Bridging the digital divide: How can we keep healthcare accessible in the digital age?
When I needed to retrieve some medical records from my old small-town pediatrician, I had expected to make a simple request over the phone and receive an email copy right away. I quickly learned that this was not going to happen. “Can’t your parents come get them for you?... It’ll have to be a fax then, honey. We don’t have email.”
In our post-pandemic age of telehealth and online patient portals, I was surprised – and a little annoyed. When was the last time I even saw a fax machine? It didn’t occur to me then that this pediatrician’s traditional communication methods could be one of the last strongholds to accessible healthcare for many in my hometown community.
Evolutions in healthcare
Healthcare took a giant leap into the digital world over the last few years, and the rapid generation of new online tools has continued since.12 As the technology advances, so must the skills people need to engage effectively with these systems.1
Without a threshold level of digital literacy, it’s impossible to fully benefit from most medical services, let alone other services outside of healthcare. To put it simply, meaningful participation in society at large now requires a basic degree of digital literacy.1 The UN has even started considering meaningful access to digital spaces as a basic human right.11
What is digital health literacy?
Digital health literacy is the ability to locate, access, and understand information from digital sources to make health-related decisions.1 More than just a helpful skill, digital literacy has become a super determinant of health. 1,8
Social determinants of health are non-medical factors that influence health outcomes, such as educational attainment.6 Digital literacy is set apart as “super” thanks to its profound connection to and influence over other social determinants of health.1 Its ubiquitous nature cuts across many other factors, giving it the ability to fundamentally impact socioeconomic status, employment, education, and of course, healthcare access.
And why is it important?
Numerous studies have established correlations between digital health literacy and health-related quality of life, disease prevalence, and disease control.7,8 Social determinants of health can have astounding effects, accounting for between 30 and 55% of individual health outcomes. In fact, these determinants sometimes exert even more influence than lifestyle choices or health care itself.6
Digital literacy isn’t only a gateway into the modern healthcare system. It is an absolute prerequisite to participation in higher education, and increasingly K-12 education, thanks to the sudden adoption of online learning tools. More broadly, it also provides opportunities for social connection and self-actualization through its vast social media networks, online communities, and free educational content. Without digital literacy, our ability to participate in society at large is compromised.11
Behavioral Science, Democratized
We make 35,000 decisions each day, often in environments that aren’t conducive to making sound choices.
At TDL, we work with organizations in the public and private sectors—from new startups, to governments, to established players like the Gates Foundation—to debias decision-making and create better outcomes for everyone.
Navigating barriers to equitable access
Who’s at risk?
In the case of digital literacy, as with other social determinants of health, there’s a socioeconomic gradient to access. People of low socioeconomic status, low educational attainment, or in geographic isolation are more likely to lack the infrastructure and knowledge required to use information technology effectively1,8 – and the risks grow for elderly and disabled populations.10
What does this look like?
These factors, especially when combined, may prevent access to everything required for internet use, such as a reliable wifi router, a device that connects to the internet, or a subscription to a data provider. The amalgamation of these factors has been coined as the “digital divide” the gap between those who can use and understand digital health technology and those who can’t.9
As digital technology in healthcare becomes more ubiquitous, the digital divide grows wider. At-risk populations may increasingly face challenges in every aspect of accessing healthcare, from the seemingly mundane task of scheduling appointments to the critical need to communicate with their clinicians and access digitally stored health information.8 In urgent cases where a patient’s need could be quickly addressed by an online consultation through an app, or a digitally-filled prescription, vulnerable populations will be at a disadvantage.
Strategies to bridge the digital divide
As healthcare becomes more digital, we need to ensure it remains accessible. Here are a few approaches that have been proposed to level the playing field.
Innovate equitably
Combating the digital divide can start at the root of the problem. When researchers are generating ideas and designing experiments for new technologies, they should make considerations for low digital literacy populations.1 Advancements in telemedicine platforms, patient information portals, and the like should address the needs of disadvantaged groups, and be made with accessibility in mind.3 Low digital literacy populations should ideally be involved in the development and testing as well, to measure accessibility and ensure that the patient interface is as simple as possible.8
Improve physical infrastructure
It’s hard to build digital literacy without a computer or a phone. Building and supplying physical infrastructure that supports access to technology can make a huge difference in disadvantaged communities.
For example, creating public access points in places like libraries supports populations without access to computers, cell phones, or the internet. Government investment in public libraries to facilitate internet access, as well as workshops on technology and internet use, has been demonstrated to lead to positive outcomes in their communities.15
More directly, subsidizing the cost of bandwidth and donating computers can single-handedly remove barriers to access for individuals and communities.2 Charities such as Kiwanis Club have raised money to donate laptops to families who can’t afford their own,16 and some federal and state policies in the US have subsidized broadband access to consumers or provided municipal broadband.17
Invest in education
Education starts small. If you’re reading this article, you’re already ahead of the curve. You can help reduce the digital divide in healthcare by sharing your tech knowledge and access with people in your life who may need a helping hand, such as older family members.8
On a larger scale, a combination of public and private aid can be used to address knowledge gaps and improve digital literacy. In 2019, the Ukrainian government created a national digital education platform that hosts dozens of courses and learning materials for its citizens.14 And just this year, the Canadian government has provided financial support to several nonprofits focused on improving digital literacy for recent immigrants.13
The bigger picture
These strategies have the potential to dramatically improve healthcare access for those with low digital health literacy. However, they address the symptoms and not the cause; barriers to access are rooted in systemic issues much bigger than the healthcare system. These issues are difficult to tackle, but working to improve the accessibility of healthcare is a great first step towards solving them.
