Clinical Resources

The iGeneration: New consumers of healthcare

The iGeneration (iGen) comprises individuals who are adolescents and young adults right now. This generation is the first to have been familiar with the Internet since childhood and to use technology readily, even automatically. How the use of technology, including social media, is affecting their formative years and beyond is uncharted territory. The author reviews characteristics of iGens, reports what is known about their attitudes regarding healthcare, discusses the increased rate of certain mental illnesses among iGen members, and provides suggestions for healthcare providers in terms of how to better care for this population.

The iGeneration (iGen), also called Generation Z, is the group after the Millennials that includes individuals born between 1995 and 2012.1 By 2020, iGen will comprise nearly one-third of the United States population and be the most diverse in the nation’s history.1 Members of this generation—iGens—are the first to have always known the Internet and smartphones. In fact, they are accustomed to being a click away from a plethora of information—factual or not. Healthcare providers (HCPs) need to be aware of the qualities that set iGens apart from members of other generations in order to provide more appropriate care for them.

Characteristics

Unlike their parents, iGens do not have first-hand memory of the 9/11 attacks. They grew up during the Great Recession of 2008, which may have helped form their ideas and values about finances and which may also affect, at least in part, their political views.2 Compared with 64% of adults overall, 81% of iGens identify money as a common stressor.3 They report experiencing stress/anxiety about national news events such as mass shootings (75% identify these shootings as a significant source of stress), increasing suicide rates, climate change, immigration separation and deportation, and sexual harassment.3 In a Pew survey, iGens, as compared with members of previous generations, were more open-minded and liberal with their views.4 They were accepting of gender-neutral pronouns and felt that racial/ethnic diversity was good for society. In this survey, only 4% of polled iGen members reported thinking that racial intermarriage was bad for society and 15% reported believing that same-sex marriage was bad for society. When asked if cohabitation out of wedlock was bad for society, 12% of iGens, versus 23% of Baby Boomers, agreed. Along the same lines, 35% of iGens, versus 42% of Baby Boomers, reported feeling that single women raising children on their own was bad for society.

Overall, compared with previous generations, more iGen teens are graduating high school without ever having held a job, dated, had sex, or tried alcohol.5 In addition, compared with previous generations, they are older when learning to drive. Compared with Millennials, iGens are more pessimistic, less confident, and less independent.5 They fear that they will make mistakes but have a strong work ethic.

Because of their deep tie to technology and social media, iGens have underdeveloped social skills, a shorter attention span, and a greater expectation of quickness and convenience.6 Furthermore, they have higher rates of anxiety, depression, loneliness, and suicide. In Twenge’s view, smartphones and social media are partly to blame for these increased rates because of iGens’ decreased in-person interactions and their observations of their peers’ enviable lives on social media.5 For example, an iGen might post a picture that she deems Instagram-worthy, with the aim of garnering enough likes. If the post garners too few likes, the girl feels that she is not good enough in the midst of watching her contemporaries’ posts of smiling faces and exciting exploits. Seldom do her friends on social media post stories/pictures of failures or disappointments. If they do happen to post about adversities, they may be accused of being attention-seekers. Many high schoolers report feeling lonely, particularly if they have been excluded from group photos posted by their friends.5

iGens’ attitudes about healthcare

The Center for Generational Kinetics has reported that 44% of iGens believe they have access to affordable, high-quality healthcare.7 This rate is lower than that of Baby Boomers (55%) and Millennials (51%). To put this statistic in perspective, fewer than half of iGens believe that they have access to affordable and high-quality healthcare. iGens are split regarding their feelings about the Affordable Care Act, with 30% feeling they have less access to high-quality healthcare since its passage, 33% reporting they have more access to high-quality healthcare after its passage, and the remainder landing somewhere in the middle.7

Little is known about this generation’s take on healthcare delivery itself. One can hypothesize that changes such as making same-day appointments, scheduling appointments online, and messaging with HCPs via healthcare apps will continue. Some organizations have begun providing healthcare through e-visits that can be completed anywhere with Internet access. To pare costs associated with emergency department visits, other organizations have started initiating home visits booked through apps.8,9 Five ways that Millennials are altering healthcare include a preference for fast delivery, receptivity to word-of-mouth marketing, checking online for information about insurance, requesting upfront cost estimates prior to treatment, and a tendency to delay care because of costs.8 Millennials prefer healthcare that is quick and easy, but not too expensive; one can assume iGens will expect the same.8

