Down the Digital Delta: Health Information Inequities Among Rural Mississippi Caregivers

Background/Objectives: As healthcare increasingly utilizes digital delivery systems, equitable access and engagement are critical, particularly for caregivers of older adults in rural regions. This study examines how education levels and geographic rurality influence health information-seeking in Mississippi, a state with persistent structural inequities, through the theoretical lenses of Digital Divide Theory and Theory of Planned Behavior. Methods: A statewide survey was conducted among caregivers in Mississippi (N = 452) who support adults aged 50+. The survey assessed rurality level, educational attainment, attitudes toward various health information sources, perceived digital accessibility, and reported challenges in obtaining necessary health guidance. Results: Findings challenged conventional assumptions regarding rural digital engagement. Rural caregivers reported higher trust in both internet and interpersonal health information sources. Rurality did not significantly predict internet use or reported difficulty finding information. However, a significant interaction between education and rurality revealed an "Outcome Divide": while higher education correlated with more positive attitudes toward online health information in urban areas, this association weakened and reversed in highly rural contexts. Conclusions: These results underscore the need for strategies beyond merely improving access to bridge digital health equity gaps. Policy and interventions must address contextual barriers, such as digital health literacy and relevance, limiting the effectiveness of digital tools, even when internet access is available. Promoting digital health literacy, integrating trusted local interpersonal networks, and adapting educational initiatives to rural realities are essential for advancing equitable and effective digital health engagement.