The Digital Divide at an Urban Community Health Center: Implications for Quality Improvement and Health Care Access

Abstract

Health care policy encourages better electronic connectivity between patient and the office practice. However, whether patients are able to partner with the practice in using communication technologies is not known. We sought to determine (1) the proportion of clinic patients who use internet and cell phone text messaging technologies, (2) the level of patient interest in using these technologies for the purpose of managing clinical appointments and patient education. Consecutive adult patients, clinicians and staff at an urban community health center were surveyed during a one-week period in order to estimate the frequency of technology use by patients. A total of 308 survey cards were collected during the designated week (response rate of 85% (308/362). One-third (34.0%, 105) of surveyed patients used the internet and text messaging daily or weekly, while nearly two-thirds (59.7%, 182) never used these technologies. There were no racial or gender differences in the proportion of patients who used the internet daily or weekly. In contrast, African-Americans used text messaging more often than whites (28.2 vs. 21.4%, P < .05), and females more than males (30.8 vs. 18.5%, P < .05). Younger patients (>50) used the internet and text messaging more often than older patients (50.6 vs. 16.6%, 44.3 vs. 7.3%, respectively). Despite the low use of both technologies, patient's interest in managing clinic appointments was high (40.3% for the Internet and 56.8% for text messaging). Clinicians and staff estimated patient's daily/weekly use of internet and cellphone messaging at 40.3% (± 22.0), and 56.8% (± 25.7), respectively. Most patients at this urban community health center reported never using the internet or cell phone text messaging. Clinicians overestimated technology use by patients. Planning for clinic infrastructure, quality improvement, and patient education should include assessment of technology use patterns by patients.

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“…Clearly, wireless mobile technology holds significant potential to improve communication regarding appointments and reminders and increase utilisation in certain underserved populations provided that patients have a mobile phone, can afford a mobile tariff and are able to utilise the full range of features available on their mobile phone. However, caution should be exhibited in recognition that Denizard-Thompson et al 187 observe that clinicians typically overestimated the usage of mobile phone technologies by their population.…”

“…African Americans and English-speaking Latinos were identified among the most active users of cell phones. 186,187 According to the Pew Report, 186 more African Americans and Latinos than Caucasians own a cell phone (87% vs. 80%) and minority cell phone owners use a greater range of the features on their phones. Denizard-Thompson et al 187 found, in their study of low-income patients in an adult medicine clinic, that SMS messaging was more common among African Americans than Caucasians, and was more common among females and patients aged < 50 years.…”

“…186,187 According to the Pew Report, 186 more African Americans and Latinos than Caucasians own a cell phone (87% vs. 80%) and minority cell phone owners use a greater range of the features on their phones. Denizard-Thompson et al 187 found, in their study of low-income patients in an adult medicine clinic, that SMS messaging was more common among African Americans than Caucasians, and was more common among females and patients aged < 50 years. Although we must be cautious in translating such trends to a UK population, it is important to consider that the overall effect of mobile phone access may be to 'leapfrog' other technologies such as landlines, thereby widening access to services.…”