Online health activities remain socially and economically stratified: Evidence from the German Microcensus

ECC2026, ECREA Health Communication Section

Marko Bachl & Elena Link

FU Berlin & JGU Mainz

2026-09-10

Introduction and research questions

Introduction

  • We all agree that health information seeking and using online tools for health-related activities is important.

  • We used to worry about digital divides even in WEIRD1 populations (e.g., Bachl, 2016).

  • We don’t worry so much anymore: e.g., “relatively minor differences in information-seeking behaviors between socio-demographic groups” (Bachl et al., 2024; also Link et al., 2021).

  • However, such findings often rely on (commercial) online access panels, which include professional online survey takers with specific online activity profiles (Hohenberg et al., 2026).

  • Homogeneity of online activities unsurprising, and probably not generalizable even to populations of “regular” online users?

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Research questions

Evidence on the prevalence and stratification of health-related online activities in the general population of Internet users from high-quality samples remains sparse.

  • RQ1: How prevalent is online HISB and online booking of medical appointments among Internet users in Germany?

  • RQ2: How do the prevalences differ by demographic and socioeconomic factors?

Data and methods

Data and methods

  • German Microcensus 2022, mandatory participation!
    • Population: All persons in Germany who have the right of residence
    • 1% sample randomly selected from official registries
  • Survey on Information and Communication Technologies (ICT) Usage in Households and by Individuals
    • Random 4% subsample of participants aged 16-75 years who have used the Internet in the last three months
    • Binary outcomes: Used the Internet for 1) online HISB and 2) making appointments with a doctor
    • Socioeconomic predictors: Gender, age, migration background, education, occupation, health problems, martial status, household size, children in household, household income, residence size, state
  • Analysis of the scientific use file: 70% sample of the complete data, released in 2025, n = 10,095 valid cases
    • Bivariate and multiple logistic regression, standardized effect sizes (McFadden’s R2)

Results

Result overview

  • 41.3% (95% CI [40.3, 42.3) of the population engaged in online HISB.

  • 21.1% (95% CI [20.3, 21.9]) booked a medical appointment online.

  • Small but meaningful associations between socioeconomic characteristics and outcomes
    • Bivariate McFadden’s R2 up to ~3% (Education)
    • Multiple McFadden’s R2 6% and 7%, respectively

Results: Education

Results: Age

Results: Gender and migration background

Results: Household income

Results: Health problems

Discussion

Discussion

  • Obvious limitations: Data from 2022 (2023 online HISB now available), coarse outcomes, almost no health-related predictors.
  • Online health activities remained socially and economically stratified in Germany, more than we would have assumed based on our recent data from online access panels.

  • We should not forget about digital divides, even in WEIRD general population studies.

  • We should worry more about data quality and generalizability.

Photo by Jeff Stapleton from Pexels

Questions & Comments?

References

Bachl, M. (2016). Online health information seeking in Europe: Do digital divides persist? Studies in Communication and Media, 5(4), 427–453. https://doi.org/10.5771/2192-4007-2016-4-427
Bachl, M., Link, E., Mangold, F., & Stier, S. (2024). Search engine use for health-related purposes: Behavioral data on online health information-seeking in Germany. Health Communication, 39(8), 1651–1664. https://doi.org/10.1080/10410236.2024.2309810
Hohenberg, B. C. von, Ventura, T., Nagler, J., Menchen-Trevino, E., & Wojcieszak, M. (2026). Survey professionalism: New evidence from web browsing data. Political Analysis, 34(3), 432–450. https://doi.org/10/hch35m
Link, E., Baumann, E., Linn, A., Fahr, A., Schulz, P. J., & Abuzahra, M. E. (2021). Influencing factors of online health information seeking in selected European countries: Analysis of country specifics. European Journal of Health Communication, 2(1), 29–55. https://doi.org/10.47368/ejhc.2021.002