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1.
JMIR Med Educ ; 10: e57077, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39353186

RESUMO

BACKGROUND: Limited digital literacy is a barrier for vulnerable patients accessing health care. OBJECTIVE: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. METHODS: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. RESULTS: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. CONCLUSIONS: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals.


Assuntos
Exclusão Digital , Telemedicina , Humanos , Feminino , Masculino , Disparidades em Assistência à Saúde , Registros Eletrônicos de Saúde , Acessibilidade aos Serviços de Saúde , Currículo , Adulto
2.
J Med Syst ; 48(1): 94, 2024 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-39377862

RESUMO

PURPOSE: Racial and ethnic healthcare disparities require innovative solutions. Patient portals enable online access to health records and clinician communication and are associated with improved health outcomes. Nevertheless, a digital divide in access to such portals persist, especially among people of minoritized race and non-English-speakers. This study assesses the impact of automatic enrollment (autoenrollment) on patient portal activation rates among adult patients at the University of California, San Francisco (UCSF), with a focus on disparities by race, ethnicity, and primary language. MATERIALS AND METHODS: Starting March 2020, autoenrollment offers for patient portals were sent to UCSF adult patients aged 18 or older via text message. Analysis considered patient portal activation before and after the intervention, examining variations by race, ethnicity, and primary language. Descriptive statistics and an interrupted time series analysis were used to assess the intervention's impact. RESULTS: Autoenrollment increased patient portal activation rates among all adult patients and patients of minoritized races saw greater increases in activation rates than White patients. While initially not statistically significant, by the end of the surveillance period, we observed statistically significant increases in activation rates in Latinx (3.5-fold, p = < 0.001), Black (3.2-fold, p = 0.003), and Asian (3.1-fold, p = 0.002) patient populations when compared with White patients. Increased activation rates over time in patients with a preferred language other than English (13-fold) were also statistically significant (p = < 0.001) when compared with the increase in English preferred language patients. CONCLUSION: An organization-based workflow intervention that provided autoenrollment in patient portals via text message was associated with statistically significant mitigation of racial, ethnic, and language-based disparities in patient portal activation rates. Although promising, the autoenrollment intervention did not eliminate disparities in portal enrollment. More work must be done to close the digital divide in access to healthcare technology.


Assuntos
Exclusão Digital , Análise de Séries Temporais Interrompida , Portais do Paciente , Humanos , Adulto , Feminino , Masculino , Grupos Raciais , Etnicidade , São Francisco , Disparidades em Assistência à Saúde , Fluxo de Trabalho , Pessoa de Meia-Idade , Idioma , Envio de Mensagens de Texto , Registros Eletrônicos de Saúde/organização & administração
4.
PLoS One ; 19(10): e0311390, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39352898

RESUMO

The study uses different statistical techniques to understand the relationship between variables explaining the digital divide and classification based on The Inglehart-Welzel Cultural Map for 2023. To achieve this purpose variables focusing on Digital Penetration (the percentage of internet and social media users and mobile cellular connections), Operating Systems share (iOS and Android), Device Traffic (laptop/mobile phone-based web traffic) as well as Mobile Commerce variables (bills and payments using mobile internet) were included in the analysis. To minimize any effects arithmetic means of data was calculated.: The results from one-way ANOVA tests indicate significant differences among groups classified by cultural values for almost all measured variables of digitalization. The mean squares and F-values across variables like cellular mobile connections, internet users, and active social media users are significant indicating a shift towards more secular and self-expressive cultural values. The results of the GLM procedure show that significant portions of the total variance in digitalization variables are associated with membership in groups based on the cultural map. This suggests that cultural classifications can explain substantial differences in digital behavior and preferences across populations. Spearman's correlation coefficients showed strong positive correlations between Traditional/Secular values and several digitalization metrics, such as the use of mobile phones or the internet for payments, and negative correlations with others like share of web traffic by device type (mobile vs. laptop/computer). These correlations suggest that cultural values play a substantial role in influencing digital habits and accessibility.


