Device-Switching and Internet Access: Enablers of Television Viewing During Load Shedding in Gauteng

COVID-19 and Mental Health Care Delivery: A Digital Divide Exists for Youth With Inadequate Access to the Internet

ObjectiveThe aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population.DesignA cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected.ResultsThe results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988).ConclusionRecommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour.

Abstract: This chapter explores effective strategies for bridging the digital divide in rural and low-income communities, addressing the socio-economic and infrastructural barriers that limit access to technology and the internet. It evaluates emerging solutions such as affordable smartphones, low-bandwidth apps, satellite internet, and community networks, while emphasizing the role of public policy, regulatory support, and sustainable business models in ensuring long-term digital inclusion. Case studies from regions in Latin America, Sub-Saharan Africa, and India highlight the impact of community-driven networks on education, healthcare, and local economies. The chapter concludes with recommendations for leveraging emerging technologies like 5G, low-earth orbit satellites, and AI-driven data optimization to further expand access and promote equitable connectivity. Keywords: digital divide, rural communities, low-income, affordable technology, community networks, internet access, sustainable models, policy support, satellite internet, 5G, low-earth orbit satellites, AI, digital inclusion, public-private partnerships, education, healthcare.

This study examines the distribution of federal funds in Milwaukee, Wisconsin between 1988–2008 under a new Neighborhood Strategic Planning (NSP) process designed to increase citizen participation and empower neighborhoods residents by giving them an increased role in the distribution of federal urban renewal funds used for the period 1998–2008. It was then compared it to the old Community Development Block Grants (CDBG) funding allocation process used between 1988–1997. This study documents that while citizen participation in the distribution of federal CDBG funds increased under the NSP process, federal funding to low-income communities decreased because city officials had the power to restructure funding priorities and allocations patterns. Also, federal funds distributed to low-income neighborhoods via community-based organizations (CBO) decreased under the NSP because the city government created new policies to increase its share of CDBG dollars to finance city services and staff funded by tax levy dollars. In effect, the city used federal funds designed to help low income communities to pay for city services and staff instead of raising its middle class residents’ property taxes to pay for them.

BackgroundTo reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored.ObjectiveThe 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs.MethodsThis study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis.ResultsOverall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants’ perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options.ConclusionsThe increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

Whether Title VII funding enhances physician supply in underserved areas has not clearly been established. To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities. A retrospective cross sectional analysis was carried out using the 2000 American Academy of Family Physicians physician database, Title VII funding records, and 1990 U.S. Census data. Included were 9,107 family physicians practicing in 9 nationally representative states in the year 2000. Physicians exposed to Title VII funding through medical school and residency were more likely to have their current practice in low-income communities (11.9% vs 9.9%, P< or =.02) and rural areas (24.5% vs 21.8%, P< or =.02). Physicians were more likely to practice in rural communities if they attended medical schools (24.2% vs 21.4%; P =.009) and residencies (24.0% vs 20.3%; P =.011) after the school or program had at least 5 years of Title VII funding vs before. Similar increases were not observed for practice in low-income communities. In a multivariate analysis, exposure to funding and attending an institution with more years of funding independently increased the odds of practicing in rural or low-income communities. Title VII funding is associated with an increase in the family physician workforce in rural and low-income communities. This effect is temporally related to initiation of funding and independently associated with effect in a multivariate analysis, suggesting a potential causal relationship. Whereas the absolute 2% increase in family physicians in these underserved communities may seem modest, it can represent a substantial increase in access to health care for community members.

