Digital Exclusion Research Articles

Exclusion and the growth of AI technology: a trade-theoretic analysis

This study provides a four-good general equilibrium framework with international trade for assessing the impact of the advancement of automation and artificial intelligence (A&AI) on the welfare of a group of agents who are excluded from both owning productive assets, such as capital and land, as well as consuming digital output (digital exclusion). We show that, depending on the magnitude of the factor intensities, the accumulation of A&AI capital may negatively affect the income of the excluded group, who provide unskilled labor, or the owners of land. In doing so, we bring out the conflict of interests that may arise between the owners of A&AI capital and other groups within society, which has implications for the pressure that exists to slow down the adoption of A&AI in an economy.

Exploring educational trends and challenges in the MENA region amidst a global crisis: An empirical analysis of the pandemic’s impact on SDG4

The paper presents a cross-country analysis of seven countries in the MENA region and explores the effects of COVID-19 on educational policymaking. The paper uses a quasi-thematic literature review to highlight the emerging themes related to the quality of education during the pandemic. The paper investigates the educational trends in seven MENA region countries and provides descriptive analysis to understand if there were changes from 2016 to 2020. In order to investigate these trends, the study uses the conceptualization of Sustainable Development Goals (SDG 4) “Quality of education.” The analysis is based on the data from the World Bank Development indicators. The paper’s evidence identifies a difference in the level of government expenditure on education within the MENA region. Pre and during COVID-19 provides crucial insights such as all countries increased their government expenditure on education except Egypt and Bahrain. The paper further addresses the contributing factors to the educational gaps in the region, such as digital exclusion, inequality (income and gender), and the government’s budget constraints during the pandemic. This study presents recommendations to bridge these identified gaps in the post-pandemic era.

Internet bez barier? Osoby niewidome i słabowidzące o swoich doświadczeniach w sieci

Introduction: The accessibility of websites for blind and visually impaired people results from international regulations (ONZ, 2006) and national regulations (Act, 2019a; Act, 2019b). People with visual disabilities are exposed to digital exclusion related to the lack of access to information resulting from the maladjustment of websites as well as limited access to appropriate software that facilitates the use of the Internet. Research Aim: The aim of the research was to learn the opinions of blind and visually impaired people regarding changes in the accessibility of websites of public and private institutions, to determine the barriers in access to the content posted on websites and to determine the opportunities offered by the Internet for blind and visually impaired people. Method: The diagnostic survey method and a tool – an original survey questionnaire were used. 102 blind and visually impaired people took part in the research. The Kruskal-Wallis H test as well as the Mann-Whitney U test were used in the statistical analysis. Results: The obtained results prove that there are statistically significant differences: in the assessment of the accessibility of websites of public institutions, banking and financial institutions; in using a screen reader (paid, free); in the use of subsidies from PFRON funds for the purchase of equipment/software conditioned by the level of education, degree of disability, gender and place of residence of the surveyed people. Conclusions: The accessibility of websites of public institutions has improved after the adoption of the Accessibility Act of 2019, partly also of private institutions. Blind and visually impaired people encounter financial and digital barriers related to access to the Internet, some of the respondents are exposed to digital exclusion, which makes it difficult to use the opportunities offered by the Internet.

Socio-economic inequalities in the breadth of internet use before and during the COVID-19 pandemic among older adults in England.

