Digital Inequity Research Articles

Social Media and Digital Inequity: Reducing Health Inequities by Closing the Digital Divide

As its usage has grown, social media has positively and negatively impacted public health. Although social media presents known harms to mental health and spreads misinformation, it also offers rapid dissemination of public health information, expanded access to health resources, and a robust source of health information. However, these benefits are not equitably shared due in part to the “digital divide” of unequal access and use of information and communication technologies. Measurable inequalities in digital access exist among regions, with an eight-fold difference between Central Africa (9.8% social media penetration) and Northern Europe (80.2% social media penetration). Digital inequalities also differ by gender, age, and socioeconomic classes within countries. Increased digital access has been positively associated with improved health information and outcomes related to chronic diseases, infectious disease outbreaks, and reproductive health. Given the expanding role of social media in public health and the emerging evidence on the health benefits of digital access, we argue for reducing digital inequities by (1) creating an enabling government policy and regulatory environment that views digital health access as a social determinant of health; (2) targeting public and private investments to expand digital access for underserved regions and populations; (3) making digital access and use affordable to low-resource populations; and (4) improving digital competency among these groups through digital literacy programs.

Digital Divide Among Homebound and Semi-Homebound Older Adults.

Using the 2022 National Health and Aging Trend Study data, we examined the digital divide among homebound and semi-homebound older adults. About 11% of older Medicare beneficiaries in 2022 were homebound or semi-homebound. Compared to non-homebound older adults, homebound older adults were significantly less likely to own a cellphone. Among those with any information and communication technology (ICT) device, homebound older adults were also less likely to have used email/texting and gone online. Older age, low income, dementia diagnosis, and moderate/severe depressive/anxiety symptoms contributed to the digital divide. Among homebound older adults, Hispanic older adults or those with limited English proficiency were less likely to have used ICT. To reduce the digital inequity among homebound older adults who are low-income, racial/ethnic minority, limited English proficient, and/or residents in non-metropolitan areas, social/structural inequities in accessibility and affordability, along with individual-level barriers, need to be addressed.

The impact of digital inequities on salivary gland cancer disparities in the United States.

Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC). The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality. Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods. Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.

Scientometric analyses of digital inequity in education: problems and solutions

There are several gaps in the field of digital inequity in education because it is still in its initial stage. To fill the research gaps, this study has revealed a complex landscape of problems and solutions. The analysis highlights the urgent need to address digital inequity that prevents equal access to educational resources and opportunities. While the challenges are numerous, the solutions are also diverse. Addressing cultural norms and stereotypes that perpetuate gender-based inequity is crucial, along with investing in gender-sensitive technology and infrastructure. Promoting digital literacy among all learners is also essential to empower them in the digital age. By taking a comprehensive approach that combines policy changes, technological advancements, and educational strategies, we can hope to bridge the digital inequity and create a more equitable and inclusive education system. Future research could highlight cross-cultural and cross-contextual studies, longitudinal studies, and integration of multiple methodologies.

Quilombola women confronting digital discrimination in Brazil

This work discusses the relationship between digital disconnection and the violation of rights in Quilombola territories. Quilombolas are an ethnic-racial group with Black origins associated with oppression and resistance over the centuries in Brazil. The research was conducted with 41 women aged between 18 and 73 who are leaders in 35 remaining Quilombola communities in Minas Gerais, Brazil. The impacts of limited access to information and communications technology (ICT) were assessed using an intersectional perspective, considering social markers of difference such as gender, social class, ethnic-racial belonging, and territory. The results show that 11 territories lack internet service, significantly restricting access to information, health, education, and social participation. The research points to the need for considering digital inequity as another matrix of intersectional oppression, as being disconnected or having restrictions on access and use of ICT increases the vulnerability of these territories, especially for the Quilombola women.

Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study.

Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population.

M28 - RAE cHealth: A Digital Tool to Support Peer Recovery-Based Treatment for Substance Use Disorder and to Reduce Digital Inequity

M28 - RAE cHealth: A Digital Tool to Support Peer Recovery-Based Treatment for Substance Use Disorder and to Reduce Digital Inequity

Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches.

In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. Based on the Arksey and O'Malley framework, this scoping review will consider priority communities' equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review's objectives. This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. DERR1-10.2196/53855.

Population ageing, incarceration and the growing digital divide: Understanding the effects of digital literacy inequity experienced by older people leaving prison.

