title: Internet-based developmental screening: a digital divide between English- and Spanish-speaking parents.
abstract: BACKGROUND
  Internet-based developmental screening is being implemented in pediatric practices across the United States. Little is known about the application of this technology in poor urban populations.
  
  
  OBJECTIVE
  We describe here the results of focus groups, surveys, and in-depth interviews during home visits with families served by an urban safety-net organization to address the question of whether it is possible to use Internet or e-mail communication for medical previsit engagement in a population that is majority Hispanic, of low socioeconomic status, and has many non-English-speaking families.
  
  
  METHODS
  This study included families in 4 clinics within a safety-net health care system. The study design included the use of (1) parental surveys (n = 200) of a convenience sample of parents whose children received primary care in the clinics, (2) focus groups (n = 7 groups) with parents, and (3) in-depth interviews during home visits with 4 families. We used χ(2) and multivariate analyses to compare Internet access in English- and Spanish-speaking families. Standard qualitative methods were used to code focus-group texts and identify convergent themes.
  
  
  RESULTS
  In multivariate analysis, independent factors associated with computer use were English versus Spanish language (odds ratio: 3.2 [95% confidence interval: 1.4-6.9]) and education through at least high school (odds ratio: 4.7 [95% confidence interval: 2.3-9.7]). In focus groups, the concept of parental previsit work, such as developmental screening tests, was viewed favorably by all groups. However, many parents expressed reservations about doing this work by using the Internet or e-mail and stated a preference for either paper or telephone options. Many Spanish-speaking families discussed lack of access to computers and printers.
  
  
  CONCLUSIONS
  In this economically disadvantaged population, language and maternal education were associated with access to the Internet. Given the potential power of previsit work to tailor well-child visits to the needs of individual families, alternative strategies to using the Internet should be explored for populations without reliable Internet access.
authors.affiliation: Department of Community Health Services, Denver Health, Denver, Colorado 80204, USA. simon.hambidge@dhha.org
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hambidge
authors.forename: Stephanie
authors.initials: S
authors.lastname: Phibbs
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.forename: David Aaron
authors.initials: DA
authors.lastname: Bergman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002657:Child Development; D002662:Child Health Services; D003120:Colorado; D003144:Communication Barriers; D004522:Educational Status; D034742:Electronic Mail; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D014505:Urban Population; D055815:Young Adult