Digital Exclusion Research Articles

Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies.

Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations.

Prevalence and characteristics of smokers interested in using virtual reality for encouraging smoking cessation: a representative population survey in Great Britain

Abstract Background Cigarette smoking is one of the leading causes of morbidity in the world. Virtual reality (VR) has been used to encourage and support quit attempts. However, interest in VR may differ according to sociodemographic characteristics. This study aimed to estimate the proportion and associated characteristics of smokers in Great Britain who were interested in using VR for smoking cessation. Methods Data were collected from 6,858 adults between February to April 2023, from the Smoking Toolkit Study—a monthly, nationally representative, cross-sectional survey of adults in Great Britain. Of these, 873 were smokers (unweighted). Prevalence of interest was assessed descriptively and associations between interest and sociodemographic and smoking characteristics were analysed with weighted logistic regression models. Results Of 905 (weighted) smokers, 34.6% (95% Confidence Interval (CI):31.0%-38.5%) were interested in using VR for smoking cessation. Smokers had greater odds of reporting interest in VR for smoking cessation who were: highly motivated to quit (Odds Ratio (OR):2.41, 95% CI:1.59–3.65), had made a quit attempt in the past year (OR:1.95, 95% CI:1.37–2.77), currently trying to cut down (OR:1.90, 95% CI:1.34–2.67) and interested in VR generally (OR:10.42, 95% CI:6.97–15.57). Those ≥ 65 years old (OR:0.29, 95% CI:0.15–0.57) and women (OR:0.69, 95% CI:0.49–0.97) were less likely to report interest. Conclusions The results of this study indicate that up to a third of adult smokers may be interested in using VR to support a quit attempt. However, the potential reach of a VR smoking cessation intervention may be lower in certain subgroups such as women, adults 65 years or older, and adults less motivated to quit. From a health equity perspective, it is recommended that non-digital but effective interventions should be made readily available for adults at risk of digital exclusion due to lack of interest. However, as VR grows in popularity and its technological potential becomes fully realised, future research could also focus on strategies to reduce digital exclusion and increase interest. For example, by involving these subgroups in co-design activities and using novel dissemination strategies.

Smart Cities, Digital Inequalities, and the Challenge of Inclusion

While cities on a global scale embrace smartness as a roadmap for efficient urban governance, disparities persist in the domain of digital accessibility, literacy, and skills, with manifestations of digital exclusion, ageism, and ableism prevalent in most digital urban experiences. Despite their commitment to bridging the digital divide, governments lack comprehensive frameworks to inform policymaking and action for inclusion in smart cities. This review paper aims to deepen the understanding of the multifaceted challenges confronting the governance of inclusion in smart cities. Drawing from a review of research encompassing digital inclusion, digital transitions, smart cities, and urban governance, we discuss who is included and excluded in the governance of smart cities; what are the necessary conditions to be met for smart cities to be considered inclusive; and how can smart city governance deliver public value and equal benefits for all. As a novel contribution, this paper outlines a reflective framework to inform citizen inclusion in the governance of smart cities. This framework is meant to act as a starting point in the design of inclusive digital urban policies, and can also be employed to assess the directions taken to date in public organizations towards more inclusive urban practices.

Can intergenerational relationships mitigate digital exclusion among China’s elderly population?

ABSTRACT In the burgeoning grey economy, the elderly have been widely praised for their digital readiness dividends. However, there remains a significant gap in the literature regarding solutions to the critical issue of digital exclusion faced by the elderly. This study utilizes the microdata from three waves of the China Family Panel Studies (CFPS) in 2016, 2018, and 2020 to explore how intergenerational relationships influence the digital exclusion of older adults and identify the mechanisms. The findings reveal that strong intergenerational bonds significantly narrow the digital divide for the elderly. The analysis highlights that such relationships have a more pronounced impact on mitigating elderly digital exclusion among early-aged parents, males, residents of rural areas, and families where parents and offsprings cohabit. The mechanisms through which these relationships exert their influence include promoting intergenerational support exchanges, providing digital guidance from children to parents, and enhancing the elderly’s acceptance of digital technology. Furthermore, this paper employs the ‘one-child policy’ as a quasi-natural experiment to examine the moderating role. The findings underscore the value of nurturing parent-child bonds in reducing digital exclusion among the elderly, offering strategic insights for addressing this issue in societies experiencing both ageing populations and declines in birth rates.