Digital inequity refers to the inequality and exclusion experienced by those who lack the same opportunities or circumstances to support the development of digital skills as the rest of modern society. One rapidly growing and highly vulnerable group to digital inequity is older people attempting to reintegrate into society after release from prison, where technology access is limited. Inadequate support for digital skills in this population entails widespread consequences for public health, human rights, social welfare and recidivism. This qualitative study is the first to: examine digital inequity experienced by older people who have been incarcerated, understand the effects of this on reintegration to society, and begin informing appropriate solutions. Semi-structured interviews were conducted with N = 15 older people (mean age = 57) who had been released from an Australian prison in the last two years, regarding their experiences of digital literacy since leaving prison. Reflexive thematic analysis was conducted under a critical realist lens. The analysis resulted in six themes that illustrated the extent of digital inequity experienced by this population, and key challenges for improving digital literacy: 'surviving in a digital world', 'stranger in a foreign world', 'questioning the digital divide', 'overcoming your "old" self', 'don't like what you don't know', and 'seeking versus finding help'. The digital inequity that older people experience during and after incarceration creates additional challenges for a growing group who are already medically and socially marginalised. Prioritisation of this group for digital literacy initiatives both during incarceration and in the community will have benefits for their health, social and financial reintegration. Their unique life experiences should be considered in designing and delivering these programs. Simultaneously, prisons should be cognizant of the potential detrimental effects of technology restriction on reintegration and criminogenic outcomes.

Digital Equity and School Leadership in a Post-Digital World

Purpose This study analyzes digital equity realities in U.S. K-12 schools and the role that school leadership plays in digital equity. Design/Approach/Methods Based on Selwyn’s conception of technology as three interlocking elements (access, educational practices, and social context), we applied the ideals of equity and social justice to each of the three elements to conceptualize a framework of digital equity, situating school practice in the larger social, cultural, and political context of the United States. Guided by this framework, we conducted a systematic literature review of the current state of digital equity and school leadership in K-12 schools. Findings The findings demonstrate that U.S. K-12 schools face digital inequity issues, including inequitable access to technology, exclusionary and punitive educational practices using technology, and an unjust social context for technology in schools. These findings indicate that school leadership plays an important role in digital inequity. Originality/Value Based on these findings, we present a framework to assist K-12 leaders in enhancing digital equity, including addressing educational inequities and creating an inclusive social context for the school, ensuring equitable accessibility to technology in schools, and supporting teachers in developing meaningful and equitable practices using technology to address the opportunity gaps encountered by marginalized learners.

Artificial intelligence in neurology: opportunities, challenges, and policy implications.

Neurological conditions are the leading cause of disability and mortality combined, demanding innovative, scalable, and sustainable solutions. Brain health has become a global priority with adoption of the World Health Organization's Intersectoral Global Action Plan in 2022. Simultaneously, rapid advancements in artificial intelligence (AI) are revolutionizing neurological research and practice. This scoping review of 66 original articles explores the value of AI in neurology and brain health, systematizing the landscape for emergent clinical opportunities and future trends across the care trajectory: prevention, risk stratification, early detection, diagnosis, management, and rehabilitation. AI's potential to advance personalized precision neurology and global brain health directives hinges on resolving core challenges across four pillars-models, data, feasibility/equity, and regulation/innovation-through concerted pursuit of targeted recommendations. Paramount actions include swift, ethical, equity-focused integration of novel technologies into clinical workflows, mitigating data-related issues, counteracting digital inequity gaps, and establishing robust governance frameworks balancing safety and innovation.

The Impact of Digital Inequities on Esophageal Cancer Disparities in the US

Background: There is currently no comprehensive tool that quantifiably measures validated factors of modern technology access in the US for digital inequity impact on esophageal cancer care (EC). Objective: To assess the influence of digital inequities on esophageal cancer disparities while accounting for traditional social determinants. Methods: 15,656 EC patients from 2013–2017 in SEER were assessed for significant regression trends in long-term follow-up, survival, prognosis, and treatment with increasing overall digital inequity, as measured by the Digital Inequity Index (DII). The DII was calculated based on 17 census tract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure access or sociodemographic, ranked, and then averaged into a composite score. Results: With increasing overall digital inequity, significant decreases in the length of long-term follow-up (p < 0.001) and survival (p < 0.001) for EC patients were observed. EC patients showed decreased odds of receiving indicated surgical resection (OR 0.97, 95% CI 0.95–99) with increasing digital inequity. They also showed increased odds of advanced preliminary staging (OR 1.02, 95% CI 1.00–1.05) and decreased odds of receiving indicated chemotherapy (OR 0.97;95% CI 0.95–99). Conclusions: Digital inequities meaningfully contribute to detrimental trends in EC patient care in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national, sociodemographic trends of the impact of online access on informed care.

