Internet Access In Rural Areas Research Articles

883. The Current State of Access: Inequitable Access to Infectious Disease Physicians in the Time of the COVID-19 Pandemic and Declining Fellowship Match Rates

Abstract Background Equitable access to specialty care is a key component of population health. Guidelines recommend specialty care within a 60-minute (min) drive. In 2017, 80% of United States (US) counties had no Infectious Diseases (ID) physicians. In the setting of the COVID-19 pandemic and declining fellowship match rates, we characterized inequities in geographic access to ID physicians in the US. Methods We geocoded the location of ID physicians from 2020 Medicare Provider Utilization and Payment Data. For people in the contiguous US, we conducted a cross-sectional analysis of one-way drive times to the closest ID physician overall and by age, gender, racial, and ethnic subgroups using 2020 US Census data. We calculated the median drive times and the proportion of each subgroup within x minutes to the nearest ID physician. Results We identified 6000 ID physicians at 2582 locations (Fig 1). Fig 2 demonstrates one-way drive times. In the US, 7.9% of people live > 60 min from ID specialty care. When stratified by rural/urban, 46.7% of rural people and 1.6% of urban people live > 60 min from the closest ID physician (Fig 3). Rural people had a median drive time of 57.2 min (95% CI 56.6-57.9) while urban people had a median drive time of 10.9 min (10.8-11.0). For people who identify as American Indian and Alaska Native (AIAN), 70.3% in rural areas and 8.8% in urban areas live > 60 min from the closest ID physician. For rural AIAN populations, median drive time was 95.1 min (86.0-104.1). For rural populations, the median drive time was > 60 min for those who identify as Native Hawaiian and Other Pacific Islander (69.1; 64.5-75.8), multiple races (65.5; 63.7-67.6), or Hispanic (66.9; 65.0-68.7). Conclusion Access to ID specialty care is inequitable. The largest disparities exist between rural and urban populations. Significant disparities exist for the AIAN population. In ID, we need recruitment and retention of our current workforce and recruitment of people who will serve rural and AIAN communities. If telemedicine continues to be supported, it could help to reduce disparities. This is also dependent on equitable access to high-speed internet, which is concentrated in urban/suburban areas. Without initiatives to expand the ID workforce and to increase internet access in rural areas, disparities in access will not improve. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc.: Stocks/Bonds

Diffusion of innovation, internet access, and adoption barriers for precision livestock farming among beef producers

This study examined the relationship between internet access type and perceptions of Precision Livestock Farming (PLF) Technologies among beef producers in a specific state. Using data collected from an internet-based survey of beef producers (n = 137), this study conducted an exploratory factor analysis to construct variables corresponding to Diffusion of Innovation (DOI) attributes that influence innovation adoption. Findings indicate producers with cable, cellular, and broadband internet access had more favorable perceptions of PLF technologies in terms of barriers to adoption, while those with no internet access or satellite connections reported higher perceived complexity with the use of PLF technologies. Trialability and observability varied across internet types, suggesting hands-on experience and practical demonstrations might be more impactful for certain groups. Beef producers with satellite internet connections were more likely to perceive the need to trial PLF technologies before adoption. This study highlights the importance of internet access in rural areas and its potential impact on the adoption of PLF technologies, offering valuable insights for industry stakeholders and policymakers to promote the adoption of PLF technologies.

Patient Satisfaction and Perception of Physician Empathy in Outpatient Community General Neurology Telemedicine