Assuntos
Telefone Celular , Mídias Sociais , Humanos , Telefone Celular/estatística & dados numéricos , Exclusão Digital , Internet , Cultura
5.
Sci Rep ; 14(1): 20399, 2024 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-39223233

RESUMO

This study analyzed the effects of digital literacy on life satisfaction in older adults aged 65 years and above in modern day Korea. It utilized raw data from the 2019-2022 Report on the Digital Divide, an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. A total of 4,216 participants were assessed from 2019-2022. Correlation between digital literacy and life satisfaction was analyzed using Pearson correlation analysis and polynomial linear regression analysis. Life satisfaction was significantly positively correlated with digital access, digital competency, and digital utilization in all the years. In 2019, participants' life satisfaction score rose significantly by 0.15 with every one-point increase in digital competency. It further rose by 0.035 in 2020, 0.030 in 2021, and 0.116 in 2022. Digital literacy was consistently positively correlated with life satisfaction in each year from 2019-2022. Of the three main elements, digital competency had the strongest impact and digital information, income, and education level also significantly impacted life satisfaction. While digital competency improved steadily from 2019 to 2022, it remains below 50% for Korea's older adult population. Further efforts are required to improve digital competency and subsequent life satisfaction among Korea's older adult population.


Assuntos
Alfabetização Digital , Satisfação Pessoal , Humanos , República da Coreia , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Exclusão Digital
6.
Stud Health Technol Inform ; 318: 188-189, 2024 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-39320210

RESUMO

Despite mobile health services becoming a vital tool for improving accessibility and connectivity for older people, there is limited understanding of how they use mHealth services in China. This research hoped to determine the use of health services, health literacy, self-efficacy, and social adaptation among over 60-year-old people in China. Results showed that 48% of participants used mHealth services, and its use correlated with self-efficacy and social adaptation. Developing targeted interventions, including online health education programs, is crucial to address the digital divide and support ageing well.


Assuntos
Exclusão Digital , Letramento em Saúde , Autoeficácia , Telemedicina , Humanos , China , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Adaptação Psicológica , Idoso de 80 Anos ou mais
7.
J Med Internet Res ; 26: e59089, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39250183

RESUMO

BACKGROUND: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. OBJECTIVE: We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. METHODS: We examined the reach of VHA's Connected Device Program using national secondary data from VHA's electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. RESULTS: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. CONCLUSIONS: This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.


Assuntos
Telemedicina , United States Department of Veterans Affairs , Humanos , Estados Unidos , Telemedicina/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos de Coortes , Exclusão Digital , Veteranos/estatística & dados numéricos , Computadores de Mão/estatística & dados numéricos , Idoso , Adulto , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
8.
Jpn J Nurs Sci ; 21(4): e12626, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39256625

RESUMO

AIM: The aim of this study was to explore the barriers and facilitators underlying the healthcare digital divide by using qualitative methodologies, integrated with the Capabilities, Opportunities, Motivations, and Behaviors (COM-B) as well as the Behavior Change Wheel (BCW) theoretical frameworks. METHODS: To conduct a thorough analysis, semi-structured,in-depth interviews were orchestrated among a cohort of older patients who had experiences with digital healthcare systems. Data were meticulously analyzed via Colaizzi's seven-step methodological procedure. RESULTS: Nine barriers were elucidated, including physical limitation, inadequate training and support, self-imposed denial, failure to rebuild the digital healthcare environment, equipment constraints, deficits in communication and feedback, skepticism regarding data accuracy and validity, sense of social deprivation, and network information boycott. Conversely, eleven facilitators were identified, encompassing peer modeling, availability of training and support, reconstructive efforts toward the digital healthcare environment, mandatory usage, familial influence, media impact, scientific publicity and education, enhancement of self-efficacy, sense of social participation, perceived convenience, and access to healthful information. CONCLUSION: Based on the COM-B and BCW models, healthcare organizations may be able to improve their digital healthcare support systems (capabilities), technical design, network speed, and equipment configuration (opportunities), as well as focus on "human-computer integration," the parallel existence of digital technology and humanistic care, and taking into account the issues of information security, accuracy, and human rights equality (motivation) while benefiting the patients, in order to bridge the healthcare digital divide for the older adults.