Development and feasibility testing of an artificially intelligent chatbot to answer immunization-related queries of caregivers in Pakistan: A mixed-methods study

BackgroundGaps in information access impede immunization uptake, especially in low-resource settings where cutting-edge and innovative digital interventions are limited given the digital inequity. Our objective was to develop an Artificially Intelligent (AI) chatbot to respond to caregiver’s immunization-related queries in Pakistan and investigate its feasibility and acceptability in a low-resource, low-literacy setting. MethodsWe developed Bablibot (Babybot), a local language immunization chatbot, using Natural Language Processing (NLP) and Machine Learning (ML) technologies with Human in the Loop feature. We evaluated the bot through a sequential mixed-methods study. We enrolled caregivers visiting the 12 selected immunization centers for routine childhood vaccines. Additional caregivers were reached through targeted text message communication. We assessed Bablibot’s feasibility and acceptability by tracking user engagement and technological metrics, and through thematic analysis of in-depth interviews with 20 caregivers. FindingsBetween March 9, 2020, and April 15, 2021, 2,202 caregivers were enrolled in the study, of which, 677 (30.7%) interacted with Bablibot (users). Bablibot responded to 1,877 messages through 874 conversations. Conversation topics included vaccination due dates (32.4%; 283/874), side-effect management (15.7%;137/874), or delaying vaccination due to child’s illness or COVID-lockdown (16.8%;147/874). Over 90% (277/307) of responses to text-based exit surveys indicated satisfaction with Bablibot. Qualitative analysis showed caregivers appreciated Bablibot’s usefulness and provided feedback for further improvement of the system. ConclusionOur results demonstrate the feasibility and acceptability of local-language NLP chatbots in providing real-time immunization information in low-resource settings. Text-based chatbots canminimize the workload on helpline operators, in addition to instantaneously resolving caregiver queries that otherwise lead to delay or default.

Digital health care service reform and health inequity for older people: a quasi-natural experiment in China.

Addressing health inequity (HI) for older people is a pivotal global public health concern, as it impedes the process of healthy ageing. The digital health care service reform (DHSR) emerges as a progressive public health approach to enhance the health and well-being of older adults by providing comprehensive and equitable medical services. This study elucidates the association between DHSR and HI for older individuals to augment comprehension of DHSR implementation. The initiation of the action plan for smart health and eldercare (SHE) in 2017 serves as a quasi-natural experiment. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, a propensity score matching (PSM) method was used to select samples, and a difference-in-differences (DID) regression was used to ascertain the net effect of DHSR on HI for older individuals in China. This methodology mitigates selection bias and segregates the DHSR effect from temporal shifts or other occurrences. The PSM-DID analysis reveals that DHSR reduced the HI index for older individuals by 0.301 (p < 0.01). Heterogeneity analyses indicate that the effect of DHSR was more pronounced in older males (-0.333, p < 0.01) than females (-0.251, p < 0.05). The impact of DHSR was notably higher for older population in the western (-0.557, p < 0.01) and central regions (-0.318, p < 0.05) compared to the eastern region, where the relationship was statistically non-significant. The results demonstrate that DHSR plays a vital role in diminishing HI, fostering inclusive growth in public health. The study underscores the imperative of sustained DHSR endeavours and allocating resources to key older demographics to substantially mitigate HI.

The impact of digital inequities on laryngeal cancer disparities in the US

ObjectivesTo develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. MethodsDII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. ResultsWith increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03–1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04–1.08), and radiation therapy (OR 1.02; 95 % CI 1.00–1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94–97). ConclusionsDigital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.

Exploring the Process of Technology Socialization (TS) in the Family: ICT Adoption for Middle-aged Parents with the Influence of Adult Children

AbstractFamily is an important socialization environment for adopting information and communication technologies (ICTs). However, while existing information systems research focuses on individual factors that influence digital inequity, it tends to ignore the influence of relational/collective factors on individuals’ ICT adoption. Drawing on technology adoption, socialization, and social identity theories, this study focuses on the process of technology socialization of ICT adoption for middle-aged parents with the influence of their adult children in Chinese families. Through in-depth interviews with thematic analysis, we identify three mechanisms in the family, including creating a family shared environment, negotiating a family ICT identity and interplay, and generating digital differentiation. These findings contribute to a technology socialization framework, addressing how individuals can become digitally savvy with the influence of the socialization agents in the family. The findings have implications for ICT firms and policy makers to promote the family shared environment as a vehicle for achieving social wellbeing and digital upskilling of middle-aged adults.