My small-town pediatrician can’t keep their fax machine forever. When they make the switch, they’ll need to make sure they aren’t leaving any patients behind. Access to healthcare should be for everyone, and any investments in the healthcare system need to be investments in inclusion.3
References
- van Kessel, R., Wong, B. L. H., Clemens, T., & Brand, H. (2022, February 7). Digital Health Literacy as a super determinant of health: More than simply the sum of its parts. Internet interventions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861384/
- Vigilante, K. (2023, February 3). The digital determinants of health: How to narrow the gap. Forbes. https://www.forbes.com/sites/forbestechcouncil/2023/02/02/the-digital-determinants-of-health-how-to-narrow-the-gap/?sh=60d4ccde59ba
- Honeyman, M., Maguire, D., Evans, H., & Davies, A. (2020). Digital Technology and Health Inequalities: A Scoping Review. Public Health Wales. https://phw.nhs.wales/publications/publications1/digital-technology-and-health-inequalities-a-scoping-review/
- Paige, S. R., Stellefson, M., Krieger, J. L., Anderson-Lewis, C., Cheong, J., & Stopka, C. (2018, October 2). Proposing a transactional model of eHealth Literacy: Concept Analysis. Journal of medical Internet research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231800/
- Kessel1, R. van, Hrzic, R., O’Nuallain, E., Weir, E., Wong, B. L. H., Anderson, M., Baron-Cohen, S., Mossialos, E. (2022). Digital Health Paradox: International policy perspectives to address increased health inequalities for people living with disabilities. Journal of Medical Internet Research. https://www.jmir.org/2022/2/e33819/
- World Health Organization. (n.d.). Social Determinants of Health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
- Liu, S., Lu, Y., Wang, D., He, X., Ren, W., Kong, D., & Luo, Y. (2023, May 26). Impact of digital health literacy on health-related quality of life in Chinese community-dwelling older adults: The mediating effect of health-promoting lifestyle. Frontiers. https://www.frontiersin.org/articles/10.3389/fpubh.2023.1200722/full
- López, M. del P. A., Ong, B. A., Frigola, X. B., Fernández, A. L., Hicklent, R. S., Obeles, A. J. T., Rocimo, A. M., & Celi, L. A. (2023, October 12). Digital Literacy as a new determinant of health: A scoping review. PLOS Digital Health. https://journals.plos.org/digitalhealth/article?id=10.1371%2Fjournal.pdig.0000279
- Spanakis, P., Peckham, E., Mathers, A., Shiers, D., & Gilbody, S. (2021, October). The digital divide: Amplifying health inequalities for people with severe mental illness in the time of covid-19. The British journal of psychiatry : the journal of mental science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111186/
- Mee, P., Gussy, M., Huntley, P., Kenny, A., Jarratt, T., Kenward, N., Ward, D., & Vaughan, A. (2023, January 1). Digital exclusion as a barrier to accessing healthcare: A summary composite indicator and online tool to explore and quantify local differences in levels of exclusion. medRxiv. https://www.medrxiv.org/content/10.1101/2023.07.12.23292547v2.full
- United Nations. (n.d.). Digital Inclusion. United Nations. https://www.un.org/techenvoy/sites/www.un.org.techenvoy/files/general/Definition_Digital-Inclusion.pdf
- Salome, D. (2023, September 10). The Rise of Digital Healthcare Post Covid-19. HealthEdge. https://healthedge.com/resources/blog/the-rise-of-digital-healthcare-post-covid-19
- Sivakumar, V. (2023, August 21). Canadian government investing $17.6 million to improve digital literacy. CIC News. https://www.cicnews.com/2023/03/canadian-government-investing-17-6-million-to-improve-digital-literacy-0333885.html#gs.1mbz7x
- Bandura, R., & Méndez Leal, E. I. (2022, July 18). The Digital Literacy Imperative. Center for Strategic and International Studies. https://www.csis.org/analysis/digital-literacy-imperative
- Providing Internet Access Through Public Libraries: An investment in Digital Inclusion and Twenty-First Century Skills. International Federation of Library Associations and Institutions. (2012, November). https://www.ifla.org/wp-content/uploads/2019/05/assets/clm/WSIS/libraries_public_access.pdf
- Chevalier, J. (2020, March 31). Good samaritans helping students with supplies, computers. CBC News. https://www.cbc.ca/news/canada/ottawa/good-news-ottawa-gatineau-cbc-1.5516608
- Schwartzbach, K. (2022, May 5). How government can make broadband more affordable. Rockefeller Institute of Government. https://rockinst.org/blog/how-government-can-make-broadband-more-affordable/
About the Author
Sophie Cleff
Sophie is an Associate at The Decision Lab. She holds a Bachelor of Science in Microbiology and Immunology from McGill University. She is passionate about applying her research background to interdisciplinary problems, especially related to public health. Before joining The Decision Lab, Sophie worked with the Montreal Children’s Hospital and Translating Emergency Knowledge for Kids (TREKK) to increase the quality, safety, and integrity of research in pediatric medicine. In her free time, she enjoys crocheting and playing the guitar.
