Digital Exclusion Research Articles

Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.

ЦИФРОВЫЕ СРЕДСТВА КОММУНИКАЦИИ В УНИВЕРСИТЕТСКОМ ПРОФСОЮЗЕ ЦИФРОВЫЕ СРЕДСТВА КОММУНИКАЦИИ В УНИВЕРСИТЕТСКОМ ПРОФСОЮЗЕ

The digital transformation of society and higher education affects university trade unions today, especially the sphere of communicative interaction between members of a trade union organization. The introduction of digital communication and information exchange tools has become a daily practice of modern university trade unions. However, representatives of the university trade union have different attitudes towards the use of digital communication tools, perceive their risks, and have different preferences in choosing certain communication tools. The purpose of the article is to identify the attitude of university trade union members to digital communication methods and their impact on various aspects of the life of university trade unions. A study conducted in 2023 in a number of universities in the Ural Federal District showed that members of university trade unions are generally ready to use digitalization tools to intensify communication and quickly achieve their goals. However, the trade union community is clearly aware of the risks of digital communication, including digital exclusion, increased information noise and reduced cohesion.

Abstract P318: English and Spanish-Speaking Patient Preferences on Home Blood Pressure Monitors: A Qualitative Study in an Urban Safety Net Setting

Background: Self-measured blood pressure (SMBP) monitoring improves hypertension (HTN) control. Adoption of SMBP monitoring is lower among low-income or minoritized patients, who have higher rates of uncontrolled HTN. Little is known about these patients’ preferences for or challenges with SMBP monitoring. Objective: We explored patient perspectives on SMBP monitoring among patients receiving care at an urban safety-net system. Methods: We interviewed English and Spanish-speaking patients with HTN about preferences for different BP monitoring devices and their accompanying mobile apps, past experiences sharing BP data with their clinical care team, and knowledge about home BP monitoring. Interviews were conducted in the participants’ preferred language. We also asked participants to demonstrate a home BP measurement to evaluate their measurement technique. We presented two BP monitoring devices: a Bluetooth-enabled device and a cellular-enabled device. Rapid qualitative data analysis was used to analyze data. Results: Of the 15 participants (8 English-speaking; 7 Spanish-speaking), eight identified as Latine, four as Black or African American, one as American Indian/Native American, one as Asian/Pacific Islander, and one as multi-ethnic. Highest educational attainment varied: five less than high school, five high school/GED, and five college. Most required assistance with Bluetooth pairing to share data and navigating app features. All participants valued tracking their BP and were motivated to engage in SMBP monitoring but desired more training. Nearly all participants demonstrated inadequate BP knowledge and incorrect BP measurement techniques based on AHA/AMA recommendations. Few reported receiving training on SMBP monitoring techniques. Spanish speakers reported that using apps was challenging due to language discordance and wanted translated apps and resources. Costs related to device features were a key factor in preferences. Conclusions: Patient-reported barriers to SMBP adoption include cost, insufficient training, digital exclusion, and language discordance. Addressing these challenges may increase adoption of SMBP monitoring in safety-net populations. Clinicians should consider patients’ preferences when recommending SMBP monitoring. Cellular SMBP devices that automatically transmit BP readings may mitigate challenges with digital literacy and promote data sharing with clinical care teams, though future studies are needed to evaluate usability.

How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self-Management Solution.

Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app. (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.

Digital Exclusion, Social Deprivation, and Clinical Outcomes of Patients Undergoing Hyperacuity Home Monitoring.

Digital exclusion is a growing challenge when deploying digital patient care pathways and a potential barrier to widespread implementation, especially in the field of smartphone-based self-monitoring of vision. This retrospective case series seeks to examine the characteristics of individuals who adhere to a smartphone homemonitoring programme using the Alleye app for retinal disease, with a focus on digital exclusion, social deprivation and clinical outcomes. We conducted a retrospective analysis of 89 patients with retinal pathologies including diabetic retinopathy and retinal vein occlusions at Moorfields Eye Hospital participating in an Alleye homemonitoring programme between April 2020 and November 2022. Postcodes were used to determine the Digital Exclusion Risk Index (DERI) and the Index of Multiple Deprivation (IMD) rebased for London. Clinical information from the electronic patient record and Alleye app usage data were extracted for each patient. Associations between the DERI/IMD, clinical parameters and app use were examined using multivariable regression models. Mean DERI was 2.56 (standard deviation [SD] = 0.36), IMD was 6.25 (SD = 2.79), visual acuity (VA) in the better eye at study entry was 83.28 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (SD = 7.92), and mean follow-up was 344.46days (SD = 260.13). During the observation period, 36% received an intravitreal injection (IVI) and VA fell by at least ten letters in approximately one in four patients. In 87.5% of patients requiring IVI, the use of the app increased. We found no association between clinical parameters and programme adherence for DERI or IMD. We found no association between high digital exclusion risk and high social deprivation with monitoring adherence to smartphone-based self-monitoring of vision, contrary to the currently available evidence. This suggests that smartphone-based self-monitoring of vision is accessible to population groups of varying digital exclusion and social deprivation risk, and can be safely employed to monitor clinical progression.