Assuntos
Exclusão Digital , Pesquisa Qualitativa , Humanos , Idoso , China , Masculino , Feminino , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade
9.
Front Public Health ; 12: 1393651, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39257946

RESUMO

Background: The digital divide is the difference between individuals who use the Internet and those who do not. Under the triple social environment of urban-rural dichotomy, population aging, and the digital era in China, the existence of digital divide among rural older adults has seriously affected their access to health information through the Internet, so it is urgent to bridge the digital divide problem they face. Methods: Based on Maslow's Hierarchy of Needs Theory and Stress Coping Theory, the impact of cultural capital on the digital divide among rural older adults was systematically analyzed using hierarchical regression and Chained Mediation Effect Tests using data from the Chinese Family Panel Studies (CFPS). Results: Cultural capital has a significant positive effect on the digital divide among rural older adults (ß = 0.178, p < 0.01). Cognitive ability and economic capacity both play independent intermediary effects between cultural capital and digital divide among rural older adults, and the intermediary chain formed by the two plays a chain intermediary effect. The increase in the cultural capital of rural older adults has led to an increase in their cognitive ability and economic capacity, which ultimately has a favorable effect on the bridging of the digital divide. Heterogeneity results suggest that cultural capital is more effective in bridging the digital divide among male rural older adults aged 60-69. Conclusion: Cultural capital is able to bridge the digital divide faced by rural older adults and is age and gender heterogeneous. At the same time, improved cognitive ability and economic capacity can also help rural older adults bridge the digital divide. Therefore, it is proposed that we increase the construction of public cultural service infrastructure in rural areas, liaise with community neighborhood committees and village committees to do a good job of publicity, improve training measures for key groups, and maintain the enthusiasm of rural older adults for learning, so as to provide references for the rural older adults in China and developing countries in general to bridge the digital divide.


Assuntos
Cognição , Exclusão Digital , População Rural , Humanos , Idoso , Masculino , População Rural/estatística & dados numéricos , China , Feminino , Pessoa de Meia-Idade , Pesquisa Empírica , Capital Social
10.
Geriatr Nurs ; 59: 526-534, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39146643

RESUMO

In the digital era, increasingly more Chinese older adults have become Internet users, but the digital divide deeply affects their health. Based on the China Longitudinal Aging Social Survey, the influence of Internet use on older adults' physical and mental health are examined. It is found that digital access, online socializing and information/knowledge acquisition improve older adults' physical and mental health, while Internet skills can hardly influence their health. Social connection and adaptation are two important channels through which Internet use improves older adults' health. Younger and better-educated older adults gain more health benefits from Internet access, but online socializing and economic activities show stronger positive health effects in less-educated older adults. Narrowing the digital divide and promoting digital cohesion are important for the health of older population, so the health and pensions sector and geriatric nursing providers should help this group integrate into digital life to improve their health.


Assuntos
Exclusão Digital , Uso da Internet , Saúde Mental , Humanos , China , Idoso , Masculino , Feminino , Uso da Internet/estatística & dados numéricos , Inquéritos e Questionários , Nível de Saúde , Estudos Longitudinais , Internet
11.
Appl Clin Inform ; 15(4): 808-816, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39038793

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic accelerated the use of telehealth. However, this also exacerbated health care disparities for vulnerable populations. OBJECTIVES: This study aimed to explore the feasibility and effectiveness of a medical student-led initiative to identify and address gaps in patient access to digital health resources in adult primary care clinics at an academic safety-net hospital. METHODS: Medical students used an online HIPAA-compliant resource directory to screen for digital needs, connect patients with resources, and track outcome metrics. Through a series of Plan-Do-Study-Act (PDSA) cycles, the program grew to offer services such as information and registration for subsidized internet and phone services via the Affordable Connectivity Program (ACP) and Lifeline, assistance setting up and utilizing MyChart (an online patient portal for access to electronic health records), orientation to telehealth applications, and connection to community-based digital literacy training. RESULTS: Between November 2021 and March 2023, the program received 608 assistance requests. The most successful intervention was MyChart help, resulting in 83% of those seeking assistance successfully signing up for MyChart accounts and 79% feeling comfortable navigating the portal. However, subsidized internet support, digital literacy training, and telehealth orientation had less favorable outcomes. The PDSA cycles highlighted numerous challenges such as inadequate patient outreach, time-consuming training, limited in-person support, and unequal language assistance. To overcome these barriers, the program evolved to utilize clinic space for outreach, increase flier distribution, standardize training, and enhance integration of multilingual resources. CONCLUSION: This study is, to the best of our knowledge, the first time a medical student-led initiative addresses the digital divide with a multipronged approach. We outline a system that can be implemented in other outpatient settings to increase patients' digital literacy and promote health equity, while also engaging students in important aspects of nonclinical patient care.