Can Social Security Bridge the Digital Divide-Induced Relative Poverty? Evidence from CFPS 2020

Digital inequality has emerged as a critical socioeconomic challenge in the era of rapid technological advancement, particularly in developing economies transitioning from absolute to relative poverty reduction. While extensive research has explored various dimensions of the digital divide, limited attention has been paid to its causal relationship with relative poverty and the potential mitigating role of social protection systems. This knowledge gap is particularly significant in China, where despite remarkable progress in poverty alleviation, the interplay between digital exclusion, social security, and relative poverty remains understudied. Herein, we employ a multi-method approach combining instrumental variable analysis, propensity score matching, and quantile regression using the China Family Panel Studies 2020 data to examine these relationships. Our findings reveal that the digital divide significantly increases the likelihood of relative poverty, with a one standard deviation increase in digital exclusion associated with a 5.3 percentage point higher probability of experiencing relative poverty. Notably, social security coverage moderates this relationship, reducing the marginal effect of digital exclusion by 0.65 percentage points for each additional social protection program. These results advance our understanding of technological inequality by demonstrating how institutional factors can mediate the relationship between digital exclusion and economic outcomes, while highlighting the need for integrated policy approaches that combine digital inclusion initiatives with enhanced social protection measures to address emerging forms of poverty in increasingly digitalized societies.

Inequalities in internet use among older people between 2004 and 2021

Although research already examined sociodemographic profiles of older internet (non-)users, it is unknown how combinations of sociodemographic factors relate to internet (non-)use. Therefore, this study aims to investigate the cumulative impact of sociodemographic characteristics on internet (non-)use among people aged 60 and older between 2004 and 2021, using representative survey data derived from the Belgian Ageing Studies (n = 61 376). Logistic regression analyses consistently associated low education, age 80 or older, low income and female gender with higher probabilities of being internet non-user between 2004 an 2021. CHAID analysis revealed that education and age are the strongest predictors of non-use. The cumulative impact of sociodemographic factors enables to reveal subgroups where prevalence rates of non-use are almost three times higher than the prevalence reported in the population of older people in general. The result that 80.1 percent of individuals aged 80 and above with limited education did not use the internet underscores the need for a comprehensive digital inclusion approach, including strategies to overcome economic barriers to internet access and tailored internet training initiatives addressing digital skills and motivation. CHAID results help policymakers and internet training providers identify subgroups with high prevalence rates of non-users and target interventions to those at a high risk of digital exclusion.

THE IMPACT OF ARTIFICIAL INTELLIGENCE ON TEACHING CAREERS: PEDAGOGICAL, ADMINISTRATIVE AND ETHICAL CHALLENGES AND OPPORTUNITIES

This article reviews the impacts of Artificial Intelligence (AI) on teaching careers, with a focus on the pedagogical, administrative, and ethical dimensions, based on an analysis of recent studies (2022-2024). In the pedagogical dimension, AI has the potential to personalize teaching through adaptive systems and virtual tutors, adjusting content to students needs. However, this personalization could compromise teachers autonomy, as they may become dependent on algorithms for decisions regarding lesson pacing and content. In the administrative dimension, AI automates tasks such as grading and lesson planning, allowing for more teaching-focused time. However, this requires new training and technological adaptations, which may increase teachers workloads. In the ethical dimension, challenges such as data privacy, algorithmic bias, and digital exclusion could exacerbate educational inequalities. The article provides recommendations for leveraging AI as a teaching aid while preserving teacher autonomy and ensuring ethical and inclusive implementation. Methodological limitations, such as the narrow temporal scope and the lack of long-term impact studies, are acknowledged. The article also calls for future research on AI integration in various educational contexts and the development of public policies to ensure equitable technology adoption in schools and universities.

