Examining Ethnic Disparities in Digital Healthcare Services Utilization: Insights from Israel

Figures & data

Table 1 Comparison of Demographic Characteristics Between the Ethnic Groups (N=606)

	Jews		Arabs		χ^2value	pvalue
	(N=445)		(N=161)
	N	%	N	%
Gender					13.31	<0.001
Woman	246	55.30%	62	38.50%
Man	199	44.70%	99	61.50%
Marital status					6.6	0.086
Single	129	29.00%	35	21.70%
Married	271	60.90%	116	72.00%
Divorced	37	8.30%	108	5.00%
Widower	8	1.80%	2	1.20%
Religiousness					55.73	<0.001
Secular	235	52.80%	33	20.50%
Traditional	135	30.30%	67	41.60%
Religious	75	16.90%	61	37.90%
Education					4.44	0.349
Elementary	5	1.10%	4	2.50%
High school	130	29.20%	46	28.60%
Professional training	63	14.20%	30	18.60%
Bachelor’s degree	178	40.00%	54	33.50%
Master’s degree or higher	69	15.50%	27	16.80%
Employment					1.31	0.518
Not working	129	29.10%	45	28.10%
Part-time employee	51	11.50%	24	15.00%
Full time employee	263	59.40%	91	56.90%
Income Level					81.02	<0.001
Lower than average	185	41.60%	133	82.60%
Average	125	28.10%	18	11.20%
Higher than average	135	30.30%	10	6.20%
Health Condition					29.18	<0.001
Not good	4	0.90%	10	6.20%
Not so good	39	8.80%	31	19.30%
Good	279	62.70%	82	50.90%
Very good	123	27.60%	38	23.60%
Chronic Diseases					0.04	0.845
No	317	71.20%	116	72.00%
Yes	128	28.80%	45	28.00%
Computer/Tablet at Home					127.29	<0.001
Yes	422	94.80%	93	57.80%
No	23	5.20%	68	42.20%
	Mean(SD)		Mean(SD)		tvalue	pvalue
Age(years)	43.9(16.4)		41.7(11.9)		1.82	0.07
min-max	20–84		21–69
No. of Children	1.9(1.8)		2.5(2.1)		−3.51	0.001
min-max	0–10		0–8

Note: Bold values denote statistical significance.

Abbreviation: SD, standard deviation.

Table 2 Mean Differences in the Research Variables Between the Ethnic Groups and Gender

	Jews (N=445)				Arabs (N=161)
	Women (N=246)		Men (N=199)		Women (N=62)		Men (N=99)		Ethnic Groups			Gender			Interaction Between Ethnic and Gender
	M	SD	M	SD	M	SD	M	SD	F(1,602)	p	ηp^2	F(1,602)	p	ηp^2	F(1,602)	p	ηp^2
Extent of Use	3.67	0.96	3.67	0.91	3.12	1.03	3.19	1.09	31.20	<0.001	0.05	0.13	0.718	0.00	0.17	0.682	0.00
Attitudes	3.96	0.64	3.84	0.67	3.45	0.61	3.54	0.61	45.06	<0.001	0.07	0.03	0.872	0.00	2.90	0.089	0.01
Digital Literacy	3.29	0.78	3.21	0.77	3.26	0.72	3.43	0.69	1.61	0.205	0.00	0.48	0.491	0.00	2.94	0.087	0.01

Note: Bold values denote statistical significance.

Abbreviations: M, Mean; SD, standard deviation; η_p², Partial effect size.

Table 3 Differences in the Extent of Use of DHS Between Ethnic Groups

		Not familiar/Never (0-1)	Seldom/Sometimes (2-3)	In Most Cases/Whenever Necessary (4-5)	Total	χ^2(df=2)
1. Scheduling appointments (to the doctor, for laboratory tests…) through the website or the application	Jews	6 (1.3%)	31 (7.0%)	408 (91.7%)	445 (100%)	69.08***
	Arabs	7 (4.3%)	51 (31.7%)	103 (64.0%)	161 (100%)
2. Viewing the results of tests on the website or in the application	Jews	6 (1.3%)	24 (5.4%)	415 (93.3%)	445 (100%)	74.20***
	Arabs	8 (5.0%)	47 (29.2%)	106 (65.8%)	161 (100%)
3. Ordering prescriptions for medicines through the website or the app	Jews	59 (13.3%)	91 (20.4%)	295 (66.3%)	445 (100%)	15.13**
	Arabs	35 (21.7%)	47 (29.2%)	79 (49.1%)	161 (100%)
4. Request for commitments through the website or the application (like form 17)	Jews	73 (16.4%)	82 (18.4%)	290 (65.2%)	445 (100%)	29.23***
	Arabs	40 (24.8%)	55 (34.2%)	66 (41.0%)	161 (100%)
5. Ascertaining medical rights on the website or in the application (such as supplementary insurance rights)	Jews	117 (26.3%)	120 (27.0%)	208 (46.7%)	445 (100%)	7.55*
	Arabs	37 (23.0%)	62 (38.5%)	62 (38.5%)	161 (100%)
6. Request for a referral for examination or treatment through the website or the application	Jews	48 (10.8%)	79 (17.8%)	318 (71.5%)	445 (100%)	27.67***
	Arabs	25 (15.5%)	57 (35.4%)	79 (49.1%)	161 (100%)
7. Search for medical information on the website or in the application (such as treatments, examinations, doctors, institutes, opening hours)	Jews	26 (5.8%)	80 (18.0%)	339 (76.2%)	445 (100%)	34.43***
	Arabs	16 (9.9%)	62 (38.5%)	83 (51.6%)	161 (100%)
8. Communication with a doctor through the website or application	Jews	48 (10.8%)	113 (25.4%)	284 (63.8%)	445 (100%)	30.30***
	Arabs	37 (23.0%)	60 (37.3%)	64 (39.8%)	161 (100%)
9. Having an online appointment (by phone or video) with a doctor	Jews	92 (20.7%)	157 (35.3%)	196 (44.0%)	445 (100%)	18.34***
	Arabs	58 (36.0%)	57 (35.4%)	46 (28.6%)	161 (100%)
10. Online pharmacy (order medication through the website or application)	Jews	220 (49.4%)	114 (25.6%)	111 (24.9%)	445 (100%)	1.36
	Arabs	71 (44.1%)	45 (28.0%)	45 (28.0%)	161 (100%)