Introduction: The Geographic Management of Cancer Health Disparities Program (GMaP) is a national NCI program with the goal of increasing cancer health disparities (CHD) research. GMaP Region 1 North (R1N) is one of seven GMaP Regional “hubs” based at NCI-designated cancer centers (CCs) across the country, covering the states of DE, KY, ME, MD, NH, VA, VT, WV, and the District of Columbia. The National Outreach Network (NON) is a national NCI program with the goal of conducting cancer education and outreach in underserved communities to reduce CHD. NON Community Health Educators (CHEs) are based at 38 NCI-designated CCs across the country. Six NCI-designated CCs with NON CHEs fall within the GMaP R1N coverage area. Methods: GMaP R1N staff and NON CHEs within the R1N coverage area met bimonthly to collaborate on the Screen to Save (S2S): NCI Colorectal Cancer (CRC) Outreach and Screening Initiative. The goal of S2S was to educate underserved communities on CRC and CRC screening. NON CHEs conducted the projects in diverse urban and rural communities within their CC catchment areas. Participants attended a CRC education event that provided an inflatable colon or a PowerPoint presentation and completed demographic and pre-/post-event surveys to gauge their knowledge of CRC screening. Surveys were submitted to NCI Center to Reduce Cancer Health Disparities program staff for review and data entry. Raw data files were returned to NON CHEs and shared with GMaP R1N staff for analysis. R1N staff provided research expertise to compare results between urban and rural S2S participants. Results: There were a total of 328 participants in S2S (n=200 urban; n=128 rural) in the GMaP R1N/NON coverage area. The median age of urban participants was 59.5 vs. 49.0 for rural participants. 95% of urban participants and 96.1% of rural participants reported having health insurance (public or private). 92.9% of urban and 88.1% of rural participants attained at least a high school diploma or GED. 76.5% of urban and 41.4% of rural participants reported ever being screened for CRC by any method. The percent increase between pre- and post-test scores for the educational intervention was 15% for urban vs. 13.3% for rural participants, with an overall percent increase in knowledge of 14.2%. Conclusions: The urban and rural participants were similar in educational and health insurance attainment levels. Urban residents reported much higher rates of previous CRC screening than rural residents, but this is likely due to the fact that more rural participants were younger than the recommended CRC initial screening age at the time (age 50). The S2S educational intervention was effective in increasing knowledge of CRC screening among both rural and urban participants, with similar increase between the two groups. Overall, this project demonstrated that two different yet complementary programs, GMaP and NON, can work together by utilizing program strengths to successfully implement an educational intervention conducted across a wide and diverse geographic area. Citation Format: Mark Cromo, Rhonda Boozer-Yeary, Melinda L. Rogers, Katelyn Schifano, Jenna Schiffelbein, Katherine L. Jones, Marcela Blinka, Julia F. Houston, Betsy Grossman, Lindsay Hauser, James Zabora, Mark B. Dignan, Tracy Onega. Integrating research and outreach to increase CRC screening knowledge in underserved communities: The Geographic Management of Cancer Health Disparities Program and National Outreach Network Screen to Save partnership [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A015.

28 | International Union Rights | 26/4 FOCUS | CLIMATE CHANGE & TRADE UNIONS The South African electricity industry is in crisis. Although peak electricity demand reaches only 60 percent of installed generating capacity, there have been periodic episodes of ‘load shedding’ since 2008 when public utility Eskom was unable to meet peak demand and had to implement rotational cut-offs to avoid total blackout. This escalating crisis reached further unprecedented levels in December 2019. With electricity prices having increased by 356 percent over the last ten years and 43 percent of people considered ‘energy poor’, this latest episode of load shedding was met by a massive public outcry. Government response measures aiming to tackle Eskom’s capacity shortfalls have so far have been successful. In a country with excellent solar and wind resources, the obvious solution to increasing access to affordable electricity, increasing supply and reducing emissions is to tap into renewable energy sources. But currently coal provides an estimated 83 percent of South Africa’s total generating capacity. The coal-dominated energy sector also provides many with jobs and livelihoods, especially within low-income and black majority communities. Renewable energy has been introduced to the country through the Renewable Energy Independent Power Producers Programme (REIPPPP), but the privatised nature of this electricity generation has been opposed by the National Union of Mineworkers (NUM) and National Union of Metalworkers of South Africa (NUMSA). REIPPPP is a manifestation of an overall shift to neoliberal policies taking place since the late 1980s – including the corporatisation of Eskom that precipitated the utility’s increasingly unsustainable and precarious financial and governance situation. Given the myriad financial and governance problems that currently plague the South African energy system, and the current deadlock between unions and the government, the possibility of both turning Eskom into a leader in renewable energies and retaining its vertically integrated utility status will be extremely challenging. Far less attention has been paid to the role that local governments can play in relation to renewables and just transition. Municipalities, in their constitutionally sanctioned function as electricity distributors, already occupy a central position in South African energy distribution. In addition, energy sourced from renewables lends itself well to a decentralised and locally managed system of generation and distribution. Thus, getting Eskom and local governments to combine their efforts to roll out renewable energy appears as a potentially viable and effective way of increasing access to clean, affordable electricity. The idea is not to prevent community organisations, cooperatives and other forms of smallscale ownership from playing their part in renewable energy development but rather to insert these smaller entities into a well-coordinated and publicly run energy sector so as to ensure equitable, reliable and affordable access to clean energy. Eskom and local governments would subsequently be tasked with overseeing and running the process. While both the government and trade unions frequently express their commitment to renewables and refer to the just transition concept, their conflicting understandings of transition have led to paralysis. Securing a just transition to a low-carbon energy system must involve more than simply helping energy workers and their communities to transition away from coal; it must also guarantee adequate access to clean energy for all. Local governments could potentially form the basis for such a low-carbon and people-centred electricity system. However, for this to happen will require breaking the current deadlock and a radical shift in the existing power dynamics around electricity in South Africa. It will also require a concerted effort to strengthen Eskom and local government institutionally and financially. The transition to a more socially, environmentally and politically just electricity system will only happen when trade unions, environmental groups, women’s groups, youth groups and frontline community organisations unite around a common vision of a people’s energy system. Uniting for Energy Democracy in South Africa SANDRA VAN NIEKERK researches energy transitions and energy democracy with the Alternative Information & Development Centre (AIDC) Energy democracy is the only way to break the deadlock between government and unions over South Africa’s electricity crisis The NUM and NUMSA have been working in partnership with Trade Unions for Energy Democracy (TUED), the Transnational Institute and AIDC under the banner of a...