Understanding digital exclusion in older adults during the COVID-19 pandemic could help tailor responses to future outbreaks. This cohort study used data from older adults aged 60+ years in England who participated in wave nine (2018/2019) of the main English Longitudinal Study of Ageing (ELSA) survey, and/or wave one of the ELSA COVID-19 sub-study (June/July 2020). Using latent class analysis and latent transition analysis, we aimed to identify distinct subgroups of older adults characterised by different patterns of internet use pre- and intra-pandemic, explore the extent to which individuals remained in the same subgroup or transitioned to a different subgroup during the COVID-19 pandemic, and examine longitudinal associations of socio-economic factors (education, occupational class, and wealth) with latent class membership. Preliminary tests showed that the types of internet activities differed between men and women; therefore, subsequent analyses were stratified by biological sex. Three clusters (low, medium, and high) were identified in male participants at both timepoints. Among female participants, three clusters were distinguished pre-pandemic and two (low versus high) during the pandemic. The latent classes were characterised by participants' breadth of internet use. Higher education, occupational class, and wealth were associated with greater odds of membership in the medium and/or high classes, versus the low class, in men and women. A high degree of stability in latent class membership was observed over time. However, men experienced a stark decrease in online health information-seeking. Our results highlight that inequality regarding the range of functional and social opportunities provided by the internet prevailed during the pandemic. Policymakers should ensure that digital access and upskilling initiatives are equitable for all.

User factors affecting the use of digital services in five European regions and countries

Digitalisation has great potential to reduce costs, improve access and enhance user experience. However, it could also increase inequality, with some people struggling to access and use digital services. It is important to understand who is likely to be excluded in this way and why. This can help to identify groups at particular risk of digital exclusion, inform efforts to overcome the barriers, and develop more inclusive digital services. This paper introduces a set of five linked datasets examining a range of user factors affecting the use of digital services. The datasets focus on the use of digital mobility services, but the data is useful in understanding the use of other digital services as well. The user factors considered include technology access, use and competence and attitudes towards digital technology. The datasets were the results of surveys in five European regions and countries (Germany, Italy, Barcelona Metropolitan Area, Flanders and the Netherlands). Samples were taken of the adult (age 16+) population with a total of 3,454 participants.

Digital exclusion and cognitive impairment in older people: findings from five longitudinal studies

ObjectivesOlder people are more likely to have digital exclusion, which is associated with poor health. This study investigated the relationship between digital exclusion and cognitive impairment in older adults from 23 countries across five longitudinal surveys.Design and measurementsDigital exclusion is defined as self-reported non-use of the Internet. We assessed cognitive impairment on three dimensions: orientation, memory, and executive function. We used generalized estimation equations fitting binary logistic regression with exchangeable correlations to study the relationship between digital exclusion and cognitive impairment, and apply the minimum sufficiently adjusted set of causally directed acyclic graphs as the adjusted variable.Setting and participantsWe pooled a nationally representative sample of older adults from five longitudinal studies, including the China Health and Retirement Longitudinal study (CHARLS), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Study (HRS), the Mexican Health and Ageing Study (MHAS) and the Survey of Health, Ageing and Retirement in European (SHARE).ResultsWe included 62,413 participants from five longitudinal studies. Digital exclusion varied by country, ranging from 21.69% (SHARE) in Denmark to 97.15% (CHARLS) in China. In the original model, digital exclusion was significantly associated with cognitive impairment in all five studies. In the adjusted model, these associations remained statistically significant: CHARLS (Odds ratio [OR] = 2.81, 95% confidence interval [CI] 1.84–4.28, ELSA (1.92 [1.70–2.18]), HRS(2.48[2.28–2.71), MHAS (1.92 [1.74–2.12]), and SHARE (2.60 [2.34–2.88]).ConclusionOur research shows that a significant proportion of older people suffer from digital exclusion, especially in China. Digital exclusion was positively correlated with cognitive impairment. These findings suggest that digital inclusion could be an important strategy to improve cognitive function and reduce the risk of cognitive impairment in older adults.

Factors influencing effective data sharing between health care and social care regarding the care of older people: a qualitative evidence synthesis.

