title: Changes over time in the utilization of disease-related Internet information in newly diagnosed breast cancer patients 2007 to 2013.
abstract: BACKGROUND
  As the number of people with Internet access rises, so does the use of the Internet as a potentially valuable source for health information. Insight into patient use of this information and its correlates over time may reveal changes in the digital divide based on patient age and education. Existing research has focused on patient characteristics that predict Internet information use and research on treatment context is rare.
  
  
  OBJECTIVE
  This study aims to (1) present data on the proportion of newly diagnosed breast cancer patients treated in German breast centers from 2007 to 2013 who used the Internet for information on their disease, (2) look into correlations between Internet utilization and sociodemographic characteristics and if these change over time, and (3) determine if use of Internet information varies with the hospitals in which the patients were initially treated.
  
  
  METHODS
  Data about utilization of the Internet for breast cancer-specific health information was obtained in a postal survey of breast cancer patients that is conducted annually in Germany with a steady response rate of 87% of consenting patients. Data from the survey were combined with data obtained by hospital personnel (eg, cancer stage and type of surgery). Data from 27,491 patients from 7 consecutive annual surveys were analyzed for this paper using multilevel regression modeling to account for clustering of patients in specific hospitals.
  
  
  RESULTS
  Breast cancer patients seeking disease-specific information on the Internet increased significantly from 26.96% (853/3164) in 2007 to 37.21% (1485/3991) in 2013. Similar patterns of demographic correlates were found for all 7 cohorts. Older patients (≥70 years) and patients with <10 years of formal education were less likely to use the Internet for information on topics related to their disease. Internet use was significantly higher among privately insured patients and patients living with a partner. Higher cancer stage and a foreign native language were associated with decreased use in the overall model. Type of surgery was not found to be associated with Internet use in the multivariable models. Intraclass correlation coefficients were small (0.00-0.03) suggesting only a small contribution of the hospital to the patients' decision to use Internet information. There was no clear indication of a decreased digital divide based on age and education.
  
  
  CONCLUSIONS
  Use of the Internet for health information is on the rise among breast cancer patients. The strong age- and education-related differences raise the question of how relevant information can be adequately provided to all patients, especially to those with limited education, older age, and living without a partner.
authors.affiliation: IMVR, University of Cologne, Koeln, Germany. christoph.kowalski@uk-koeln.de.
authors.forename: Christoph
authors.identifier: http://orcid.org/0000-0002-7438-4321
authors.initials: C
authors.lastname: Kowalski
authors.forename: Eva
authors.identifier: http://orcid.org/0000-0002-7606-6140
authors.initials: E
authors.lastname: Kahana
authors.forename: Kathrin
authors.identifier: http://orcid.org/0000-0002-9214-4516
authors.initials: K
authors.lastname: Kuhr
authors.forename: Lena
authors.identifier: http://orcid.org/0000-0002-8628-7166
authors.initials: L
authors.lastname: Ansmann
authors.forename: Holger
authors.identifier: http://orcid.org/0000-0001-9154-6575
authors.initials: H
authors.lastname: Pfaff
mesh_terms: D000368:Aged; D001943:Breast Neoplasms; D003625:Data Collection; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: breast neoplasms; digital divide; disease-related Internet information; hospital differences; multilevel analysis