Abstract

Digital technologies are central sources of health information, yet meaningful engagement with online resources varies widely, even among individuals with regular Internet access. This study examined whether digital self-efficacy and stage of change for using the Internet to obtain health information predicted evaluation of a culturally tailored online health portal. A cross-sectional survey was completed by 206 adult African American women following structured exposure to a nutrition and physical activity website designed using both surface- and deep-structure cultural tailoring strategies. Measures assessed digital self-efficacy, stage of change for Internet-based health information use, attitudes toward website features, and overall portal evaluation. Bivariate analyses indicated that higher digital self-efficacy and more advanced stage of change were associated with more favorable portal evaluation. In multivariable regression models, stage of change and endorsement of valued website features emerged as significant independent predictors, whereas structural access indicators did not. Digital self-efficacy was associated with evaluation but did not retain independent significance after accounting for readiness. Regression diagnostics supported the stability of model estimates. Qualitative findings reinforced these results, with participants emphasizing clarity, usability, and culturally relevant representation as central to engagement. Integration of qualitative and quantitative findings demonstrated methodological triangulation, supporting the interpretation that engagement reflects both cognitive appraisal of design features and developmental readiness. These findings suggest that digital health engagement is a staged, psychologically mediated process rather than a direct consequence of access. Interventions that align with motivational readiness and incorporate culturally responsive design may enhance sustained engagement and advance digital health equity.

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