Digital Health Engagement Behaviors in U.S. Family Caregivers: Trend Analysis Using HINTS 2019-2022 (Preprint)

BACKGROUND Digital health has provided caregivers with access to supportive resources without space-time restrictions. Caregivers’ digital health engagement behaviors can help them track their own health and that of care recipients as well as communicate with others. While digital health tools have become more prevalent since COVID-19, the trend of caregiver engagement has been less explored. OBJECTIVE This study examined the trends and factors associated with selected digital health engagement behaviors in family caregivers in the United States (U.S.), using the Health Information National Trends Survey (HINTS) datasets collected in 2019, 2020, and 2022. METHODS Our cross-sectional data analysis included 1,676 family caregivers. Dependent variables were: 1) access to online medical records (caregiver’s, care recipient’s); and 2) health-related use of social media (sharing health information, interacting with others, watching health-related videos). Independent variables were survey year, demographic, socioeconomic, caregiving, and Internet technology factors. Weighted multivariable logistic regression analyses were conducted. RESULTS Among 1,676 caregivers (2019: n = 570; 2020: n = 412; 2022: n = 694), access to online medical records increased from 2019 to 2022. Access to caregivers’ own records rose from 48.7% to 72.6% (P<.001), and access to care recipients’ records increased from 30.8% to 44.5% (P<.001). Health-related social media use also increased, including sharing health information (22.5% vs 39.1%, P<.001), interacting with others (16.6% vs 27.0%, P<.001), and watching health-related videos (49.5% vs 60.9%, P=.005). In adjusted analyses, higher education (college graduate vs ≤high school: OR = 2.75, 95% CI 1.56–4.85, P<.001) and having health insurance (OR = 2.40, 95% CI 1.24–4.68, P=.010) were associated with access to caregivers’ records. Female sex (OR = 1.96, 95% CI 1.36–2.84, P<.001) and spousal caregiving (OR = 2.14, 95% CI 1.26–3.65, P=.005) were associated with access to care recipients’ records. High-speed internet access was strongly associated with digital engagement outcomes (e.g., sharing health information: OR = 3.98, 95% CI 2.15–7.35, P<.001). CONCLUSIONS Digital health engagement—including access to online medical records and the use of social media for health-related purposes—among U.S. family caregivers increased following the COVID-19 pandemic. These findings suggest that healthcare professionals and researchers should consider multifaceted factors, such as age, race/ethnicity, geography, education, insurance coverage, and digital access, when designing and implementing digital health tools and technology-based interventions. Future research should evaluate how digital technologies, automation of systems “talking” to other systems, including artificial intelligence (AI) can better support caregivers’ health information needs and care coordination. The varying learning curves for individuals and groups could further be explored for effective and efficient adoption and utilization.