he opinions o bo h p o iles we e eco ded along
wi h MobU esponses o a speci ic ques ion abou using hose websi es om a mobile
de ice. Table 2 shows he compa ison o opinions ega ding AC public heal h websi es
by use p o ile.
To be e unde s and he balance be ween ca ego ies, a isual indica o was c ea ed.
Mul iplie s we e used o each pe cen age o cases ma ked in he esponse ca ego ies
(Ve y bad = *0; Bad = *1; Un ema kable = *2; Good = *3; Ve y good = *4). The maximum
accumula ed alue o 400 poin s became a denomina o ha made i possible o s anda d-
ize sco es in a ange o 0 (Ve y bad) o 1 (Ve y good). This indica o was applied o o he
ques ions in he same way, mul iplying he sco es by “n (numbe o ca ego ies)-1”.
Table 2. Opinions o Au onomous Communi y heal h websi es (by use p o ile).
F equency
Sco e
Ra ing o AC
Websi es
Ra ing o Mobile Ve -
sion o AC Websi es
Ra ing o AC
Websi es
Ra ing o Mobile Ve -
sion o AC Websi es
WebU
MobU
MobU
WebU
MobU
MobU
Ve y bad
0.4
0.8
3.1
0
0
0
Bad
2.5
3.9
1.5
2.46
3.88
1.53
Un ema kable
19.3
15.5
22.9
38.64
31.01
45.80
Good
66.7
65.9
55.7
200.00
197.67
167.18
Ve y good
11.2
14.0
16.8
44.70
55.81
67.18
Sco e (0–1)
0.7145
0.7209
0.7042
Sou ce: au ho s’ own da a.
0.0 20.0 40.0 60.0 80.0 100.0
MobU-Reques , change o cancel an appoin men wi h my gene al
p ac i ione , a medical specialis o o he heal hca e p o essional
WebU-Reques , change o cancel an appoin men wi h my gene al
p ac i ione , a medical specialis o o he heal hca e p o essional
MobU-Access my medical eco ds
WebU-Access my medical eco ds
MobU-Access o ecei e medical es esul s
WebU-Access o ecei e medical es esul s
MobU-Communica e wi h a heal hca e p o essional
WebU-Communica e wi h a heal hca e p o essional
MobU-Reques change o doc o
WebU-Reques change o doc o
MobU-Manage my medical iden i ica ion ca d ( eques new ca d, change
in o ma ion … )
WebU-Manage my medical iden i ica ion ca d ( eques new ca d, change
in o ma ion … )
Pe cen o o al
MobU s WebU anking o impo ance o eHeal h se ices
Ve y
Somewha
No e y
No
impo an
Figu e 2. Ranking o he impo ance o heal h se ices (by use p o ile).
Table 2. Opinions o Au onomous Communi y heal h websi es (by use p o ile).
F equency Sco e
Ra ing o AC Websi es Ra ing o Mobile Ve sion
o AC Websi es Ra ing o AC Websi es Ra ing o Mobile Ve sion
o AC Websi es
WebU MobU MobU WebU MobU MobU
Ve y bad 0.4 0.8 3.1 0 0 0
Bad 2.5 3.9 1.5 2.46 3.88 1.53
Un ema kable 19.3 15.5 22.9 38.64 31.01 45.80
Good 66.7 65.9 55.7 200.00 197.67 167.18
Ve y good 11.2 14.0 16.8 44.70 55.81 67.18
Sco e (0–1) 0.7145 0.7209 0.7042
Sou ce: au ho s’ own da a.
To be e unde s and he balance be ween ca ego ies, a isual indica o was c ea ed.
Mul iplie s we e used o each pe cen age o cases ma ked in he esponse ca ego ies
(Ve y bad = *0; Bad = *1; Un ema kable = *2; Good = *3; Ve y good = *4). The maximum
accumula ed alue o 400 poin s became a denomina o ha made i possible o s anda dize
sco es in a ange o 0 (Ve y bad) o 1 (Ve y good). This indica o was applied o o he
ques ions in he same way, mul iplying he sco es by “n(numbe o ca ego ies)-1”.
As is appa en , he e we e no g ea di e ences be ween MobU and WebU a ings o AC
websi es, al hough he gene ally a o able opinions o MobU we e somewha a enua ed
when i came o e alua ing he mobile e sions o hose websi es.