Abstract
 Introduction: We assessed patients’ satisfaction and perception of physician empathy after implementation of video telemedicine service for general neurology follow-up visits at two community spoke clinics that serve patients in rural areas located approximately 45 miles from a medical center hub.
 Methods: Consecutive patients who completed a telemedicine neurology follow-up visit from February 12, 2020 to January 13, 2021 at the spoke clinic in Red Wing, MN and from July 21, 2021 to January 21, 2022 at the spoke clinic in Austin, MN were asked to complete a paper-based survey at the conclusion of the telemedicine visit. The neurologist conducted the telemedicine visit from the medical center hub site in Rochester, MN or from their own home using the InTouch (Teladoc Health™) operating system mobile telehealth platform. All patients had previously completed an initial traditional face-to-face consultation at the spoke clinic with the same neurologist performing the follow-up telemedicine visit. Primary outcomes were Telemedicine Patient Satisfaction Measure and Consultation and Relational Empathy scores and mean total favorable survey responses.
 Results: 31 patients at our clinic in Red Wing, MN and 38 patients at our clinic in Austin, MN participated in telemedicine neurology follow-up visit, completed the survey, and were included in the final analysis.
 The mean Telemedicine Patient Satisfaction Measure scores (possible score of 12-60) were 55 (range 42-60), and for all items ‘agree’ or ‘strongly agree’ was rated on average 94% of the time. The mean Consultation and Relational Empathy scores (possible score of 10–50) were 44 (range 28–50), and for all items ‘very good’ or ‘excellent’ was rated on average 90% of the time. 
 Both neurologists conducting telemedicine visits reported that this model of care improved work-life balance with reduced travel time.
 Discussion: We successfully implemented a telemedicine service for general neurology follow-up visits at two community spoke clinics serving patients in rural areas without compromising on perceived care. We were able to bridge the gap between patients’ needs for local care and physicians’ need for work-life balance. Patients’ perception of physician empathy and satisfaction with telemedicine neurology follow-up visits was high. This model of telemedicine avoids the barriers of limited internet access in rural areas and minimizes technology related anxiety that is often present in telemedicine visits to patients’ homes. This model allowed for high quality neurological examination with high resolution pan-tilt-zoom camera on a mobile platform, incorporation of vital signs, nursing support, and lab services that may have contributed to the patients’ and neurologists’ satisfaction. Our study supports our continuation and expansion of this TM model in our community clinic spoke sites and may help to improve access to neurological care for patients in rural areas.
 Keywords: Telemedicine, patient satisfaction, empathy, general neurology, teleneurology

Informaciono-komunikacione tehnologije i ruralni razvoj u Srbiji

The use of the information and communication technologies (ICTs) transforms ways of manufacturing, doing business, working, accessing public services, informing and communicating. They enable overcoming of both geographical distances and underdevelopment of infrastructures in rural regions and less developed ones. That is why ICTs can play an important role in encouraging economic development of rural areas, improvement of life quality of their population as well as lessening of social exclusion. The paper is focused upon the possibilities of invigorating rural development in Serbia on the basis of the ICTs use, primarily the Internet. The paper firstly points to the main features of the Serbian village development; then it analyses the Internet access in rural areas. Finally, it points to the ways in which the ICTs can be used for stimulating economic development of the Serbian village in addition to improving life quality of the rural population.

Digital technologies as factor of human capital formation in Ukraine

The paper emphasizes that today's society is largely determined by the level of development of digitaltechnologies. The ability to access the Internet provides households with additional opportunities for income growth and competitive positions in the labor market. Today, the development of social networks creates additional opportunities for social integration of each person. Therefore, we can speak about new terms and concepts of "digital homelessness" and "digital inequality", which characterize the limited opportunities of individual members of the society in accessing the World Wide Web. It is clear that digital technologies ultimately shape the quality of human capital in the country. The purpose of this article is to analyze the impact of the accessibility to the Internet on the level of income and life quality in Ukrainian households. The authors used methods of grouping, graphic, Student's t-test of comparison of averages, monographic, induction, deduction, and generalization methods in this study. The authors assessed the impact of the Internet availability on the income level of households in large cities and in rural areas. The obtained results indicate that in large cities as well as in rural areas the income level of households with access to the Internet was more than twice higher than that of households without access to the Internet. Non-randomness of these discrepancies was confirmed using the Student's t-test comparing averages. The paper estimates dependence of self-assessment by households on their income and the availability of the Internet. It turns out that the share of those who assessed their income as "enough and made savings" of households in large cities with access to the Internet equaled 10.4%, and those who did not have access to the Internet - 6.2 %. In rural areas, this ratio was equal to 12.5 % and 6.4 %, respectively. The conducted research allowed the authors to establish close connection between the level of the Internet access and the level of households' income both in large cities, and in rural areas. The authors have also confirmed that the level of the Internet access in rural areas was lower than that in large cities. Key words: human capital, households, digital technologies, household's income level, rural areas, digital inaccessibility.

