Adding to the list of rural inequalities—Digital technology exclusion

Walker, Joanne

doi:10.1111/ajr.12585

Cited by 2 publications

(2 citation statements)

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“…Older people may be reluctant or unable to embrace new technologies or new ways of working [ 12 ] and are concerned about the confidentiality of remote consultations as are those who live in shared accommodation and have difficulty in finding a private space to have a remote consultation [ 65 ]. Patients on low annual household incomes or from disadvantaged groups tend to be digitally excluded compared to those with a higher annual household income and white, and those living in rural areas can have poor digital infrastructure [ 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Jones

Damery²,

Phillips³

et al. 2022

PLoS ONE

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Background Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. Aim To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. Methods Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. Results Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). Conclusions Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities. Trial registration PROSPERO registration no: CRD42021241791.

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Section: Discussionmentioning

confidence: 99%

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Jones

Damery²,

Phillips³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Together, these results demonstrate room for broader implementation in rural or remote regions and community settings around the world. Nevertheless, an important issue to recognize is that rural and vulnerable populations are currently experiencing the largest digital divide [68][69][70]. Inequalities in access exist because of variations in location, age, education, and income level.…”

Section: Principal Findingsmentioning

confidence: 99%

eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review

Stewart¹,

Milton²,

Yee³

et al. 2022

J Med Internet Res

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Background eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. Objective The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. Methods A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. Results A total of 39 papers were included in this review. The sample sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46%) regions than in rural (3/39, 8%) regions or a combination of urban and rural areas (8/39, 21%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31%), hospitals (14/39, 36%), community outreach (10/39, 26%), or a combination of these settings (3/39, 8%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children’s health over time (16/39, 41%), and two-thirds (25/39, 64%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36% (14/39) of studies; however, only 3% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns; ways to address these barriers were not thoroughly explored. Conclusions eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery; however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world.

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Adding to the list of rural inequalities—Digital technology exclusion

Cited by 2 publications

References 1 publication

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review

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