Do Language Fluency and Other Socioeconomic Factors Influence the Use of PubMed and MedlinePlus?

BACKGROUND Increased usage of MedlinePlus by Spanish-speakers was observed after introduction of MedlinePlus in Spanish. This probably reflects increased usage of MEDLINE and PubMed by those with greater fluency in the language in which it is presented; but this has never been demonstrated in English speakers. Evidence that lack of English fluency deters international healthcare personnel from using PubMed could support the use of multi-language search tools like Babel-MeSH. OBJECTIVES This study aims to measure the effects of language fluency and other socioeconomic factors on PubMed MEDLINE and MedlinePlus access by international users. METHODS We retrospectively reviewed server pageviews of PubMed and MedlinePlus from various periods of time, and analyzed them against country statistics on language fluency, GDP, literacy rate, Internet usage, medical schools, and physicians per capita, to determine whether they were associated. RESULTS We found fluency in English to be positively associated with pageviews of PubMed and MedlinePlus in countries with high literacy rates. Spanish was generally found to be positively associated with pageviews of MedlinePlus en Español. The other parameters also showed varying degrees of association with pageviews. CONCLUSIONS After adjusting for the other factors investigated in this study, language fluency was a consistently significant predictor of the use of PubMed, MedlinePlus English and MedlinePlus en Español. This study may support the need for multi-language search tools and may increase access of health information resources from non-English speaking countries.

[1]  A. Klassen,et al.  Communication and language challenges experienced by Chinese and South Asian immigrant parents of children with cancer in Canada: Implications for health services delivery , 2012, Pediatric blood & cancer.

[2]  Luke W Johnston,et al.  Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities , 2010, Clinical orthopaedics and related research.

[3]  Hui-Wen Vivian Tang,et al.  The Relationship Between English Language Adoption and Global Digital Inequality: A Cross-Country Analysis of ICT Readiness and Use , 2011, Int. J. Distance Educ. Technol..

[4]  Robert M. Wolk.  The effects of English language dominance of the Internet and the digital divide , 2004, 2004 International Symposium on Technology and Society (IEEE Cat. No.04CH37548).

[5]  R. Zuwallack,et al.  Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences. , 1998, American journal of respiratory and critical care medicine.

[6]  Kevin Fiscella,et al.  Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Findings From a National Sample , 2002, Medical care.

[7]  M. Rhee,et al.  The impact of language as a barrier to effective health care in an underserved urban Hispanic community. , 1998, The Mount Sinai journal of medicine, New York.

[8]  L. Loutan,et al.  Language difficulties in an Outpatient Clinic in Switzerland , 2005, Sozial- und Präventivmedizin.

[9]  L. Binder,et al.  Development, implementation, and evaluation of a medical Spanish curriculum for an emergency medicine residency program. , 1988, The Journal of emergency medicine.

[10]  P. Garner,et al.  Access to electronic health knowledge in five countries in Africa: a descriptive study , 2007, BMC Health Services Research.

[11]  Paul Fontelo,et al.  MedlinePlus en Español and Spanish-speakers. , 2007, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[12]  Homero Gil de Zúñiga,et al.  Reshaping Digital Inequality in the European Union: How Psychological Barriers Affect Internet Adoption Rates , 2006, Webology.

[13]  Heeyoung Park,et al.  Web-based consumer health information: public access, digital division, and remainders. , 2006, MedGenMed : Medscape general medicine.

[14]  T. Brennan,et al.  Impact of language barriers on patient satisfaction in an emergency department , 1999, Journal of General Internal Medicine.

[15]  P. Lewis.  Ethnologue : languages of the world , 2009 .

[16]  T. Edejer.  Disseminating health information in developing countries: the role of the internet , 2000, BMJ : British Medical Journal.

[17]  Madeline Zavodny,et al.  Immigrants, English Ability and the Digital Divide , 2007, SSRN Electronic Journal.

[18]  D W Baker,et al.  Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. , 1998, Medical care.

[19]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .