How research can guide efforts to close the digital divide
Research shows that the digital divide hinders digital healthcare access among Latino patients, highlighting the need for targeted solutions to tackle technology challenges.
The digital divide in healthcare -- the gap between populations who have access to digital health tools and the digital health literacy to use them and those who do not -- is a trenchant barrier to telehealth adoption. It is well-known that digital divide challenges typically affect underserved and minority populations, making it more difficult for those groups to access telehealth. However, it is those groups that stand to benefit the most from telehealth access. Thus, health systems must close the digital divide to advance health equity.
The first step in addressing the digital divide is to identify and understand the challenges vulnerable populations face regarding digital health technology. Researchers from Thomas Jefferson University and Esperanza Health Center aimed to do just that, publishing their findings on digital health access and use challenges within the Latino community in PEC Innovation.
Multiple social determinants of health limit telehealth use among Latino patients. A study by the UCLA Latino Policy and Politics Institute published in January 2023 found that older Latino adults faced more difficulties with telehealth utilization than older adults from other race/ethnic groups due to factors like language barriers and access to technology.
To gain a deeper understanding of the Latino population's experiences with digital health technology and assess their willingness to learn more about it, Jefferson and Esperanza researchers interviewed Latino patients about their digital health readiness.
A term coined by Jefferson researchers, digital health readiness refers to "the broad range of barriers that we see as potentially limiting people's ability and willingness, or really the readiness, to engage in telehealth," explained Kristin Rising, M.D., founding executive director at the Jefferson Center for Connected Care, in an interview.
She added that despite a growing focus on digital health literacy, it doesn't consider a broader hurdle to telehealth adoption: patient trust.
"We really realized in our individual conversations with patients, and then in broader research studies, that there were many other important barriers, [such as] trust in telehealth as high-quality care, trust in inputting personal information in a device, understanding the relevance of telehealth…. And we were really searching for something to kind of encompass this broader concept, and digital health readiness is what we settled on."
The study's primary goal was to illuminate the digital health readiness challenges facing the Latino population in Philadelphia and the support they need to overcome those challenges. The findings could also help healthcare providers create and implement population-specific interventions to enhance digital health uptake within underserved communities.
A look into the study and its findings
Research is a practical approach to assessing patient-facing barriers to digital healthcare. However, Rising pointed out that research efforts are more effective if they involve the communities facing those barriers.
"As we started to think about how we were going to start to tackle the digital health readiness challenges in the city, we said, well, maybe we need to be engaging with some of the populations who we know are having lower uptake overall, with the Latinx population being one of those," she said.
Thomas Jefferson University had an existing relationship with Esperanza Health Center, which offers a wide array of adult and pediatric healthcare services to the Latino community in Philadelphia. The Jefferson research team reached out to the health center to discuss digital divide challenges and found that the health center was struggling with some digital health access issues, including low patient portal use.
"So, they were really excited to partner and to do some work to dive further into figuring out how we could better support the population in the uptake of the tools like the portal," Rising said.
Together, the organizations created a research team that included researchers from the Jefferson Center for Connected Care and Latino community research assistants from the Esperanza Health Center. Jefferson researchers trained the community research assistants to conduct qualitative interviews and analyses.
If we start to have these dialogues, and in ways that are supportive and open, then we can at least start to address some of those potential concerns…instead of just putting people in the buckets of 'Never did it, not going to ever do it,' and not leaving room for that potential for change.
Kristin Rising, M.D.Founding executive director, Jefferson Center for Connected Care
The researchers conducted individual semi-structured interviews with 28 Esperanza Health Center patients. These patients were 18 years and older, spoke English or Spanish and self-identified as Latino. Most study participants reported using the internet (82.1%); however, 78.6% reported not feeling comfortable using the internet.
The study revealed that not having the skills to navigate technology was the patients' main challenge in using digital health technology. Older adult participants specifically mentioned struggling to understand technology and not always having someone to help them with technology at home.
The interviews further revealed that the lack of access to the needed technology and internet services as well as language barriers were also significant challenges to using digital health technology.
"We would think that there are more options available, but actually, in our interviews, we identified that that is an ongoing challenge, especially for communities where English is their second language -- the Spanish-speaking population," Karla Martin Gonzalez, MPP, a study author and senior clinical research coordinator at Jefferson Center for Connected Care, said in an interview. "Not all of the resources are available in Spanish."
Despite these hurdles, Latino patients said they saw value in using digital health technology for several reasons, including that it saves travel time, makes going to the pharmacy to pick up medication easier and facilitates communication with providers. They also expressed interest in learning more about digital health technology and technology in general.
However, trust was an issue among the study participants. Most expressed some level of distrust with health information found on the internet. Common reasons for distrust included participants' limited ability to determine if the information was factual, to understand the information and to identify non-biased information. Still, participants reported high trust in communicating with healthcare providers through technology.
"[The study findings reinforce] the complexity of digital health readiness and how much we really need to have a flexible system that's able to incorporate everyone's different lens or angle or combination of kind of readiness barriers, right?" Rising said.
What the findings mean for efforts to address the digital divide
The study findings offer several key points for healthcare providers to consider as they develop strategies to tackle the digital divide within underserved communities.
Rising noted that the findings indicate that healthcare providers should not make assumptions about who can, can't, will, or won't use digital health tools. Providers must also approach patient hesitancy with openness and curiosity and have conversations with their patients about the barriers they are facing.
"If we start to have these dialogues, and in ways that are supportive and open, then we can at least start to address some of those potential concerns … instead of just putting people in the buckets of 'Never did it, not going to ever do it,' and not leaving room for that potential for change," she said.
Another lesson that providers can glean from the study findings is the necessity of creating culturally sensitive and relevant resources.
"[Not only] thinking about language access, but also thinking about how does the community access information and resources?" Martin Gonzalez said. "For example, with the Latino community, YouTube and WhatsApp are two big apps that are mostly used. So how can we include those in the interventions that we're designing so the community has access to and receives the information through the tools and media that they're [already] using to access information?"
Following the study, the research team created resources specific to the Latino population. According to Josefina Hendry, community research assistant at Esperanza Health Center, the resources include a list of places where people can learn English and how to use smartphones and tablets as well as videos designed to teach people how to access and use the patient portal.
"The health center also created an app which is easier for patients to use," Hendry said. "They can send and receive messages from their doctors, see test results and request prescription refills and appointments."
Further, the study underscores the importance of community-based academic partnerships and training. Martin Gonzalez noted that including community members in the research process and training them to conduct research improves the quality of the research data.
"The quality of the data that you obtain is much richer because it's from the community members themselves that are experiencing these barriers and these issues," she said.
Incorporating the community and widening research efforts to better understand the wide-ranging barriers to digital healthcare adoption is critical to achieving health equity. Providing underserved communities the tailored support they need to access digital health programs could help close the widening gap between the healthcare haves and have-nots.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