Accessibility of distance teaching and learning platforms used as catch up strategies amidst COVID-19 pandemic in rural areas

The study explored accessibility of distance learning platforms used as catch up strategies amidst COVID-19 pandemic in rural areas at two selected secondary schools in Isoka district of Zambia. This study attempted to answer the research question ‘How accessible are the distance learning platforms used as catch up strategies amidst COVID-19 to learners in rural areas like those in Isoka district? The study employed a descriptive case study design following a qualitative approach. The study population comprised of grade 12 learners at Isoka boys’ and Muchinga secondary schools in Isoka district. Fifty (50) grade 12 leaners were purposively sampled to take part in the study. Qualitative data were collected using open-ended questionnaires and analysed thematically. Major findings of the study were that: (i) There was limited access to distance learning platforms used as catch up strategies during COVID-19 by some learners at the two secondary schools due to reasons such as; lack of technological devices and gadgets like smartphones, laptops, television sets and radio, unstable internet access, and insufficient power supply; (ii) There was no access to distance learning platforms at all, by some learners who literally had no gadgets and technological devices to use to access the online and broadcasted lessons. As a result, most of the learners experienced little or no learning through distance learning platforms used amidst COVID-19 pandemic. This study recommends that government in partnership with cooperating partners and other stakeholders should improve the internet access in rural areas. There is also need for the government through the ministry of education to find a way of providing rural schools with technological devices such as tablets, smartphones, laptops, and television sets so that learners can use them to access lessons through distance learning in case of predicaments such as COVID-19 pandemic.

Digital competence in scientific research in higher education

Background: Due to the current contingency due to covid 19, students and teachers have had to face new digital challenges in such a way that they seek to become aware of how important digital skills are for the learning process. However, it is evident that, in Peru, there is a digital divide due to inequality; therefore, there is no good university service due to the lack of Internet access in rural areas. The digital skills of university students allow the production of new knowledge and technological innovation from the development of digital skills. Objective: The general objective of the research was to identify the country with the most scientific production through a bibliometric and bibliographic review, to search for the production of research works on the construct of digital competence in scientific research in higher education during the period 2016- 2021. Methodology: The research was developed under a qualitative approach based on a documentary review of the studies carried out in the period 2016-2021 in Latin American countries of the digital competence variable, 44 articles registered in the Scopus database were identified.

Enhancing rural income through public agricultural R&D: Spatial spillover and infrastructure thresholds

AbstractHow much farmers benefit from public agricultural research and development (R&D) has been a topic of continued interest. Compared to studies based on classical statistics, we show theoretically and employ the Spatial Durbin Model and the Panel Threshold Regression Model to investigate the different impacts and spatial spillover effects of public agricultural R&D on farm and nonfarm income. Using China's provincial panel data from 2000 to 2015, we find that public agricultural R&D has a positive impact on rural household income. This impact is mainly reflected by nonfarm income and exhibits heterogeneous interprovincial‐spatial spillover. We also find that interregional differences in infrastructure, represented by road transportation and Internet access in rural areas, are the main reasons for the spatial heterogeneity. Higher road density and Internet penetration enhance the positive impact of public agricultural R&D on rural income, and the enhancement exhibits characteristics of thresholds, after which the size of enhancement becomes increasingly larger.

Study of the state and prospects of digital development in Ukraine

The article describes the strengthening of European and international influences on the digital transformation in Ukraine, emphasizes the priorities of the national policy of digital transformations and digital development in the conditions of war including the need to develop the single digital market with the European Union and a structure for bringing Ukraine’s digital sector closer to the European one. In view of the fact that the appropriate legal framework for digital development affects the scale and pace of digital transformations in the country, the introduction and using of digital technologies, we have analyzed and characterized the regulatory and legal support for digital development and digital transformation of Ukraine in recent years, as well as the functions of the relevant structures, such as the Committee on Digital Transformation and the Ministry of Digital Transformation of Ukraine. The state of digital society development during the «covid-2019» pandemic has been revealed. It was emphasized that the pandemic has simultaneously become a catalyst for digital change and transformation and revealed the difficulties in digital transformations related to data privacy and cyber security issues, lack of budget and resources. In the article, the authors single out the main obstacles to digital development in Ukraine for 2019–2021, among which the lack of funds for digital transformations is the most significant. Based on statistical data, an analysis of the funding for the digital transformations in Ukraine in 2020–2021 has been carried out according to priority areas including the National program for Informatization, the Internet access in rural areas, digitalization, the development of administrative services and the expansion of Centers for the provision of administrative services, the development of priority projects in the IT-sphere and IT education. The priority areas of the digital reconstruction and development of Ukraine for 2022–2025 have been analyzed, such as the development of digital economy, the restoration of digital infrastructure, the restoration and development of the Centers for the provision of administrative services, state information resources in cloud technologies, the development of public electronic registers, etc. The expected funding volume for the areas of digital reconstruction and development of Ukraine for 2022–2025 have been given; the largest planed measures and the amount of expenditures within every area of digital reconstruction and development of Ukraine for 2022–2025 have been highlighted.