Notes: *p<0.05,**p<0.01,***p<0.001.

Table 4 Pearson Correlations Between the Research Variables Among the Two Ethnic Groups

	Jews (N=445)		Arabs (N=161)
	Attitudes	Digital Literacy	Attitudes	Digital Literacy
Extent of Use	0.39*	0.41*	0.34*	0.28*
Attitudes		0.34*		0.53*

Note: *p<0.001.

Table 5 Hierarchical Linear Regression Analysis for Predicting the Extent of Use of DHS Among the Ethnic Groups

Predictor Variable	Jews (N=444)						Arabs (N=160)
	B	S.E	β	t	p	R^2	B	S.E	β	t	p	R^2
Step 1: (Constant)	3.35	0.17		20.24	<0.001	0.05	30.40	0.22		15.74	<0.001	0.03
Gender (1= Woman)	0.01	0.09	0.01	0.15	0.885		-0.02	0.19	-0.01	-0.13	0.898
Religiousness (1= Religious)	-0.10	0.12	-0.04	-0.85	0.399		0.05	0.18	0.02	0.28	0.782
Income (1= Average or above)	0.39	0.09	0.21	40.36	<0.001		0.29	0.23	0.10	10.23	0.221
Health Condition (1= Good)	0.12	0.15	0.04	00.79	0.433		-0.35	0.20	-0.14	-10.75	0.083
No. of Children	-0.00	0.03	-0.00	-0.07	0.943		-0.01	0.04	-0.02	-00.28	0.780
Step 2: (Constant)	0.85	0.28		3.04	0.003	0.25	0.85	0.53		1.60	0.112	0.17
Gender (1= Woman)	-0.06	0.08	-0.03	-00.81	0.417		01	0.18	0.00	0.06	0.956
Religiousness (1= Religious)	-0.07	0.11	-0.03	-00.64	0.524		0.13	0.17	0.06	0.74	0.458
Income (1= Average and above)	0.21	0.08	0.11	20.61	0.009		0.12	0.22	0.04	0.54	0.588
Health Condition (1= Good)	0.01	0.13	0.00	0.04	0.966		-0.46	0.19	-0.19	-20.43	0.016
No. of Children	0.02	0.02	0.03	0.75	0.451		0.01	0.04	0.01	0.14	0.889
Attitudes	0.40	0.06	0. 28	60.21	<0.001		0.51	0.16	0.29	30.23	002
Digital Health Literacy	0.35	0.05	0.29	60.55	<0.001		0.23	0.14	0.15	1.73	0.086

Note: Bold values denote statistical significance.

Abbreviations: B, Unstandard coefficient; S.E, Standard Error; β, Standard coefficient.

Figure 1 A Moderated Mediation Model for Predicting the Extent of Use of DHS. The model based on Hayes’ (2017) PROCESS model 7, unstandardized regression coefficients are provided along the paths. *p<0.05, **p<0.001.

Abbreviation: Int, Interaction.

Table 6 Results of the PROCESS Model 7 Analysis (N=606)

Mediation
Path			Effect	S.E	LLCI	ULCI
X	→	M	0.29	0.04	0.216	0.359
M	→	Y	0.49	0.06	0.381	0.608
X(M)	→	Y	0.30	0.05	0.203	0.403
Conditional Indirect Effect		W=0(Jews)	0.14	0.03	0.088	0.205
		W=1(Arabs)	0.23	0.04	0.153	0.317
Moderation
Path			B	S.E	LLCI	ULCI
W	→	M	−1.01	0.26	−1.522	−0.503
X*W	→	M	0.17	0.08	0.024	0.322
X	→	MW=0(Jews)	0.29	0.04	0.216	0.359
X	→	MW=1(Arabs)	0.46	0.07	0.329	0.591
IMM			0.09	0.04	0.013	0.165

Abbreviations: S.E, Standard Error; LLCI, lower limit confidence interval; ULCI, upper limit confidence interval; X–Digital Literacy; W–Religion; M–Attitudes; Y–Extent of Use; IMM–Index of Moderated Mediation.