Exploring temporal trends and social disparities in the use of digital health applications examined through two cross-sectional studies in Germany

Digital innovations in healthcare can improve its quality and access, but evidence also reveals threats to health equity, conceptualized as a digital divide. This divide results from existing inequities in both access to and the ability to use digital technologies. Therefore, the purpose of this study is twofold: (1) to investigate temporal trends in the use of specific digital health applications (DHAs) and (2) to examine their use among different population groups. The analysis is based on two cross-sectional, online surveys conducted in Germany in 2020 (N = 1,570) and 2022 (N = 1,200). Participants were recruited by an external survey company. Commonly provided DHAs in Germany, like online services (online appointment booking or online request for medication), online video consultations, and insurer applications for personal data exchange, were included. Socioeconomic, sociodemographic, and health-related indicators were assessed. For data analysis, chi-squared tests, U-tests, and logistic regression analyses were used. DHA use increased from 2020 to 2022, with the use of online services growing the most. A digital divide was observed. Lower use was identified among older generations and those with low educational attainment and low subjective social status. Additionally, digital (health) literacy, and positive attitudes toward DHAs were associated with increased DHA use. The findings indicate the existence of a digital divide that persists over time. The analysis underscores the need for interventions to mitigate related inequities. Beyond improving access to DHAs, interventions to promote digital (health) literacy are of paramount importance.