Strategies to advancing digital health equity: perspectives from underserved groups

Abstract Digital Health Technologies (DHTs) are revolutionizing healthcare. However, there is a lack of demonstrable health benefits across all populations. To advance digital health equity, we explored the perspectives of underserved groups on strategies to support digital inclusivity. Participants belonged to two or more CLEARS (Culture (ethnicity, language, religion), Limiting conditions (visual or hearing), low Educational attainment, older Age, Residence (rural, deprived or no fixed address), low Socioeconomic status) groups. This framework encompassed sociodemographic factors associated with digital exclusion and recognizes the role of intersectionality.(1) Twenty-nine individuals participated in focus groups (n = 4) or interviews (n = 11) and shared their perspectives on the barriers to DHTs, innovative ideas to improve inclusivity, and perceived feasibility of implementing changes. An inductive reflective thematic analysis was used to analyze the transcripts, assisted by N-Vivo. Participants experienced fragmented communication with healthcare providers when using DHTs, explaining how they received a no-reply SMS message asking them to confirm an appointment via a link but were unable to access the link. Current solutions to overcoming such barriers included using non-digital routes (e.g., visiting a pharmacy) or calling non-emergency healthcare services. Many participants expressed the need for DHT support services to be implemented to provide educational support and access to devices. However, some participants raised concerns about the financial strain this might place on healthcare systems. Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity. (1)Wilson et al. (2023). Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review. Alzheimer’s &amp; Dementia. Key messages • Strategies to mitigating digital exclusion within healthcare should be designed with underserved groups. • Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.

Development of an air quality communication strategy with underserved groups

Abstract Air quality is the greatest environmental health threat. Effective communication can support individuals to take actions to protect themselves, however, we know some groups are less likely to engage with exposure reducing behaviours than others. We aimed to explore what information individuals want to receive about raised air pollution levels, when, where and how they would like to receive it. In this qualitative study individuals participated in either semi-structured interviews (n = 6) or focus groups (n = 8) in North East England between Oct23-Feb24. We used purposive sampling underpinned by extensive community-based engagement to ensure inclusion of those who were underserved and/ or at risk of digital exclusion. The Capability Opportunity Motivation-Behaviour model was used to help guide discussions and the data thematically analysed using an inductive approach. Fifty individuals participated, many of whom were of non-white ethnicity (n = 23, 46%), spoke English as an additional language (n = 12, 24%), and had lower educational attainment levels (i.e., no-qualifications n = 7, 14%). Participants discussed four aspects that they deemed important to include in air quality communication: (1) the risk and harms of air pollution should be stated, and be tailored because “what’s a dangerous level for one person isn’t a dangerous level for another”(P41) (2) Participants felt detail about the pollutants should be included such as: “what is causing the air pollution?”(P15) to “avoid the exposure to this source”(P21). (3) Messages should also include actionable recommendations about how to protect oneself and, (4) various ways to communicate these messages (text-message-based approaches being the most popular) were suggested. Our findings indicated using a combined communication strategy including text messages and community-based approaches. This work can inform the development of inclusive future air quality information communication Key messages • Effective communication can support individuals to take actions to protect themselves from air pollution. • A combined communication strategy including text messages and community-based approaches were suggested as being effective communication strategies.

Introduction to the digital health divide

Abstract This presentation will introduce the concept of digital health divide. It refers to inequalities in accessing and using digital technologies, leading to digital exclusion. Digital inclusion is defined by the United Nations as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”. Indeed, digitalisation is a worldwide phenomenon that permeates all levels of determinants of health inequities, leading to several populations being more adversely affected. Age, gender, education, and economic status are significant determinants amplifying the digital divide’s impact, with older individuals, women, less educated individuals, and economically disadvantaged populations bearing disproportionate effects. The relationship between the digital divide and health leading to the digital health divide can be direct and indirect. Here, access to the latest advancements in health technologies used along the health span (eHealth, mHealth) - from health prevention to patient care - can directly influence the user’s health. However, the lack of access to or use of existing technologies can also indirectly affect their well-being. A globally informative example of this indirect association is the lack of internet access in rural areas during the hard COVID-19 lockdowns, leading to the loss of a school year for many pupils. Indeed, school attendance and attainment are associated with better physical and mental health. Currently, there is a lack of operationalisation of the digital health divide, making it difficult to measure it accurately. The absence of a standardised evaluation and therefore evidence-based information hinders governments and organizations’ efforts to effectively address digital health divide.