The flexible use of energy is seen as a key option to facilitate the integration of volatile renewable energy sources (RES) into the electricity sector. In this study, we focus on flexibility in the service sector, in terms of flexible technologies, experiences and willingness to participate in demand response (DR) actions. We analyse the technically possible future deployment of flexibility, the practically possible deployment of flexibility and also take the reduction of RES surplus electricity into account. Our results are based on survey data from over 1.500 service sector companies (offices, trade, hospitality) and modelling results with a time resolved DR model (eLOAD). The data show that service sector companies have few experiences in DR so far, which is among others caused by the unfavourable regulatory conditions to participate in flexibility markets. The currently most common forms of DR are load shedding and flexible tariffs and optimized purchase of electricity. Participation in DR varies between subsectors and company sizes, but on average all subsectors are interested in extending (automated) DR measures in the future. Our projections result in a possible technical deployment of flexible electricity of 7.74 TWh of which about 510 GWh can be used to reduce renewable surplus electricity (in case of a 50% RES share). In case of a 80% RES share, this can reach 1.63 TWh. Integrating the willingness of companies to participate in DR, the practical possible deployment results in 131 GWh reduction of renewable surplus electricity. This can be interpreted as a first-mover potential for DR. Future increased need for flexible demand could raise the profit for the companies and their willingness in participating in DR. Further analyses on most promising target groups of companies would help to tap the potentials and to create market offers as well as policies to incentivise participation.

Objective: To examine clinician-assisted computerized psychological treatment for depression and alcohol/other drug use comorbidity in rural and urban communities. Methods: Participants in an Australian randomized controlled clinical trial who completed the 3-month post-baseline assessment were examined (n = 163), including those from remote/outer regional (n = 16, 10%) and inner regional (n = 37, 23%) areas and major cities (n = 110, 67%). Participants were using alcohol and/or cannabis at hazardous levels in the month prior to baseline and concurrently reported at least moderate levels of depression. Following provision of the first treatment session (conducted face-to-face for all conditions), participants were randomized to: (1) nine further face-to-face sessions of combination cognitive behavioral therapy and motivational interviewing; (2) nine sessions of combination cognitive behavioral therapy and motivational interviewing delivered via computer, with brief clinician assistance; or (3) nine sessions of supportive counseling. Blind, independent follow-up occurred at 3 months post-baseline. Changes in depression, alcohol, and cannabis use at 3 months post-baseline were the outcomes of interest, with rurality, treatment allocation, and treatment preference fulfilment as independent variables. Self-reported helpfulness and experience of treatment was also explored. Results: Participants completing the 3-month post-baseline assessment (n = 163) were significantly older than those who did not (n = 111) and attended significantly more treatment sessions. The outcomes of interest, including helpfulness of treatment, were not significantly associated with rurality. Of the 92 participants indicating a treatment preference prior to randomization, 13 (14%) nominated a preference for computer-delivered treatment. However, treatment preference did not affect retention, therapeutic alliance, or the benefits reported by urban and rural participants in the trial receiving computerized treatment. Computerized treatment was associated with significantly greater reductions in alcohol use relative to face-to-face cognitive behavioral therapy/motivational interviewing (d = 0.621) and supportive counseling (d = 0.904). Conclusions: Computer-delivered cognitive behavioral therapy and motivational interviewing (with clinical assistance) is an efficacious treatment for depressive and addictive disorders, with similar levels of acceptability and benefit in rural and urban participants. Computerized psychological treatment might be an acceptable treatment for underserviced populations, with real potential to bridge service gaps and to overcome isolation and perceived stigma among isolated communities. This clinical trial is registered with the Australian New Zealand Clinical Trials Registry as trial #ACTRN12610000274077 (http://www.anzctr.org.au/trial_view.aspx?id=335314).

