Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice

Abstract

Background South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review

“…Of the 17 US studies, 1 (6%) was conducted among Tongan American communities [61], and 2 (12%) were conducted among Korean immigrants or Korean American individuals [45,62]. Immigrants were also represented in 15% (5/34) of the studies from other countries, including Israel [20], Australia [42,54], Canada [43], and Hong Kong [41]. Refugees were represented in 6 studies: 2 (33%) from Sweden [48,49]; 1 (17%) each from Australia [33], Germany [58], and Canada [44]; and 1 (17%) conducted across Egypt, Germany, and Sweden [38].…”

“…In total, 38% (13/34) of the studies did not include an intervention (data not shown). Instead, participants were asked for their views on mobile technology and health apps [39,61]; their web-based health information-seeking behavior and needs [40,42,52,57,59]; their use and intentions regarding telehealth [32]; their attitudes toward the use of apps in health-related research [55]; their views on health technology more broadly [43]; and their perspectives on internet-based mental health [44], social media postings [53], and technology-based cancer support programs [45]. breastfeeding, information about infant immunizations, and reminders about infant and maternal follow-up and well-being NR b SbS a -an e-mental health intervention for depression with 3 tailored components: the content (educative narratives and exercises), the guidance model (contact with a trained nonspecialist), and the delivery system (web or app) Internet-based intervention; computer or smartphone Burchert et al [38], 2019 Once 3D animation to teach hypertension and diabetes prevention and management; culturally tailored animated videos, short pre-and posttests, and brief educational games that included voice-over and icons Android or iOS app; smartphone or tablet Garner et al [41], 2021 NR Interviews to explore attitudes about the internet as a tool for nutritional therapy interventions; all participants were members of a web-based nutrition forum receiving nutritional consultation and long-term treatment via the internet Web-based forum; computer Gesser-Edelsburg et al [20], 2017 NR Self-navigated web-only interface with information about breast cancer grouped into an 8-section workbook presented on the site and downloadable in full or by section Self-navigated website; computer Johnson-Turbes et al [46], 2015 NR Weekly SMS text messages "checking-in" for young Indigenous people who have used drugs, with follow-up support from a case manager for participants reporting a problem SMS text messaging service; mobile phone Jongbloed et al [47], 2020 45-60 minutes A computer-based counseling tool that includes audio narrated risk assessment, tailored feedback through skill-building videos, and a risk-reduction plan; on Internet-based intervention; computer Kurth et al [30], 2016 completion, participants received a printout of their tailored feedback and healthpromotion plan to share with their health care provider 8 weeks Individually tailored, guided ICBT c treatment that was culturally adapted for the target audience: a total of 9 treatment modules and weekly feedback on Internet-based intervention; computer or smartphone Lindegaard et al …”

“…Digital literacy is defined as the skills necessary for technology use and problem-solving [63]. Core digital skills such as the ability to open an app, use SMS text messaging, or manually enter data proved challenging for many participants and, in some cases, created a reliance on others for help [39,43]. This finding was observed across all cultural groups and ages and in 38% (13/34) of the studies [30,31,34,35,38,39,42,43,50,[55][56][57]59,61,62,64].…”

“…Core digital skills such as the ability to open an app, use SMS text messaging, or manually enter data proved challenging for many participants and, in some cases, created a reliance on others for help [39,43]. This finding was observed across all cultural groups and ages and in 38% (13/34) of the studies [30,31,34,35,38,39,42,43,50,[55][56][57]59,61,62,64]. Other digital literacy barriers included a fear that technology is dangerous or intimidating reported by older Greek and Italian immigrants [42], Indigenous people [47], and Asian Indian immigrants [43].…”

Virtual care use among older immigrant adults in Ontario, Canada during the COVID-19 pandemic: a repeated cross-sectional analysis

“…Older immigrants in Canada are even more vulnerable to breakdowns in the system, and may face additional challenges when accessing healthcare, including cultural differences, discrimination, language barriers, literacy, health beliefs, and spatial isolation[8-11]. In addition, some barriers to access for older adult populations, such as physical or mental disabilities, inexperience or discomfort with technology, or lack of digital equipment[12-14] may be even more pronounced among immigrants who migrated at an older age and have poor social determinants of health upon arriving in Canada. Furthermore, some recent immigrants may face further health decline with increasing years of residency in Canada and poor access to health care[15].…”