Sharing data about patients between health and social care organisations and professionals, such as details of their medication, is essential to provide co-ordinated and person-centred care. While professionals can share data in a number of ways - for example, through shared electronic record systems or multidisciplinary team meetings - there are many factors that make sharing data across the health and social care boundary difficult. These include professional hierarchies, inaccessible electronic systems and concerns around confidentiality. Data-sharing is particularly important for the care of older people, as they are more likely to have multiple or long-term conditions; understanding is needed on how to enable effective data-sharing. To identify factors perceived as influencing effective data-sharing, including the successful adoption of interventions to improve data-sharing, between healthcare and social care organisations and professionals regarding the care of older people. MEDLINE and seven further databases were searched (in March 2023) for qualitative and mixed-methods studies. Relevant websites were searched and citation-chasing completed on included studies. Studies were included if they focused on older people, as defined by the study, and data-sharing, defined as the transfer of information between healthcare and social care organisations, or care professionals, regarding a patient, and were conducted in the United Kingdom. Purposive sampling was used to obtain a final set of studies which were analysed using framework synthesis. Quality appraisal was conducted using the Wallace checklist. Stakeholder and public and patient involvement groups were consulted throughout the project. Twenty-four studies were included; most scored highly on the quality appraisal checklist. Four main themes were identified. Within Goals, we found five purposes of data-sharing: joint (health and social care) assessment, integrated case management, transitions from hospital to home, for residents of care homes, and for palliative care. In Relationships, building interprofessional relationships, and therefore trust and respect, between professionals supported data-sharing, while the presence of professional prejudices and mistrust hindered it. Interorganisational Processes and procedures, such as a shared vision of care and operationalisation of formal agreements, for example data governance, supported data-sharing. Within Technology and infrastructure, the use of technology as a tool supported data-sharing, as did professionals' awareness of the wider care system. There were also specific factors influencing data-sharing related to its purpose; for example, there was a lack of legal frameworks in the area of palliative care. Data-sharing was usually discussed in the context of wider initiatives, for example integrated care, which meant the information provided was often limited. The COVID-19 pandemic has had significant impacts on ways of working; none of our included studies were conducted during or since the pandemic. Our findings indicate the importance of building interprofessional relationships and ensuring that professionals are able to share data in multiple ways. Exploration of the impact of new technologies and ways of working adopted as a result of the COVID-19 pandemic on data-sharing is needed. Additionally, research should explore patient experience and the prevention of digital exclusion among health and social care professionals. The protocol was registered on PROSPERO CRD42023416621. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135660), as part of a series of evidence syntheses under award NIHR130538, and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

The Digital Inclusion Challenges Among Rural Migrant Employees – A Phenomenological Study

Abstract: The digital age demands proficiency in Information and Communication Technologies (ICTs) for economic success and social connection, especially in cities. However, young adults migrating from rural areas to Indian cities like Bengaluru often face digital exclusion. This study explores the challenges and psychological effects of this divide on young migrant employees (aged 21-25). Using interviews with 33 participants, the research identified key barriers: limited access to technology and the internet due to cost, lack of digital literacy skills, and anxieties around using unfamiliar tools. Furthermore, the study examined the psychological impact, drawing on theories of stress and coping (Lazarus & Folkman, 1984) and self-efficacy (Bandura, 1986). Digital exclusion can act as a stressor, leading to frustration, anxiety, and feelings of inadequacy. Low selfefficacy related to technology hinders motivation and perpetuates the cycle of exclusion. While acknowledging limitations in sampling, the research offers valuable insights into the experiences of young migrants. It highlights the psychological toll of digital exclusion and its impact on integration. These findings can inform policymakers and organizations to bridge the digital divide. Targeted interventions such as training programs, subsidized internet access, and user-friendly technology design can empower migrants and foster their success in the urban workforce

ICTS in Brazilian family farming: facing isolation and digital exclusion

The article records the evolution of primary data made by the Brazilian Institute of Geography and Statistics (IBGE) with the aim of understanding the progressive digital inclusion in the Brazilian rural world. We revisit in an updated perspective a survey that originates in 2006 and continues until 2022, relating the consumption of ICTs by Brazilian family farming. The importance of mobile phones is highlighted, anticipating the arrival of Smartphones and the Internet in rural areas. The exodus of young people, especially girls, is a reality even in family farming. Masculinization and aging are constant in rural reality, aspects that greatly contribute to the wear and tear of the social fabric. The analysis of the evolution of primary data on the presence of ICTs allows us to understand the characteristics of digital inclusion in the Brazilian rural world. At the end, we present our reflection on the potential of ICTs in the context of gender and generation relations for rural development policies.

