Telehealth and the digital divide as a social determinant of health during the COVID-19 pandemic

Abstract

Telehealth has been shown to have comparable health outcomes in terms of patient-physician communication, and patient satisfaction and engagement. Nevertheless, the digital divide has exacerbated the social and economic factors that create barriers to health and well-being. It, therefore, maybe a social determinant of health (SDOH). Such issues as decreased internet connectivity and a lack of Wi-Fi and video chat/webcam in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of color, the poor, and medically underserved. The social aspects of the provision of health care by physicians and health care workers are utilized to combat mistrust and strengthen the physician–patient therapeutic relationship. Addressing policy changes to address the digital divide as a SDOH may strengthen existing health care and public health systems to allow for patient and community-centered approaches to expressing lived narratives, including in a digital format.

Telehealth in cancer care during COVID-19: disparities by age, race/ethnicity, and residential status

“…In addition to attitudes towards telehealth, social determinants may play a role in the general uptake of telehealth, and in the use of different telehealth modalities (video versus phone). Recent studies on general medical encounters during the SARS-CoV-2 pandemic have suggested differences in use of telehealth by sex, age, income, type of insurance, and race/ethnicity [11][12][13][14][15][16][17]. These studies underscore the possibility that telehealth may increase health care disparities among historically marginalized population groups.…”

Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally

“…These levels are similar to other national data which show that approximately one-fifth of all Americans may not have proper digital literacy skills [ 12 ]. We note that digital health skills may be low due to the sociodemographics associated with the veterans cared for by the VA, as it selectively cares for individuals who are older, less educated, more rural, and with lower socioeconomic status [ 13 ]—all factors known to be associated with lower digital health literacy [ 4 , 14 , 15 ]. Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA appear to have more digital health skills and be more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on these individuals.…”

Door-to-door recruitment during the COVID-19 pandemic: Lessons learned from a population-based, longitudinal cohort study in North Carolina, USA

“…Employing diverse recruitment methods meant that we reached out to people through email, postal mail, phone calls, and door-to-door visits to homes. This was especially important during the COVID-19 pandemic when the digital divide caused additional barriers to resources for many (11). We also offered diverse ways to participate in the study to maximize inclusivity and offset concerns about transmission risk in public spaces.…”