The Digitalization of Social Care in England and Implications for Older, Unpaid Carers: Constructionist Thematic Analysis.

Globally, populations are aging, generating concerns about the sustainability of health and social care provision. In terms of the public provision of social care in particular, unpaid carers provide much of the support to people with disabilities and older people. In addition, there is an increased onus in many countries on digital transformation projects, in the hope that the digitalization of services can create efficiencies and savings in both costs and care labor. In England, the focus of this paper, the shift to digital services is also framed as a means to enhance choice and control for older unpaid carers, while being part of a broader offering that includes nondigital alternatives and support to mitigate digital exclusion. This study examines the impact of digitalization on older, unpaid carers-a group more likely to be both expected to engage digitally with services and at risk of digital exclusion-in England, focusing on their lived experiences in terms of caring and access to social care. We used a constructionist approach to thematic analysis, where data from 48 older unpaid carers collected through focus groups were analyzed using thematic analysis, resulting in 4 prevailing themes. Our findings indicated that while unpaid carers largely acknowledge the benefits of digitalization, they also highlight several points of failure, whereby engagement with digital spaces is experienced as coercive and exacerbates feelings of exclusion. These are further worsened by government failures to address issues of connectivity, imposing additional financial burdens and complicating tasks such as benefit applications. In this study, we have highlighted the need for greater involvement in shaping both policy and technological solutions, which in turn will be more inclusive and aligned to the aspirations and circumstances of older carers.

Dinâmicas de imperialismo e colonialismo na era digital

The investigation presents a reflection on data market strategies anchored in imperialism and colonialism in the digital era. It discusses the commodification of internet user data on different digital platforms, as well as strategies to mitigate these practices and studies on the topic. The research is descriptive, bibliographic and qualitative, reflecting on data, information, power and manipulation of society through digital platforms. The bibliographic survey was carried out on the Capes Periodicals Portal considering only articles published in open access and peer-reviewed, covering the entire period available until December 2023. The data market carried out by large technology corporations exerts dominance over the economy and culture, through the control and exploitation of user information. This phenomenon raises concerns related to privacy, concentration of power and digital exclusion. The data market presents significant challenges in the digital era, demanding effective responses from civil society, governments and international organizations. To address this problem, it is essential that Brazil strengthens its technology industry and implements data protection policies.

Patient experience and barriers of using a mHealth exercise app in musculoskeletal (MSK) Physiotherapy.

Digital transformation has led to an abundance of digital health technologies (DHTs) readily available for Physiotherapists. In July 2020, the Physiotherapy department at a London NHS Trust implemented a mobile health (mHealth) exercise application (app), Physitrack. This service evaluation aims to evaluate patient experience and identify any barriers to using Physitrack/PhysiApp in musculoskeletal (MSK) Physiotherapy. An online experience survey was sent to 10,287 MSK Physiotherapy patients who had appointments between January 17th and April 9th 2022.The survey received 1,447 responses (response rate: 14.07%), with 954 (65.93%) respondents previously provided PhysiApp as part of their Physiotherapy management. Most participants used PhysiApp (83.06%), found it easy to use (82.20%) and had positive perceptions on how it added value to their Physiotherapy treatment through its functionality. However, negative impacts on patient-centred care and practical exercise demonstration were apparent in the qualitative results. Key barriers to use included suboptimal explanation, digital exclusion, registration/ login issues and opinion that PhysiApp was superfluous to Physiotherapy treatment. These differed to the main barriers of why participants stopped using/ used PhysiApp less: if they were confident exercising without it, their condition improved/ resolved, loss of motivation, their exercise programme ended or if they found their exercise programme was unsuitable. Despite multiple interdependent factors influencing patient experience and barriers of using PhysiApp, the survey results revealed the significant influence that is exerted by MSK Physiotherapists. The patient-physiotherapist interaction can positively or negatively impact upon many barriers of use and the subsequent potential added value of PhysiApp to MSK Physiotherapy treatment. Future research should focus on those at most risk of digital exclusion and health inequalities, exploring their barriers to using mHealth apps and other DHTs.