Who is most at risk of digital exclusion within healthcare?

Abstract Introduction There has been a rapid growth in the use of digital technologies in healthcare to improve population health. However, due to digital exclusion (DE) (the unfair differences in motivation, access and use of these technologies), some demographic groups are unable to harness the health benefits of these technologies. Various frameworks have been designed to highlight groups vulnerable to health inequities, but none focus on DE. To provide better support for digitally excluded individuals, we must start by identifying demographic groups most at risk of DE. Aim Review the literature to identify demographic groups most at risk of DE within healthcare. Methods PubMed, Google Scholar and Scopus were searched on 22nd October 2022 in a non-systematic way to scope and examine emerging evidence surrounding groups at risk of DE within healthcare. English-language peer-reviewed articles and grey literature (e.g., government reports and regulatory organisation documents) identifying demographic groups at risk of DE and possible factors influencing exclusion were included. Search terms included words associated with DE and health inequity. Data extracted from the included articles included the different demographic groups highlighted and reasons for DE. Results Analysis of twenty-two included articles highlighted six common sociodemographic factors associated with DE that we compiled into six groups. These groups include Culture (ethnicity, language, religion), Limiting conditions (visual and hearing impairments), Education, Age, Residence (rural, deprived areas, homeless), and Socioeconomic status, forming the CLEARS framework. Cultural factors associated with DE included bias in artificial intelligence models used in healthcare technologies, low sensitivity in sensors when used across different ethnic backgrounds, and lack of consideration for different religious groups. Limiting conditions may make it difficult to use the technology, such as reading health information on small screens if visually impaired. Low educational attainment and old age (over 65) were frequently associated with poor digital literacy skills and poor understanding of the benefit of health technologies, thus reducing motivation and use of health technologies. Residential factors centred around barriers to accessing infrastructure to support connectivity (e.g. WiFi) and socioeconomic factors, including financial barriers to compatible devices and connectivity. Individuals who identify with two or more of these groups (intersectionality) are at even greater risk of DE. Conclusion This review identified six groups at risk of DE, the contributing reasons for exclusion, and the role of intersectionality. The CLEARS framework generated from this review can guide researchers and health technology developers in identifying groups that need to be involved in the co-design of digital health technologies to support inclusion. During the development of the CLEARS framework, groups in previous health inequities frameworks, such as the LGBTQ+ community, were considered, but later excluded due to the lack of representation within the literature. However, it is also important to recognise underserved groups are less likely to appear in the literature. Further work is needed to design tailored guidelines to support the development of inclusive digital health technologies that meet the needs of underserved groups.

P121 Understanding barriers to digital inclusion from Urdu speakers’ perspective: remote monitoring of rheumatoid arthritis

