Digital divide in social media use among cancer survivors and the moderation role of offline social support.

Abstract

Social media has transformed cancer care by expanding access to information and support, yet disparities in its use persist. This study examined 1) social media use behavior prevalence and social media engagement levels among different age and race/ethnicity cancer survivor subgroups and 2) how age and race/ ethnicity interact with offline social support and influence cancer survivors' social media engagement. We conducted a secondary cross-sectional analysis of cancer survivors using nationally representative data from the Health Information National Trends Survey 5 (Cycles 1-4; 2017-2020; n = 2579). We used weighted chi-square tests and multinomial logistic regression models to analyze the associations between age, race/ethnicity, and offline social support with social media engagement levels (none, passive, or active). Patterns of social media use varied significantly across age and race/ethnicity. Young adult cancer survivors had significantly higher level of active social media engagement (F=18.67, p < .001) compared to other age groups. Offline social support moderated these patterns: as age increased, survivors with offline support were less likely to engage actively (RRR=.9, p < .001). Hispanic survivors with offline support demonstrated significantly higher active engagement compared to White survivors (RRR=65, p < .001). Social media engagement among cancer survivors is shaped by the intersection of age, race/ethnicity, and the availability of offline social support. Offline and online support may act as complementary resources, particularly for young adults and Hispanic groups. Healthcare providers should assess offline social support when developing digital health interventions. Tailored strategies are needed to enhance equitable access to online health information and peer support, particularly among young adults and ethnic minority cancer survivors.