Wireless Last Mile Study in Rural Areas

Internet access has become a primary human need. During the COVID 19 pandemics, almost all activities such as studying and working online. However, several rural areas still did not have internet access due to weak cellular signals. Internet access in rural areas can have various alternatives, such as VSAT (satellite). It needs an inexpensive and precise way to complete the internet access coverage because many customers were concentrated in areas far from the VSAT terminal. WLAN 802.11n was an alternative way to expand the range of internet coverage with low cost and easy implementation. Our case study uses the 5GHz frequency with a sectoral antenna as the multi-hop point-to-point backhaul network's frequency to avoid the risk of channel interference on the backhaul. On the other hand, 2.4GHz frequency with an omnidirectional antenna serves smartphone customers. On the test results, the network latency between multihop access point, has a maximum value of 19,894 ms. This result means that the latency obtained can be categorized as preferred VoIP services based on ITUT G.1010 in the local network. Then for the customer on the fourth hop, 3968 meters from the VSAT terminal, the UDP data rate of 1.04Mbps was stable, and the TCP data rate decreased to 1.26Mbps. This paper emphasizes the use of multihop 5Ghz WLAN 802.11n as a backhaul to expand internet access coverage from VSAT in rural areas, where the concentration of customers was far apart and there were many buffalo horn barriers in traditional homes and buildings.

Internet Access in Rural Areas: Brake or Stimulus as Post-Covid-19 Opportunity?

The lack of internet access in most rural areas has become a challenge worldwide. The Covid-19 pandemic has highlighted trends such as teleworking and e-commerce, meaning an opportunity for the local economy of these areas, but with serious difficulties in carrying it out. This paper aims to detect this lack of internet in inland areas of the region of Valencia through local actors, in order to identify clear priorities and real needs through an explorative and replicable approach based on agglomerative hierarchical clustering (AHC). The main findings suggest that there are different patterns in the rural internet access related to adequate infrastructure and planned actions by local councils. In this way, a multitude of contextual elements have emerged that influence the importance of efficient access to the internet in rural areas. It is essential to know the real needs and demands of the population before implementing plans and programs that may not be relevant for the actors involved in territorial development.

Society of Behavioral Medicine (SBM) urges Congress to ensure efforts to increase and enhance broadband internet access in rural areas.

The Society for Behavioral Medicine (SBM) recommends expanding access to high-speed, high-definition internet and increasing broadband width for rural communities in the USA to increase telehealth opportunities for populations facing geographic barriers to accessing quality healthcare. High-speed telehealth will allow healthcare providers to care for patients in "real time" and will expand access to specialty providers thereby increasing timely follow-up, improving health outcomes, and reducing rural health disparities. Moreover, SBM recommends that the current National Broadband Plan legislation be protected and enhanced to ensure high-quality, but also affordable, internet services in rural areas. Several legislative bills have been put forth but are not fully funded or enacted by individual states. In addition, further mechanisms and supplemental funding are needed to address the continued lack of resources to enhance rural broadband including infrastructure, research, and regulatory reform.

Bridging Indonesia’s Digital Divide: Rural-Urban Linkages?

While Indonesia is recorded as one of the greatest social media republics in the world, the gap of rural-urban internet access remains a great challenge. As reported in the 2016 Information and Communication Technology (ICT) Indicators, the number of households with internet access in rural areas is nearly half of those in urban areas; 26.3% and 48.5% in a consecutive way. Rather than simply seeing the internet as a medium, this paper discusses the internet as material culture; therefore, it goes beyond the access and focuses on the ways people use the internet to define their culture. From this perspective, this paper draws the two levels of the digital divide of Indonesian rural-urban dwellers. Lack of motivation and limited material access due to social inequality is at the very base of the digital divide. Subsequently, digital skills and usage deepen the digital divide. While splitting people into either rural or urban categories often produces misleading policies, this paper proposes the rural-urban linkages to bridge the digital divide in Indonesia. The rural-urban linkages particularly incorporate the flow of people and information across space as well as the interconnection between sectors, such as agriculture and service.