Abstract Background/Aims Chronic musculoskeletal conditions are more prevalent in South Asian (SA) communities, particularly for women and older adults, who face existing barriers in accessing healthcare services. Remote patient monitoring (RPM) has the potential to enhance management of long-term conditions like rheumatoid arthritis, offering insights into disease activity and supporting shared decision-making. However, SA communities in the UK and elsewhere, are commonly underrepresented in the development and evaluation of digital health technologies where language and other barriers may limit adoption and use. This research aimed to explore perspectives of Urdu speaking members of South Asian communities on barriers for engaging with RPM using an app designed for people with rheumatoid arthritis (RA). The focus on Urdu speakers provides an example to ensure RPM benefits South Asian communities, and particularly where language may be a barrier. Methods The study included nine participants, primarily females with one male participant, aged 55-75, who were Urdu speakers and diagnosed with or suspected of having RA. They were recruited from community organisations in Greater Manchester and introduced to the RPM app for monitoring symptoms. Semi-structured interviews were conducted in Urdu to investigate barriers to digital inclusion. The interviews were transcribed and analysed in Urdu (by Urdu speaking members of the team) with selective translation into English. Thematic analysis was used to identify themes and subthemes related to digital exclusion and strategies for addressing these issues. Results Participants’ responses were themed into five key areas concerning digital inclusion and potential solutions: 1. Existing use of digital devices and resources ; most expressed limited use of digital technology in day to day living, 2. Concerns about privacy ; some expressing caution and lack of confidence in security, 3. Views about symptom tracking; many were positive about tracking symptoms to share with doctors, though some said they would not want the constant reminder of their condition, 4. Barriers to engagement with the app; women, older individuals, and those with limited tech exposure, emphasizing the need for translated versions and family support, 5.Social Support to engagement with technology; Suggestions included workshops to improve digital literacy, translated materials (including audio) and reminders, as well as family support. Conclusion The study revealed challenges faced by women, older individuals, and those with limited tech exposure when using the app, emphasizing the need for translated versions and family support. The study also highlighted a need to consider intersectional dimensions of inequality for tailoring solutions. Overall, the study emphasizes the significance of tailored support and accessibility measures for the diverse communities like SA Urdu community when implementing digital health solutions. Disclosure Y. Masood: None. S. Ali: None. H. Chadwick: None. K. Staniland: None. S. van der Veer: None. W. Dixon: Consultancies; WGD has received consultancy fees from Google unrelated to this work. C. Sanders: None.

Navigating the labyrinth of social exclusion: a bibliometric review

Purpose This study aims to provide a comprehensive bibliometric analysis of social exclusion research, examining its evolution and identifying emerging trends and influential contributions in the field. Design/methodology/approach Using bibliometric and thematic analysis of 3,041 Scopus database documents, the study uses tools like VOSviewer for network analysis and Biblioshiny for trend analysis, focusing on publication patterns, author contributions and thematic clusters. Findings The findings reveal significant growth in social exclusion research since 1979, highlighting key contributions from diverse academic fields. Notable trends include the rise of digital exclusion and environmental justice themes. The study identifies leading authors, institutions and countries contributing to this field, along with highly cited documents that have shaped the discourse on social exclusion. Research limitations/implications The study acknowledges its reliance on Scopus data and suggests incorporating other databases for future research. It highlights the need to explore emerging topics and address literature gaps. Originality/value This paper presents a unique bibliometric perspective on social exclusion research, underscoring its interdisciplinary nature and evolving focus. The study’s comprehensive approach offers valuable insights into the field’s trajectory, contributing to a deeper understanding of social exclusion phenomena.

Using digital tools in clinical, health and social care research: a mixed-methods study of UK stakeholders

ObjectiveThe COVID-19 pandemic accelerated changes to clinical research methodology, with clinical studies being carried out via online/remote means. This mixed-methods study aimed to identify which digital tools are currently used...

Guidance on how to involve people with lived experience in research on digital mental health interventions

IntroductionDigital technologies and interventions (defined as patient-facing or self-administered interventions delivered through a digital platform) have an increasing role in mental health care. It is key to ensure that appropriate patient and public involvement (PPI) is not overlooked when developing new digital mental health interventions (DMHIs). The unique perspective offered by those with lived experience can improve study conduct and design as well as ensure that interventions meet the needs of users, which may improve their quality and acceptability.ObjectivesTo develop guidance for the involvement of people with lived experience of severe mental illness in designing and conducting research on DMHIs.MethodsFour co-production workshops were arranged online with people who have lived experience of severe mental illness. Initial ideas were formulated in the first workshop and were then prioritised in the second workshop using the nominal group technique. The prioritised ideas were then refined in workshops three and four. Minutes were generated from each workshop and were validated by the those who took part. These minutes were analysed using thematic analysis.ResultsNineteen people with lived experience participated in the co-production workshops overall. Six people took part in one workshop only and 13 took part in multiple workshops. Two main themes were identified in this study: why do people become and remain involved in PPI?; and what areas should be discussed within PPI consultations? Three subthemes associated with the second theme were also identified. These are: areas related to specific types of DMHI; areas related to any type of DMHI; and what can make a difference within DMHIs? To ensure that people become and remain interested in PPI around DMHIs, it is important to provide a non-judgemental space for people with lived experience to discuss any concerns and ensure they feel valued during consultations. Aspects to consider discussing in PPI consultations around the development of DMHIs include the provision of safety and security within DMHIs, issues around digital exclusion and the potential impact of people’s symptoms on DMHI use. Finally, points that were identified as important to consider when developing DMHIs include offering encouragement throughout the DMHI, accommodating for individual and collective needs within DMHIs and developing a structure within the DMHI which includes adding in attainable goals.ConclusionsIf used, the information provided from this study can generate positive and productive PPI consultations where those with lived experience can make significant contributions to the development of DMHIs. Such contributions will increase the acceptability and efficacy of the DMHIs developed.Disclosure of InterestNone Declared

