Inequities still exist in the use of digital health technology across different sociodemographic subgroups

Karri, Kishore; Yarra, Pradeep

doi:10.1136/ebnurs-2020-103355

Cited by 4 publications

(10 citation statements)

References 3 publications

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“…A study pointed out that access to home-based telemedicine was inequitably distributed in the United States owing to the limited reach of fixed broadband in rural areas [ 57 ]. Of the 41 studies, 12 (29%) studies reported an unfair phenomenon of digital exclusion [ 19 , 23 , 24 , 34 , 35 , 41 , 44 , 46 , 49 , 50 , 61 , 64 ]. A study described how, without proper planning and safeguards, digital health technologies can contribute to expanding health inequity, widening the digital divide that separates those who can from those who cannot access such interventions [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most (37/41, 90%) papers reported the factors that influence health inequities brought about by digital health services. Of these 37 studies, 18 (49%) studies reported the important role of age in determining whether patients use or do not use digital health technologies, especially among the older adults [ 18 , 33 , 35 , 39 , 42 , 44 - 47 , 49 , 53 , 56 , 58 , 59 , 61 , 62 , 65 , 66 ]. Race and ethnicity have long been considered as one of the causes of the causes of health inequities [ 51 ]; the acknowledged health benefits of eHealth or mobile health initiatives have seen limited application among Black communities [ 1 , 24 , 42 , 45 , 51 , 55 , 61 , 65 , 66 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of these 37 studies, 18 (49%) studies reported the important role of age in determining whether patients use or do not use digital health technologies, especially among the older adults [ 18 , 33 , 35 , 39 , 42 , 44 - 47 , 49 , 53 , 56 , 58 , 59 , 61 , 62 , 65 , 66 ]. Race and ethnicity have long been considered as one of the causes of the causes of health inequities [ 51 ]; the acknowledged health benefits of eHealth or mobile health initiatives have seen limited application among Black communities [ 1 , 24 , 42 , 45 , 51 , 55 , 61 , 65 , 66 ]. In addition, some studies (8/41, 20%) reported that citizens living in rural areas were affected by poor access to and availability of digital health technologies resulting from limited internet broadband coverage [ 24 , 42 , 45 , 46 , 56 , 57 , 62 , 66 ].…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, SES (eg, education and income) [ 69 ] was also discussed. Some (18/41, 44%) studies have reported differences in the acquisition and adoption of digital health technologies by different groups of citizens based on a combination of income and education [ 18 , 24 , 33 , 34 , 36 , 37 , 42 , 44 , 46 , 47 , 49 , 50 , 53 , 56 , 59 - 61 , 64 ], whereas others (13/41, 32%) have independently explored the 2 dimensions of income [ 32 , 35 , 38 , 52 , 55 , 58 , 65 - 67 ] and educational attainment [ 19 , 44 , 54 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the above factors, poor health conditions have been observed to hinder access to digital health technologies at a physical level [ 38 , 40 , 45 , 49 , 55 , 61 ] or a lack of confidence in health advice and health decision-making at a psychological level [ 38 , 42 ]. A literature review found that some people may have difficulty learning to use the internet because of visual or hearing impairment, arthritis, or hand movement difficulties [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review

Yao¹,

Wen-li²,

Evans³

et al. 2022

J Med Internet Res

166

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Background Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics’ Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results A total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review

Yao¹,

Wen-li²,

Evans³

et al. 2022

J Med Internet Res

166

View full text Add to dashboard Cite

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Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study

O’Brien¹,

Li²,

Chaibva³

et al. 2023

J Med Internet Res

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Background Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers’ contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.

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Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review (Preprint)

Wen-li¹,

Cao²,

Shen³

2021

Preprint

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BACKGROUND Digital health technologies are rapidly adapting to healthcare contexts to provide improved medical services to citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities. OBJECTIVE The aim of this study is to systematically review the inequities of healthcare services brought about by the adoption of digital health technologies. The influencing factors of inequities, as well as corresponding countermeasures to ensure the health equity between different groups of citizens, is also studied. METHODS A systematic review of literature published from 1990 to 2020 was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review process, and the electronic databases of Web of Science Core Collection, PubMed, and Scopus. Search, sorting, and data extraction processes were completed by two authors of the paper using Thomson Endnote. RESULTS In total, 1,895 studies were collected during the search process, of which 40 were identified for analysis. The earliest literature identified was published in 1993, with the number remaining below 2 for a long period of time. The number started to increase until 2016, with a peak thereafter being reached in 2020. The United States, the United Kingdom, and Norway ranked as the top three in terms of publication output. Health inequities caused by digital health technologies were mainly reflected by access and availability of digital technologies and the differences in healthcare outcomes. The factors that influenced inequities included: demographic factors (i.e., gender, age, race, region, economy, and education level), health conditions, and eHealth literacy. Finally, government agencies and medical institutions, digital health technology providers, and healthcare service receivers can all take actions to alleviate inequities, in future. CONCLUSIONS Findings provide a comprehensive starting point for future research allowing for further investigation into how digital health technologies may influence the unequal distribution of healthcare services. The interaction between individual subjective factors, as well as social support, and influencing factors should be included in future studies. In particular, access and availability to digital health technologies by vulnerable groups should be of paramount importance.

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Inequities still exist in the use of digital health technology across different sociodemographic subgroups

Cited by 4 publications

References 3 publications

Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review

Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review

Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study

Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review (Preprint)

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