Advanced practitioners working with older people in primary care and community settings: a survey of roles and use of technology.

Advanced practitioner (AP) roles are becoming increasingly common in primary care and community settings for supporting older people and those living with frailty. The aim of this study was to explore health and social work AP roles in primary care and community settings in the UK, and understand how they support older people and factors that may impact on APs use of technology in practice. A cross-sectional, web-based survey was adopted to explore the views and perspectives of APs. The survey received 111 responses. There were different views as to whether technology was suitable for older people. Although digital exclusion was a concern, it was perceived that this would change in the future as generations become more digitally literate. Respondents suggested that using technology brought about efficiencies and the ability to respond sooner to symptom changes, with some concerns mentioned regarding the accuracy of technology that may miss signs and symptoms. This is the first national survey to explore advanced practice roles with older people in non-hospital settings. While APs have wide-ranging skills, few currently use technology in their practice. Findings will inform a future study on digitally enhanced comprehensive geriatric assessments.

Navigating digital financial exclusion: legal imperatives for disabled people in China

This paper examines the barriers hindering access to digital financial services for individuals with disabilities in China and proposes strategies to address these challenges. Despite rapid growth in inclusive digital finance, practical experience reveals uneven coverage, leading to digital exclusion and discriminatory practices. Barriers include limited access to digital infrastructure, standardised financial products neglecting diverse needs, and insufficient financial education. Moreover, legal safeguards exhibit notable deficiencies, lacking the incorporation of accessibility requirements and effective enforcement mechanisms. Therefore, strengthening legislative, enforcement, and judicial safeguards is essential. Proposed measures include integrating accessibility provisions into financial laws, developing tailored regulatory mechanisms, and enhancing judicial interpretations. These efforts will improve accessibility and foster a digitally enriched quality of life for individuals with disabilities in China.

Calling for allied efforts to strengthen digital health literacy in Sweden: perspectives of policy makers

BackgroundA more digitalised world comes with the promise to improve people’s lives. Therefore, it is essential that policymakers also align digital interventions with initiatives to empower citizens and strengthen their digital health literacy. The aim of this study was to explore the views of Swedish policymakers regarding the potential and barriers of a European strategy to strengthen digital health literacy.MethodRepresentatives from Swedish governmental agencies and regions were purposively approached by email to ask them to participate in online workshops to discuss the potential and barriers of developing a European strategy to strengthen digital health literacy.ResultsThe results highlight the need for a national strategy to strengthen digital health literacy. The findings point to critical areas for improvement, ethical and social considerations, and the importance of inclusive and accessible health information online. Participants identified vulnerable groups requiring targeted support to enhance their digital health literacy, particularly those at risk of digital exclusion. Participants emphasised the importance of considering various combinations of conditions or problems that people may have, urging policymakers to adopt a nuanced approach to enhance digital literacy.ConclusionsThere is a critical need for policymakers to strengthen digital health literacy in the population to ensure health equity in relation to digitalisation opportunities. Policymakers advocate for a dedicated national strategy, supporting policymakers to prioritize digital health literacy. Tailoring information, enhancing digital support for prevention, and considering ethical implications are reported as important aspects to improve digital health literacy.