A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation.

Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation. Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies. Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa. A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.

Digital Currencies: Is Africa Ready?

Digital currencies are likely to modify the way businesses, people and governments transact in Africa. Nonetheless, several factors need to be assessed before the wide adoption of digital currencies in the continent. These factors include the regulatory environment for fintech, the condition of digital infrastructure and the degree of financial inclusion. This paper assesses the readiness of African countries for the issuance of digital currencies. The paper gives an overview of the African countries that have implemented or are considering implementing digital countries. It discusses the issues to be considered for a conducive environment to launch digital currencies. It explores the opportunities and challenges of developing and issuing digital currencies in Africa. The paper finds that although the developed mobile money network infrastructure, high mobile money penetration, the growth of the digital economy and high degrees of financial exclusion position Africa well for the adoption of central bank digital currencies (CBDCs), several challenges need to be addressed. These encompass lower levels of financial inclusion, digital exclusion, the digital divide, poor digital infrastructure and regulatory uncertainty. The paper provides recommendations for improving the prospects of digital currencies in Africa. These include the creation of a legal and regulatory framework for digital currencies, investing in digital infrastructure, improving internet connectivity and educating citizens on digital currencies. Digital currencies can lead to improved economic growth, increase cross border payments, promote financial inclusion and sustainable development Keywords: Africa, Digital Currencies, Digital Infrastructure, Financial Inclusion, legal, regulatory environment

The digital divide in action: how experiences of digital technology shape future relationships with artificial intelligence

AbstractThe digital divide remains an ongoing societal concern, with digital exclusion shown to have a significantly detrimental impact on people’s quality of life. Artificial intelligence (AI), the latest wave of digitalisation, is being integrated into the fabric of society at an accelerated rate, the speed of which has prompted ethical concerns. Without addressing the digital divide, the AI revolution risks exacerbating the existing consequences of digital exclusion and limiting the potential for all people to reap the benefits provided by AI. To understand the factors that might contribute to experiences of AI, and how these might be related to digital exclusion, we surveyed a diverse online community sample (N = 303). We created a novel measure of digital confidence capturing individual levels of awareness, familiarity, and sense of competence with digital technology. Results indicated that measures of digital confidence were predicted by structural, behavioural, and psychological differences, such that women, older people, those on lower salaries, people with less digital access, and those with lower digital well-being, reported significantly less digital confidence. Furthermore, digital confidence significantly moderated the relationship between people’s experiences with everyday AI technologies and their general attitudes towards AI. This understanding of the spill-over effects of digital exclusion onto experiences of AI is fundamental to the articulation and delivery of inclusive AI.

