title: Patient use of email for health care communication purposes across 14 European countries: an analysis of users according to demographic and health-related factors.
abstract: BACKGROUND
  The use of the Internet for health purposes is growing steadily, yet the use of asynchronous communication tools for health care purposes remains undeveloped. The introduction of email as a method of communication in health care has the potential to impact on both patients and health care professionals.
  
  
  OBJECTIVE
  This study aims to describe the characteristics of people who have sent or received an email to or from their doctor, nurse, or health care organization, by country and in relation to demographics, health care resource use, and health status factors.
  
  
  METHODS
  We conducted a secondary analysis of data (N=14,000) collected from the online Citizens and Information Communication Technology for Health survey, a project undertaken in 2011 by the Institute for Prospective Technology Studies of the European Commission's Joint Research Centre. The survey was developed to understand and characterize European citizens' use of information communication technologies for health. Descriptive and statistical analyses of association were used to interpret the data.
  
  
  RESULTS
  Denmark reported the highest level of emails sent/received (507/1000, 50.70%). The lowest level reported was by participants in France (187/1000, 18.70%). Men used email communication for health care more than women, as did respondents in the 16-24 age group and those educated to tertiary level or still within the education system. As self-reported health state worsens, the proportion of people reporting having sent or received an email within the context of health care increases. Email use, poor health, multimorbidity, and number of visits to a physician are positively correlated.
  
  
  CONCLUSIONS
  The use of email communication within the context of European health care is extremely varied. The relationship between high email use, poor health, doctor visits, and multimorbidity is especially pertinent: provision of asynchronous communication for such groups is favored by policymakers. Low reported email use by country may not necessarily reflect low interest in using email for health care: local health policies and technical infrastructures may be significant factors in the delay in implementation of alternative forms of routine health communication.
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. nicola.newhouse@phc.ox.ac.uk.
authors: Nikki
authors: http://orcid.org/0000-0001-9002-3588
authors: N
authors: Newhouse
authors: Francisco
authors: http://orcid.org/0000-0001-5361-7678
authors: F
authors: Lupiáñez-Villanueva
authors: Cristiano
authors: http://orcid.org/0000-0001-5019-1712
authors: C
authors: Codagnone
authors: Helen
authors: http://orcid.org/0000-0002-7072-1925
authors: H
authors: Atherton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003625:Data Collection; D003695:Delivery of Health Care; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D055815:Young Adult
keywords: Europe; Internet; chronic illness; eHealth; electronic mail; health services; patient activation; patient-doctor communication; survey