Identifying and understanding digital exclusion: a mixed-methods study

ABSTRACT Many of our transactions and interactions are now exclusively online; however, whilst we live in a world which is becoming ubiquitously digital, digital exclusion remains a complex societal issue. This study aimed to identify the scale and characteristics of ‘digitally excluded’ individuals in one borough in North East England and investigate factors influencing experiences of digital exclusion. A two-phase, sequential explanatory mixed-methods design was used. Phase One utilised a survey which was sent to every household in the borough (N = >98,000). The surveys (N = 9181) were analysed using exploratory univariate analysis, followed by a two-staged regression model. Of those responses, 1130 individuals (12.3%) were identified as digitally excluded. Older adults with disability, no or low-level education, and residing in specific (micro) geographical areas, were at higher risk of digital exclusion. Smaller household sizes and lower income also contributed to digitally exclusion. To further enhance inclusivity, three focus groups were conducted with groups who were identified as being at higher risk of digital exclusion (N = 10). Discussions highlighted the complexities of digital exclusion and digital use across communities and within individual circumstances. Digital exclusion is multi-factored and complex. It requires regional institutions and local communities to collaborate in an integrated governance framework to improve digital inclusion.

Somebody who understands the culture and their needs that can cater for them in their retirement time: a peer research study exploring the challenges faced by British Muslims with palliative care needs during the COVID-19 pandemic

BackgroundInequities in palliative and end-of-life care access exist, with evidence of lower uptake of these services among people from the British Muslim community. Little research exists exploring the experiences of...

What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal study.

Background Since 2022, general practice has shifted from responding to the acute challenges of COVID-19 to restoring full services, using remote and digital modalities as well as traditional in-person care. Aim To examine how quality domains are addressed in contemporary UK general practice. Design and setting Multi-site, mostly qualitative longitudinal case study, placed in national policy context. Method Data were collected from longitudinal ethnographic case studies of 12 general practices (2021-2023); multi-stakeholder workshops; stakeholder interviews; patient surveys; official reports; and publicly-accessible patient experience data. Data were coded thematically and analysed using Institute of Medicine domains, Starfield's core features of primary care and sociological and socio-technical theories. Results Quality efforts in UK general practice occur within cumulative impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, infrastructure unfit for purpose, and distanciated ways of working. Providing the human elements of traditional general practice is difficult and sometimes impossible. Triage systems designed to increase efficiency have introduced new forms of inefficiency and compromised other quality domains. Long-term condition management varies in quality; amidst some convenience gains, some practices rely on remote, asynchronous data entry by patients and fragmented care by underqualified staff. Measures to mitigate digital exclusion do not compensate for extremes of structural disadvantage. Many staff are stressed and demoralised. Conclusion Contemporary hybrid general practice features changes with the unintended effect of dehumanising, compromising and fragmenting care. Risks to patients and the core values of general practice should be urgently addressed.

Student Support for Incarcerated Females in an Open Distance e-Learning Institution

In South Africa, higher education is a constitutionally enshrined basic human right and one of the cornerstones for accomplishing the ideals of offenders’ rehabilitation and preparation for life beyond bars. However, acquiring higher education whilst serving a sentence in a correctional centre is compounded by many institutional challenges especially towards incarcerated female students. Framed by the transactional distance theory (TDT), the qualitative study from which this paper emanates, used purposive and snowball sampling to recruit twenty-nine female distance learning students incarcerated at four female correctional centres across three provinces in South Africa. Based on the thematic content analyses of the data, the findings indicate that there is restricted access to learning resources, and that online participation in both learning and assessment is affected by erratic internet connectivity caused by UNISA-DCS hubs (computer laboratories) due to the security-focused nature of the correctional centres. Furthermore, the lack of direct access to the internet, smartphones, or internet‐enabled devices exacerbates the digital marginalisation and exclusion of incarcerated students which engenders feelings of despondency against a system that is meant to empower them. Thus, owing to these findings, the paper recommends that practitioners, researchers, and policymakers must endeavour to design not only inclusive, but correctional centre-friendly student support. This entails acknowledging that incarcerated students do not have 24/7 access to the internet, the technological gadgets that make online learning possible and some incarcerated students having limited digital literacy. There is a need to design learning policies and strategies that are flexible to enhance the learning experiences and graduateness of incarcerated students.