Industry 4.0 in Finance, Digital Financial Services and Digital Financial Inclusion in Developing Countries: Opportunities, Challenges, and Possible Policy Responses

Fintech and the adoption of Fourth Industrial Revolution (industry 4.0) technologies have expanded the provision and uptake of digital financial services (DFSs) globally. Digital transformation in the financial industry intended to modify financial service provisioning by reducing the costs of accessing and challenges such as inaccessibility due to remoteness, not having a bank account, not having a credit history, or having erratic incomes. Digital financial inclusion (DFI) aims to ensure that financial services, such as deposits, payments, transfers, withdrawals, investments, accessing insurance and credit, checking account balances, receiving money, and making international remittances, are conducted conveniently, easily, safely, reliably, and affordably. DFI focuses on ensuring access to financial services through digital channels and platforms for individuals, businesses, and households, to promote financial inclusion for all stakeholders, especially previously financially excluded groups. Through a critical review of the literature, this study explores the opportunities and challenges of DFI or the adoption and use of DFS. The review unpacks the possible benefits of using DFSs, which include the broadening financial inclusion, increasing diversity and innovation in the financial services sector, attainment of the SDGs, reduction of poverty, increased economic growth, and minimization of the gender financial inclusion gap, as well as reduction in inequalities. The constraints include the inadequacy of digital infrastructure, taxes on DFS, literacy challenges, digital exclusion, poverty and the gender divide, risks, and lack of trust in the financial services sector. The study recommends appropriate regulation and oversight, literacy enhancement initiatives, investment in digital infrastructure, and increased consumer protection as measures to improve DFI in developing countries.

‘Taking the router shopping’: How low-income families experience, negotiate, and enact digital dis/connections

Within digital media scholarship, there are significant bodies of literature investigating forced disconnection (‘digital exclusion’) and voluntary disconnection (‘digital disconnection’) but there is little research addressing entanglements between them. This article explores how bringing together these bodies of literature through an empirical study offers new pathways and considerations for both areas. In doing so, we draw on qualitative data about the forms of disconnection experienced, negotiated, and enacted by low-income families in regional Australia before and during their participation in a digital inclusion initiative that provided them with Internet connections and laptops. We argue that their experiences illustrate the complex interplay of voluntary and involuntary factors that shape socially situated practices of disconnection. We also identify further implications for inclusion and disconnection research, including the need to recognise that within digital inclusion initiatives, participants’ non-use of provided technologies does not necessarily indicate failure but may instead be a positive outcome.

Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services.

The popularity of eHealth services has surged significantly, underscoring the importance of ensuring their usability and accessibility for users with diverse needs, characteristics, and capabilities. These services can pose cognitive demands, especially for individuals who are unwell, fatigued, or experiencing distress. Additionally, numerous potentially vulnerable groups, including older adults, are susceptible to digital exclusion and may encounter cognitive limitations related to perception, attention, memory, and language comprehension. Regrettably, many studies overlook the preferences and needs of user groups likely to encounter challenges associated with these cognitive aspects. This study primarily aims to gain a deeper understanding of cognitive accessibility in the practical context of eHealth services. Additionally, we aimed to identify the specific challenges that vulnerable groups encounter when using eHealth services and determine key considerations for testing these services with such groups. As a case study of eHealth services, we conducted qualitative usability testing on 2 online symptom checkers used in Finnish public primary care. A total of 13 participants from 3 distinct groups participated in the study: older adults, individuals with mild intellectual disabilities, and nonnative Finnish speakers. The primary research methods used were the thinking-aloud method, questionnaires, and semistructured interviews. We found that potentially vulnerable groups encountered numerous issues with the tested services, with similar problems observed across all 3 groups. Specifically, clarity and the use of terminology posed significant challenges. The services overwhelmed users with excessive information and choices, while the terminology consisted of numerous complex medical terms that were difficult to understand. When conducting tests with vulnerable groups, it is crucial to carefully plan the sessions to avoid being overly lengthy, as these users often require more time to complete tasks. Additionally, testing with vulnerable groups proved to be quite efficient, with results likely to benefit a wider audience as well. Based on the findings of this study, it is evident that older adults, individuals with mild intellectual disability, and nonnative speakers may encounter cognitive challenges when using eHealth services, which can impede or slow down their use and make the services more difficult to navigate. In the worst-case scenario, these challenges may lead to errors in using the services. We recommend expanding the scope of testing to include a broader range of eHealth services with vulnerable groups, incorporating users with diverse characteristics and capabilities who are likely to encounter difficulties in cognitive accessibility.