Learning experiences from an online QI fellowship programme during COVID-19 – a qualitative study

BackgroundDuring the COVID-19 pandemic in the United Kingdom, multiple aspects of everyday human existence were disrupted. In contrast, almost all levels of educational learning continued, albeit with modifications, including adaptation to virtual—or online—classroom experiences. This pedagogic transition also occurred in the National Institute of Health and Care Research Applied Research Collaboration Northwest London’s (NIHR ARC NWL) Improvement Leader Fellowship, an annual programme focusing on quality improvement (QI). This qualitative study aimed to understand how these changes impacted the Fellows’ learning experience.MethodsWe explored the experiences of two cohorts of programme Fellows (n = 18, 2020–2021 and n = 15, 2021–2022) with focus groups, analysed under a constructivist qualitative research paradigm.ResultsThe two primary and four sub-themes that emerged were: Online QI learning experience (benefits and challenges) and Implementing online QI learning (facilitators and barriers). While benefits had three further sub-themes (i.e., digital flexibility, connection between learners, and respite from impact of COVID-19), challenges had four (i.e., lack of interaction, technological challenges and digital exclusion, human dimension, and digital fatigue). While the facilitators had three sub-themes (i.e., mutual and programmatic support, online resource access, and personal resilience), barriers had one (i.e., preventing implementation and lack of protected time).ConclusionDespite challenges to in-person ways of working, online learning generally worked for action-orientated QI learning, but changes are needed to ensure the effectiveness of future use of virtual learning for QI. Understanding the challenges of the translation of learning into action is crucial for implementation learning, gaining insight into how improvement Fellows navigated this translation when learning remotely and implementing directly in their workplace is key to understanding the evolving nature of implementation over the pandemic years and beyond.

Young People’s Diversity and Digital Media: A Systematic Review (2010–2022)

Youth is not a homogeneous group. With this motto in mind, YouNDigital aims to study youth, their engagement with news, and digital citizenship dynamics. One of the core elements of the project is a digital newsroom, a space for meeting and exploring digital citizenship and news, considering the significant disparities that characterise individuals in this group. In order to better understand the target groups and to support the decisions regarding the development of the youth-led digital newsroom, the research team carried out a systematic literature review focused on youth, digital citizenship, diversity, and different methodological approaches. This article explores the outcomes of the systematic literature review, particularly delving into the data gathered in one of the subclusters (Diversities). Findings underscore the challenges of inclusivity and diversity and the need for tailored media and digital literacy interventions that consider cultural differences, socioeconomic factors, and evolving technological landscapes. They also highlight the difficulties, as well as the positive results, of using digital tools and strategies to trigger learning and motivational processes for diverse audiences—digital tools that rely on media creation, creativity, critical thinking, and collaboration can promote the empowerment and inclusion of youth from distinct backgrounds, bridging the gap between their realities and citizenship experiences. For research teams, the findings point out that involvement in collaborative, immersive, and participatory processes anchored on sustained literature review processes can encourage distancing preconceptions while bringing them closer to research participants. The article contributes to discussions regarding the potential and the challenges of considering youth’s diverse backgrounds through pillars such as co-creation or inclusive design, and the urgency of mitigating youth social and digital exclusion in order to enhance democratic participation.

The Digital Exclusion of People with Intellectual Disabilities During the COVID-19 Pandemic

The Digital Exclusion of People with Intellectual Disabilities During the COVID-19 Pandemic

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

AbstractExisting disparities in digital access were exacerbated with the accelerated shift to online provision of services during the COVID-19 pandemic, particularly for already disadvantaged groups. Metrics to quantify relative local differences in levels of digital exclusion are a necessary pre-requisite for the targeting of interventions to address these disparities. In this study we developed a composite indicator and an interactive dashboard ‘The Lincolnshire Digital Health Toolkit’ to explore digital exclusion in Lincolnshire, UK. To develop the indicator, individual variables were normalised and aggregated, intra-variable correlations explored, and factor analysis used to determine variable weightings. Three underlying factors were identified that explained a significant proportion of the variance in the original variables, the first two predominantly related to socioeconomic deprivation and lack of activity. In general, coastal areas in the east of the county had higher levels of digital exclusion, with significant local variation particularly within urban areas. Long travel times to reach medical facilities are an additional barrier in some communities. The toolkit has been used to support the evidence-based geographic targeting of interventions to address barriers to accessing digitally based health information and services. The impact of digital exclusion must be addressed to reduce marginalisation and isolation. The Lincolnshire Digital Health Toolkit provides a novel composite metric tailored to the conditions of this largely rural county and an interactive dashboard to support decisions on resource allocation.