E-health: psychosocial challenges for South Australian rural mental health consumers

Introduction: Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise the number of rural mental health consumers able to receive support. The Australian Government has prioritised e-health within the remit of the Australian Digital Health Agency and the National Digital Health Strategy. However, despite increasing interest in e-health in policy and practice settings, uptake has been underwhelming. This study investigated the factors affecting the likely engagement the internet, both for general and e-health purposes, within the context of South Australian rural mental health consumers. The focus was on psychosocial predictors, which embraced intrinsic (motivation), as well as extrinsic factors concerning equity, such as income, occupation, education and geographic location. Methods: Participants in this quantitative study included 208 mental health consumers in rural South Australia who had recently accessed a local health network mental health service. Data were sourced from the service's clinical management database and a questionnaire constructed for the study. The questionnaire included measures of personal characteristics, motives, equity and internet use. Results: Motives and equity-related variables were directly linked to general internet use, which subsequently affected the likelihood of using the internet for health purposes. Intrinsic rather than extrinsic factors were the most significant drivers of internet use; that is, higher levels of general internet use were associated with being younger, having stronger motivation, greater trust, higher education, being employed, having a higher income and having home internet access. For health internet use, the identified significant associations were more modest and included only being younger, having stronger motivation, and greater trust. The model indicated that there were no direct predictors of internet use for health beyond use of the internet for general purposes. However, key study variables provided significant indirect paths to health internet use. General internet use was strongly influenced by motivation, and age and equity to a lesser extent. Motivation was influenced by trust, and age and equity, with trust also influenced by age and equity. Conclusion: This quantitative investigation sought to describe the barriers to and enablers of internet use generally, based on the assumption that before people will use the internet for health, they need to be prepared to use it for general purposes. The model proposed in the current research offers an indication of some of the factors that may influence rural mental health consumers' use of the internet for both general and health purposes. To appropriately design future e-health initiatives, the initial focus must be on consumers' individual capacity and willingness to use the internet generally. Policymakers and service providers are acutely interested in leveraging internet use to facilitate positive health outcomes. Understanding the factors that affect rural mental health consumers' use of the internet in general is beneficial in informing the efficient allocation of resources and the appropriate design of e-health initiatives to produce innovative solutions.