Table 3p esen s he esul s o o he eHeal h se ices based on he same
calcula ion pa e n
.
In . J. En i on. Res. Public Heal h 2021,18, 13055 9 o 17
Table 3. F equency and impo ance o eHeal h se ices (by use p o ile).
Sco es Rega ding F equency o Use o
eHeal h Se ices
Sco es Rega ding Impo ance o
eHeal h Se ices
WebU MobU Di
WebU-MobU WebU MobU Di
WebU-MobU
Reques a second medical opinion 0.0523 0.0811 −0.0288 0.7509 0.7519 −0.0010
Regis e a complain 0.0607 0.0848 −0.0241 0.7857 0.8010 −0.0154
Access medical es esul s 0.1444 0.3077 −0.1632 0.7563 0.7667 −0.0104
Recei e medical es esul s 0.1202 0.2564 −0.1362 0.7706 0.8333 −0.0627
Check an appoin men o posi ion on a
wai ing lis 0.1948 0.2701 −0.0753 0.8362 0.8640 −0.0278
Check p esc ip ions o medica ions 0.1236 0.1411 −0.0176 0.7259 0.7275 −0.0016
Reques eimbu semen o expenses 0.0486 0.0751 −0.0265 0.7031 0.7025 0.0007
Recei e in o ma ion on p e en a i e
heal h campaigns 0.1118 0.1042 0.0077 0.7519 0.7743 −0.0224
Consul wi h a heal hca e p o essional
online by ideocon e ence 0.0117 0.0061 0.0056 0.7392 0.7813 −0.0420
Moni o heal h using emo e measu ing
de ices (glucose, blood p essu e . .. ) 0.0760 0.0841 −0.0081 0.7500 0.7787 −0.0287
Compile da a abou indi idual physical
ac i i y (sma wa ches, pulsome e s) 0.1566 0.1976 −0.0411 0.6509 0.6432 0.0077
Abili y o send heal h- ela ed pho os o
iles o a p o essional 0.0513 0.0685 −0.0171 0.7012 0.7442 −0.0430
A e age 0.0960 0.1397 −0.0437 0.7435 0.7640 −0.0206
Sou ce: au ho s’ own da a. Highes and lowes equencies/sco es a e showed in di e en colo s.
Fo his, Tables 3–5, which ha e he same layou , he explana ion o he colo s is as
ollows: in columns WebU and MobU, he sco es ob ained a e shown om lowes ( ed)
o highes (g een); in e media e alues a e shown in o ange and yellow. In he Di WebU-
MobU columns, he di e ences in a o o MobU a e highligh ed in ed; hose ea u es in
which WebU sco es highe a e in g een.
Table 4. Impo ance o measu es o os e access o eHeal h (by use p o ile).
WebU MobU Di WebU-MobU
Imp o e in e ne speed 0.8579 0.8590 −0.0011
Imp o e co e age and access in all o Spain 0.9002 0.9033 −0.0031
Reduce in e ne cos s 0.8956 0.9192 −0.0236
Reduce cos s o de ices (mobile phones, compu e s, able s) 0.8625 0.8687 −0.0062
Imp o e ci izen educa ion in new echnologies 0.9233 0.9116 0.0116
Inc ease secu i y and p i acy o pe sonal da a 0.9331 0.9338 −0.0008
Make known and simpli y he use o digi al ce i ica es and
na ional ID ca ds 0.8887 0.9000 −0.0113
Mo e encou agemen om medical p o essionals o pa ien s o
make g ea e use o hese echnologies 0.8278 0.8244 0.0034
Publicize and in o m mo e abou heal h websi es and apps 0.8520 0.8564 −0.0044
Be e coo dina ion among medical cen e s, hospi als,
pha macies and p o essionals 0.9501 0.9495 0.0006
In . J. En i on. Res. Public Heal h 2021,18, 13055 16 o 17
ollo e Inno ación O ien ada a los Re os de la Sociedad, Con oca o ia 2014). This ac does no imply
he exis ence o any ype o con lic o in e es ei he due o such unding o o o he easons.
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen :
In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen :
The su ey will be a ailable in his public eposi o y: h p://www.
a ces.cis.es/jEs udios.jsp.
Con lic s o In e es :
The au ho s decla e no con lic o in e es . The unde s had no ole in he design
o he s udy; in he collec ion, analyses, o in e p e a ion o da a; in he w i ing o he manusc ip , o
in he decision o publish he esul s.
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