Mental illness among iGens

One cannot discuss caring for iGens without noting the sharp increase in reported depression, anxiety, and loneliness among teens and young adults. Among U.S. adolescents aged 12-17 years, 18.1% reported having depression at some point in their lives.10 In 2016, suicide was the second leading cause of death (17.3% of deaths) for individuals aged 10-24 years.11 Among students entering college, most rated their mental health as below average, 31% reported feeling useless, and 36% felt that they could not do anything right.5 According to Twenge, “Teens who spend more time with their friends in person are happier, less lonely, and less depressed, while those who spend more time on social media are less happy, lonelier, and more depressed.”5

The U.S. Preventive Services Task Force has recommended screening adolescents and adults for depression.12,13 The task force has not specified the frequency of such screening but has suggested that repeated opportunistic screening at healthcare visits may be the best approach. The Patient Health Questionnaire (PHQ) is commonly used in the adult setting, and the PHQ for adolescents or the primary care version of the Beck Depression Inventory is used in the adolescent setting. If depression is identified, individuals should undergo treatment and appropriate follow-up. Treatment can include medication, counseling of various types, or a combination of both.12,13

Suggestions for caring for iGens

Not much is known about how to market healthcare toward iGens or best practices for using technology to provide health information. Some ideas to consider include using QR codes that iGens can scan for health information that they can review on their smartphone (as opposed to giving them paper handouts). Another consideration is the wealth of facts and fiction at their fingertips on the Internet. HCPs should offer patients a list of reputable websites, YouTube channels, and apps to ensure that they find accurate information. If HCPs prefer to post fliers or provide patient handouts, they should consider the usefulness of attention-grabbing infographics. When doing any type of testing in the office or clinic, HCPs should advise iGen patients that their test results will not likely be immediately available. HCPs should also ask patients by what means they would like the results conveyed (e.g., telephone call, office visit, online healthcare portal, letter, email).

Healthcare providers need to routinely screen iGen patients for depression and anxiety. Just as HCPs tell patients to use condoms to protect themselves against sexually transmitted infections, they should counsel iGens about the potential dangers of spending too much time using electronic devices, particularly social media sites, and the benefits of spending more face-to-face time with friends, family members, and new acquaintances. In addition, HCPs can talk to patients about ways to better manage stress, including the use of coping mechanisms; the benefits of exercise; and the importance of sleep hygiene and getting enough sleep.

Conclusion

Although iGens are accustomed to using technology, they need to learn how to use it most efficiently, while being mindful of the necessity of privacy. The oldest iGens are in their early 20s, making them newly independent consumers of healthcare. HCPs need to be mindful of generational changes and expectations in order to provide the best healthcare possible to this group of young people.

 

Corinne A. Coppinger is a nurse practitioner at the Mercy McAuley Clinic at Mercy Hospital in Washington, Missouri. The author states that she does not have a financial interest in or other relationship with any commercial product named in this article.

 

References

  1. Time Video. How Generation Z Will Change the World. April 23, 2018. com/5250542/generation-z/
  2. Dimock M. Defining Generations: Where Millennials End and Generation Z Begins. January 17, 2019. org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/
  3. American Psychological Association. Stress in America: Generation Z. October 2018. org/news/press/releases/stress/2018/stress-gen-z.pdf
  4. Parker K, Graf N, Igielnik R. Generation Z Looks a Lot Like Millennials on Key Social and Political Issues. January 17, 2019. org/2019/01/17/generation-z-looks-a-lot-like-millennials-on-key-social-and-political-issues/
  5. Twenge J. iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthood—and What That Means for the Rest of Us. New York, NY: Atria; 2017.
  6. Chicca J, Shellenbarger T. A new generation of nurses is here: strategies for working with Generation Z. Am Nurse Today. 2019;14(2):48-50.
  7. Center for Generational Kinetics, Dorsey J. iGen’s Political and Civic Outlook: 2016 National Study on the Unexpected Viewpoints of the Generation After Millennials. com/wp-content/uploads/2016/02/iGen-Gen-Z-Political-Civic-Outlook-Research-White-Paper-c-2016-The-Center-for-Generational-Kinetics.pdf
  8. Schwan J. Millennials shifting health care delivery. Argus Leader. November 3, 2015. com/story/news/business-journal/2015/11/03/millennials-shifting-health-care-delivery/75120050/
  9. Zimmerman K. This company will bring health care to your door, on demand. December 3, 2017. forbes.com/sites/kaytiezimmerman/2017/12/03/this-company-will-bring-health-care-to-your-door-on-demand/#7827f068e1c5
  10. Lu W. Adolescent depression: national trends, risk factors, and healthcare disparities. Am J Health Behav. 2019;43(1):181-194.
  11. Heron M. Deaths: leading causes for 2016. National Vital Statistics Reports. 2018;67(6):1-77. gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf
  12. S. Preventive Services Task Force. Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. jamanetwork.com/journals/jama/fullarticle/2484345
  13. S. Preventive Services Task Force. Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(5):360-367.
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