Problematic Internet Use, Online Racism, and Mental Health Issues Among Racially Minoritized Emerging Adults in the United States

AbstractProblematic internet use has been linked with numerous mental health issues. However, little research has examined the relevant factors that may explain this association. For racially minoritized individuals, problematic internet use may increase the likelihood of encountering race-based cyberaggression and racist content, commonly known as online racism. Thus, we examined whether problematic internet use is associated with mental health issues through exposure to online racism. Using data from 338 racially minoritized emerging adults (Mage = 23.28, SD = 2.38), we conducted a path analysis of problematic internet use predicting mental health issues (anxiety, depressive symptoms, loneliness) via online racism. The indirect relationship was significant suggesting that problematic internet use is associated with greater perceived online racism, which in turn was associated with greater depressive symptoms, anxiety, and loneliness. Online racism is likely a digital inequity that disproportionately impacts the costs of problematic internet use among racially minoritized emerging adults.

Bursaries Reimagined: Addressing Digital Inequity through a Library-Led, University-Wide Laptop Bursary Program

The rapid switch to online learning in early 2020 exacerbated problems students were already having with obtaining and maintaining up-to-date devices and a reliable internet connection. MacEwan University Library began offering 4-month term laptop loans at the beginning of the pandemic, but it was clear this was not fully meeting student needs. In response to conversations with faculty and students, the library secured funds from the university’s Student Technology Fee to launch a laptop bursary pilot in Winter 2022, which in turn expanded to a university-wide bursary in Fall 2022. This article discusses why an in-kind laptop bursary was the right approach at the right time in this setting; how this initiative contributes to equity and accessibility; and finally, perceptions of the value of this work, its fit within the scope of the library, and how the unique position of the library as a student-focused service and academic unit positioned it well to successfully offer this bursary. Challenges and opportunities for improvement are also discussed.

Reckoning with Digital Inequity in Place-Based Community Revitalization

Place-based community development in America has a rich history. Practices and procedures for successful redevelopment are supported by lobbying efforts, public administration, policy, federal funding, and the efforts of non-profits dedicated to neighborhood revitalization. Community revitalization work is often centered around specific geographic locations, while in recent decades modern technology has caused social networks to become increasingly geographically disparate. Social networks have been demonstrated to support the economic mobility that community development strives to create. However, the impact of modern technology on place-based community development has not been clearly understood. Increasing digitalization has impacted the effectiveness of place-based social equity efforts such as community organizing, affordable housing and economic development, and financial capability interventions. This essay explores how place-based community organizing led to the creation of current policies that govern community development, how technology has impacted urban communities and how these changes may subsequently affect social equity objectives in public administration.

The impact of digital inequities on gastrointestinal cancer disparities in the United States.

Modern-day internet access and technology usage substantially impacts aspects of surgical care but remain ill-defined for their associations with gastrointestinal-cancer (GIC) outcomes. We sought to develop the Digital Inequity Index (DII), a novel, a self-adapted tool to quantify access to digital resources, to assess the impact of "digital inequity" on GIC care and prognosis. Adult (20+) patients with gastrointestinal malignancies between 2013 and 2017 were identified from the Surveillance, Epidemiology, and End Results Program database. DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, broadband type, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked relative across all US counties, and then averaged into a composite score. The association between DII and surgery receipt, staging, surveillance period, and survival time were assessed with multiple logistic and linear regressions. Among 287 228 patients, increasing DII was associated with increased odds of late-stage disease (highest odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.05-1.10 for hepatic) and decreased odds of receiving surgery (lowest OR: 0.94, 95%CI: 0.93-0.96 for hepatic). Higher DII was associated with shorter postoperative surveillance length (largest decrease -20.4% for hepatic) and overall survival length (largest decrease -16.0% for pancreatic). Sociodemographic and infrastructure-access factors contributed equivalently to surveillance time disparities, while infrastructure-access factors contributed more to survival disparities across GICtypes. As technology dependence has increased, inequities in digital access should be targeted as a contributor to surgical oncologic disparities.