Preventable blindness is a global public health problem. In South Africa (SA) the prevalence of blindness is increasing, with a higher proportion of cataracts than the global norm, and a large rural population with limited access to specialised eye-care services. To determine the level of knowledge regarding preventable blindness and treatment options within a rural and urban population. Rural and urban areas in the Eastern Cape, SA. A descriptive cross-sectional study was conducted among 309 participants. Questionnaires were administered by fieldworkers at the different sites. Proportions were calculated and χ2 tests done to determine whether there was any significant relationship between the categorical variables. Data analysis was done using Stata version 15. Participants were almost equally distributed among the urban (49.2%) and rural areas (50.8%). Both groups had a similar composition of males and females. Most participants had completed high school. The results showed a statistically significant difference between the urban and rural participants' knowledge about the causes of blindness: refractive error χ 2 (1, N=30) = 8.20, p<0.05, and cataract χ2 (1, N=28) = 8.64, p<0.05. The top two differences in the views between urban and rural participants regarding symptoms associated with eye problems (p<0.05) were: 'people who need spectacles have double vision', χ2 (1, N=122) = 28.19; and 'people who need spectacles squint their eyes', χ2 (1, N=124) = 17.37. The majority of urban participants reported opting to go to a private optometrist for eye health services, while the majority of rural participants would go to a pharmacy. Both groups were aware of the role of ageing in blindness. Urban participants in this study appeared to be more knowledgeable than rural participants about the causes and symptoms of blindness and its treatment options. These findings should provide some value to those who provide primary healthcare services in rural areas as there is a clear opportunity for patient education and health promotion regarding the causes and symptoms of these common preventable causes of blindness. Addressing this knowledge gap regarding the causes and symptoms of blindness and the treatment options is a critical first step for awareness programmes in rural areas. Without this, there will be little demand for any treatment or service. Future studies are needed to understand which health promotion interventions are effective in preventable blindness in rural populations.

One measure of the progress of a nation is the expectancy of inhabitants, especially for the elderly. One of the primary efforts made for the elderly to achieve the quality of life and to remain reasonable is by eating nutritious and diverse foods as well as maintaining nutritional status in a balance condition. The fulfillment of nutritional needs can help in the process of adapting or adjusting to the changes they experienced and can maintain the continuity of body cell changes so that they can prolong life. Generally, support and attention from family members are needed by the elderly, especially in their food consumption. This research applied a qualitative method with a cross-sectional design. This research was conducted in Titi Kuning Village (representing urban areas) and in Ranto Baek Village (representing rural areas). Sampling was carried out using inclusion criteria with the criteria, not dementia, not lying sick, and being able to stretch both hands. Total sampling used in this study, 108 people from the village of Ranto Baek, and 438 people from Titi Kuning village became the sample of this research. As a result of the frequency distribution of urban and rural elder's knowledge about nutritional needs, most urban participants have good knowledge; totally, 251 participants (57.3%) and rural participants have sufficient knowledge, a total of 44 participants (40.7%). The results of the frequency distribution of the urban and rural elderly on eating patterns indicated that both urban and rural participants have a good eating pattern total 282 (64.4%) for urban participants and 85 (77%) for rural participants. In addition, frequency distribution results of the nutritional status of urban and rural elders show that many urban participants have good nutritional status, i.e., 213 (48.6%) and rural participants have heavy weight-loss nutritional status as many as 61 participants (58%). This study found that the knowledge, eating pattern, and nutritional status of participants in the city all were good, whereas the knowledge of the participants in the village was sufficient; the nutritional status was a heavyweight loss, yet the eating pattern was good. The difference between rural and urban communities is due to the influence of participants' insight, the neighborhood, the mass media, and the information available. The results of this study can be a reference for the initial material to conduct further research related to the regulation of balanced nutrition for the elderly.

Social capital and health in rural and urban communities in South Australia

The spread of the Coronavirus 2019 (COVID-19) is by far one of the most serious global threats to academics, teaching and learning in African Higher Education Institutions (HEI) in decades. Unsurprisingly, the surge in digitalisation and internet use has played a critical role in salvaging the academic environment. Universities have and are still increasingly shifting courses online at home. Whilst the internet is an important resource in efforts to stay informed and proceed with daily lives during the COVID-19 pandemic, these online approaches to reducing risk are not available to everyone in the same way. It is evident that poorer students who live in less affluent areas pay more for less reliable internet service provision. Although smartphones dominate most socioeconomic groups, they are still a poor alternative for broadband internet access for tasks such as online classes. The digital divide leaves the vulnerable student population who lack access to a reliable broadband internet connection, at a significant disadvantage when it comes to accessing and engaging with forms of knowledge transfer and acquisition.

Traditionally, survey data and travel data are considered and analyzed independently. By being able to combine survey data with the respective trip data, this paper analyzes patterns between quantitative mobility data and qualitative survey responses. Firstly, we apply spatial-temporal clustering on the mobility data to understand travel patterns. Secondly, we utilize association rule mining to understand the differences between the clusters. Lastly, we apply association rule mining on the combined mobility and survey data set to understand the perception of Covid-19 related measurements in public transportation. With the created association rules, public transportation authorities can comprehend how different measurements affect the awareness of their services.