Towards a Digitalised Criminal Justice System: Lessons from Poland

The Covid-19 pandemic has expedited technological advancements within the Polish criminal justice system, notably through the integration of remote communication tools for legal proceedings. This paper examines the introduction and impact of remote hearings, including those for detention on remand, arguing for the expansion of remote hearings beyond cases where the defendant is in custody. It highlights the existing legal framework's limitations, such as the conditional telephone contact between a defendant and their defense counsel, which infringes on the right to defense due to the lack of confidentiality and effectiveness in legal assistance. Furthermore, the paper discusses the potential benefits of digitizing criminal proceeding files, including improved efficiency, accessibility, and the safeguarding of the fair trial principle. Despite potential drawbacks like digital exclusion and security concerns, the implementation of a unified digital system across all courts is proposed to facilitate data exchange and streamline proceedings. Additionally, the paper addresses the limitations of replacing human interpreters with automated translation software in criminal proceedings, emphasizing the necessity of human oversight to ensure fair trial guarantees. The study suggests a hybrid approach to translation that combines machine translation with human verification, drawing parallels with GDPR provisions for human intervention in automated decision-making processes.

New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

BackgroundInnovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse.MethodsWe mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively.ResultsOne hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves).ConclusionsWe found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.

A fissura digital

Jan Van Dijk's The Digital Divide explores the complex dynamics of the digital divide and its profound implications for contemporary society. Van Dijk reveals how digital exclusion exacerbates socioeconomic disparities, making marginalized communities more vulnerable to cybercrime and hindering their access to economic opportunities and social integration. Van Dijk's work underscores the urgent need for concerted efforts by academia, policymakers and practitioners to address the digital divide and promote a more equitable digital future.

The Dual Risks of Digital Exclusion and Unaffordability of Telecommunications in Lower‐Income Australian Households

AbstractWe analyse household telecommunications spending in Australia over the period 2006–2021 using Household Income and Labour Dynamics in Australia (HILDA) survey data. We find the affordability of telecommunications is improving, and that telecommunications spending behaves like other core necessities, such as food. We find households in which members are not employed, have relatively low education, are elderly, Aboriginal or Torres Strait Islanders or immigrants, speak English poorly, reside alone, or have long‐term health conditions are at heightened risk of digital exclusion due to lower spending on telecommunications. Households located in rural areas, with children or with members that work from home are at higher risk of digital exclusion as a consequence of overspending on telecommunications. Overall, the number of people at risk of digital exclusion from inadequate spending or overspending is quite small in Australia. The risks appear to have decreased during COVID‐19. Telecommunications is a core necessity but given the small number of people at risk of exclusion, policies addressing affordability should be highly targeted.

The Double Burden: The Digital Exclusion and Identity Crisis of Elderly Patients in Rural China

The rapid digitalization of China’s healthcare system, a phenomenon that accelerated during the Covid-19 pandemic, had two negative consequences for a significant portion of elderly persons in China. The first is an unfortunate practical outcome: their exclusion from many health services such as online medical appointment platforms, e-prescription requests, obtaining e-referrals, and sharing electronic medical records. The second is an emotionally debilitating identity crisis as elderly persons’ former status as knowledgeable senior mentors was replaced with social perceptions of them as helpless and ignorant souls reliant on more youthful persons for guidance and assistance. This article adopts a grounded theory to explore the phenomenon from the perception of excluded elderly persons using participatory observation and in-depth interviews of 44 elderly clients of a rural hospital in the Shandong province in eastern China. The study shows that the current focus on direct practical aspects of digital exclusion may fail to capture the impact and ancillary consequences such as a painful loss of self-esteem by the digitally excluded. As the study illustrates, the practical aspects can all be overcome through intervention by those who aid the digitally excluded but this help may exacerbate the rarely considered ancillary harms of digital exclusion. Studies of digital exclusion will make more significant contributions to our understanding of the phenomenon if they look beyond the obvious direct consequences of digital exclusion to consider possible ancillary and flow-on effects.

The problem of digital exclusion and the computerization of court proceedings on the example of the institution of consumer bankruptcy

The problem of digital exclusion and the computerization of court proceedings on the example of the institution of consumer bankruptcy

Lessons learned from a multi-site collaborative working toward a digital health use screening tool.

Digital health has the potential to expand health care and improve outcomes for patients-particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients' needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients' readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity.