Africa Telecommunications Infrastructure in 2018: Overview and Policy Recommendations

The internet is the single most effective mechanism in human history for promoting global economic prosperity and lifting the world’s population out of poverty. Many of the next billion internet users will come from Africa. While the coverage and speed of mobile services in Africa has improved dramatically in recent years, significant barriers still exist in improving internet coverage across the continent. This paper provides an overview and policy recommendations for the three main areas of Africa's Telecommunications Infrastructure: undersea cable, terrestrial broadband networks, and mobile services. The following are some general policy recommendations for African countries to improve their national telecommunications infrastructure: •All countries should adopt basic legislation ensuring free and unrestricted transfer of commercial data across national boundaries. •Nations should enter into regional broadband agreements, utilizing nearby international cables to decrease access costs for consumers. Often, accessing submarine cable can completely change the growth trajectory of the ICT market in a country. •Every country should construct at least one Internet Exchange Point (IXP) to distribute incoming international traffic. IXP’s decrease international routing fees and can substantially lower local internet prices. •Every regulator or communications ministry on the continent should begin the process of liberalizing the mobile (if it has not been privatized already) and fixed-line sectors. •The future of communications in Africa is mobile. Every country should heavily invest in constructing and expanding national 4G networks while planning for 5G. •While mobile has provided the majority of growth for telecoms, countries cannot neglect their national fixed-line infrastructure as years of decay have limited access rates and stunted overall sector growth. •Countries should adopt legislation that standardizes local access services that connect individual neighborhoods and homes into the national backbone. Currently, many urban households cannot take advantage of increased investment in the national backbone due to predatory pricing schemes and a lack of quality assurance standards. •In most African cities, copper and fiberoptic internet cables are tangled with electrical lines on street lamps, limiting expansion to other areas and making cable repair expensive. Local and national governments must better enforce cable installation regulations to remove the inefficiency. •Internet access in rural areas across Africa remains almost nonexistent. In maturing markets such as Nigeria, Kenya, and South Africa, governments should create tax incentives for the large telecoms to extend access to rural villages. •Lastly, each nation should promote ICT skill training and provide subsidized education for communications professions.

Are smartphones smart for economic development?

Smartphones’ independence of landline networks qualifies them for communication and Internet access in rural areas of developing countries. Drawing upon rural Southeast Asian survey data, this research provides probably the first econometric indication for smartphones’ contribution to households’ income.

A Second-Generation Digital Terrestrial Television Wireless Return Channel Standard for Providing Internet Connectivity in Rural Areas in Latin America

This paper proposes the development of a second-generation digital terrestrial television wireless return channel for providing universal Internet access in rural areas in Latin America, namely DVB-RCT2. The paper reviews the first-generation return channel terrestrial standard DVB-RCT, and discusses which features of the state-of-the-art second-generation digital terrestrial TV standard DVB-T2 should be adopted for DVB-RCT2. Capacity and coverage performance estimations for DVB-RCT2 are provided.

Breaking the walls of social exclusion of women rural by means of ICTs: The case of ‘digital divides’ in Galician

This paper examines the digital divides for women in rural areas within the Information Society, referring particularly to the Galician experience (Autonomous Region in the North West of Spain). In order to explore the barriers to social and labor exclusion it was elaborated a survey relating with the use and impact of ITC in social and labor experiences of rural women. The results showed that rural women are aware of the key role played for ITC on their way to achieve the participation on decision making process as well as in social life and labor. The main barriers to the Internet penetration in women social life were employment, education and income. From an individual point of view, the existence of non-users was explained by a combination of access problems, lack of ICT skills or rather negative attitudes towards ITC. Finally, a bunch of policy recommendations is proposed focus on providing better Internet access in rural areas and to sensitize the population, particularly the oldest, about the importance of gender equality in access to technology in order to avoid digital barriers for rural women and reduce social exclusion of this group.