INCREASING OR DECREASING FRUGALITY: THE CONNECTION BETWEEN DIGITALISATION AND FRUGAL INNOVATION

Within wider debates on sustainability and digitalisation, frugal innovation (FI) scholars largely assume that digital technologies are important for FI in realising more sustainable outcomes. However, very few studies interrogate this causality. To tackle this challenge, we connect FI with digitalisation. Thereto, we conceptualise digital technologies as and within FIs and discuss three frugality dimensions to analyse three empirical case studies of digitally-enabled FIs. We use these cases to introduce new nuances on how digitalisation affects frugality and scaling. Our results unveil that digitalisation can increase frugality by enabling more accessible and affordable solutions through new flexible funding schemes and pay-as-you-go models. However, our evidence also implies decreasing frugality by an increase in end-user costs and digital exclusion. Likewise, increasing frugality through complexity reduction seems mainly to benefit intermediaries and frugal innovators themselves, whereas benefits of digitalisation in terms of complexity reduction for end-users seem to be limited. Digitalisation can even increase complexity for end-users, thus suggesting decreasing frugality. Finally, just like with non-digital innovations, scaling of digitally enabled innovations is dependent on the quality of logistical infrastructure and local adaptation practices. Moreover, scaling of digitally-enabled innovations is limited to users in regions with a proper ICT infrastructure.

The perspectives of doing, being, belonging, becoming on older homecare recipients’ use and experiences with technologies in the Assisted Living Project in Norway

ABSTRACT The Assisted Living project (2016-2019) aimed to investigate older adults’ needs for digital technology for daily support and to develop technology solutions in collaboration with the user group. This paper presents data extracted from three sub-studies: Sub-study 1 investigated older homecare recipients’ use of and attitudes towards digital technology, sub-study 2 explored assisted living residents’ needs and requirements for technology, and sub-study 3 explored their experiences with environmental sensor technology to support safety and daily living. The aim was to explore how the occupational science concepts of doing, being, belonging, and becoming can provide a deeper understanding of technology use among participants in the Assisted Living Project. This study demonstrates that for older adults in the Assisted Living project to become technology users required both personal motivation and cognitive capacity for learning to use the device and become familiar with the technology, and access to internet and digital tools. Digitalization in society leads to new challenges for all citizens, especially those who are less familiar with using digital technology. By applying an occupational science perspective to technology use, this paper contributes to creating awareness about digital exclusion and occupational injustice. It provides a deeper understanding of use and non-use and the digital divide, such as the consequences of not having access to digital healthcare services, that may lead to breaches of democratic human rights.

The Capabilities Divide: ICT Adoption and Use among Bedouin in Israel

ABSTRACT The Bedouin community, a subpopulation of the Arab minority in Israel, has been subject to systematic discrimination throughout the state’s history, including in accessibility to digital services. Based on 25 semi-structured, in-depth interviews with Bedouin men and women residing in unrecognised villages – townlets that are not legally designated as municipal entities by the state and therefore lack basic infrastructure – this study asks whether and how the capabilities approach can be used to assess and examine ICT usage among the Bedouin as a marginalised community with distinct needs. The analysis illuminates the tensions and contradictions that characterise their digital experiences and shows that the capabilities approach is particularly apposite for understanding digital exclusion while compensating for the shortcoming of the digital divide framework. The findings uncover the ubiquitous presence of mobile smartphones among Bedouin users as the central enabler of their desired capabilities while pointing out the vital place religion plays in the community members’ decision-making regarding the use of ICTs for the realisation of their desired capabilities.

Teachers' situated knowledge: Addressing digital exclusion in rural contexts

This study delves into the intricate challenges surrounding incorporating information and communication technologies (ICTs) in education, particularly in regions characterized by digital exclusion, such as rural areas. By recognizing the potential of ICTs to support and expand student learning opportunities, this research explores the necessity for effective implementation through tailored professional development aligned with teachers' contextual conditions and needs. In addressing these challenges, the study explores the concept of technological appropriation, underscoring the significance of individual and contextual elements in adapting ICTs to users' specific needs and environments. Through unstructured face-to-face interviews with 21 teachers immersed in a digitally vulnerable rural context, this research unveils insights into how educators’ appropriate technologies to enhance student learning. The findings of this study contribute to the development of educational practices tailored to rural contexts, focusing on providing a meaningful and effective learning experience for students. By shedding light on teachers' strategies for navigating the digital landscape in challenging environments, the research aims to inform policies and practices that bridge the technological gap, ultimately fostering equitable access and enhanced educational outcomes in rural settings.