Assuntos
Exclusão Digital , Atenção Primária à Saúde , Estudantes de Medicina , Telemedicina , Humanos , Assistência Ambulatorial , COVID-19 , Pacientes Ambulatoriais , Registros Eletrônicos de Saúde
12.
JMIR Ment Health ; 11: e51315, 2024 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-39058547

RESUMO

BACKGROUND: Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). OBJECTIVE: This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. METHODS: The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. RESULTS: There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. CONCLUSIONS: Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes.


Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Humanos , Acessibilidade aos Serviços de Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Masculino , Feminino , COVID-19/epidemiologia , Adulto , Pessoa de Meia-Idade , Telemedicina , Medicina Estatal , Reino Unido , Tecnologia Digital , Entrevistas como Assunto , Exclusão Digital
13.
PLoS One ; 19(7): e0305655, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38976657

RESUMO

INTRODUCTION: Population aging and internal migration have become the "norm" in China's population development. Influenced by both "mobility" and "old age," internal elderly migrants (IEMs) face the second-level digital divide problems primarily characterized by digital technology usage gap, which can lead to adverse health outcomes. Understanding the impact of the digital divide on the health of IEMs can provide effective solutions to meet the health needs of this particular group and facilitate their better integration into a digital society. Therefore, this study aims at exploring the impact of the digital divide on the health of IEMs, and identifying priorities and recommendations for improving IEMs' health by mitigating the adverse effects of the digital divide. METHODS: In the 2017 China Migrant Dynamic Survey (CMDS), a cross­sectional sample of 169,989 internal migrants in 32 provincial units across China was recruited by stratified probability proportionate to size sampling (PPS). We focus on IEMs and require interviewees to be 60 years and older. Therefore, we excluded samples younger than 60 years of age and retained only 6,478 valid samples. Subsequently, STATA 17.0 software was applied to analyze the data. Based on the research objective and Grossman's model of health demand, we empirically tested using ordered logit regression. RESULTS: The digital divide does affect the health of IEMs in general and its negative effects tend to decrease significantly with age. In terms of groups, its impact showed noticeable group differences in residence arrangement, public health services and medical insurance coverage. Compared with IEMs who live alone or only live with their spouse, have not received public health service, and have not been covered by any medical insurance, the digital divide imposes a smaller adverse impact on the health of IEMs who live with at least one offspring, have received public health service, and have covered in at least one medical insurance. In terms of potential mechanisms, among the effects of digital divide on the health of IEMs, the mediating effect of urban integration is not significant, the social interaction has only a partial mediating effect, and the medical convenience has a significant mediating effect. CONCLUSION: Our findings confirm the existence of the third-level digital divide among IEMs concerning health, that is, the digital divide has adverse health outcomes for this group, and underscore the important implications of reducing the negative impact of the digital divide in improving the health status of IEMs.


Assuntos
Exclusão Digital , Migrantes , Humanos , China , Migrantes/estatística & dados numéricos , Estudos Transversais , Idoso , Masculino , Feminino , Pessoa de Meia-Idade , Nível de Saúde , Inquéritos e Questionários
14.
J Aging Stud ; 69: 101227, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38834250

RESUMO

The COVID-19 pandemic erupted in early 2020. The Swiss Federal Council implemented a semi-lockdown in March 2020, asking people, particularly older adults, to stay at home to limit the transmission of the disease and to use digital tools to maintain their social relations and activities. This study inquired how older adults confronting precarity experienced these restrictions, how digital tools functioned in this context, and what learning could therefore be imbibed for the post-pandemic era. We conducted semi-structured telephone interviews with adults aged between 66 and 90 years living in a rural and mountainous Swiss region. The obtained data were subsequently thematically analyzed. The results revealed that the respondents experienced ageism during the semi-lockdown and reported limited or non-existent opportunities to use digital tools to maintain online social contact. This predicament increased their sense of loneliness and amplified their feelings of rejection by the outside world. These observations elucidate the need for the enhancement of non-ageist social support for older people, including individuals with limited social and material resources. We advocate the adoption of innovative initiatives in the post-pandemic era to better include precarious older people in our localities and neighborhoods.


Assuntos
Etarismo , COVID-19 , Exclusão Digital , Solidão , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Idoso , Etarismo/psicologia , Suíça , Masculino , Feminino , Idoso de 80 Anos ou mais , Solidão/psicologia , SARS-CoV-2 , População Rural
15.
Gerontologist ; 64(9)2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38898816

RESUMO

BACKGROUND AND OBJECTIVES: Significant societal and technological changes in the 2010s called for an up-to-date understanding of the digital divide among older adults in the United States. This trend study aimed to examine the effects of race/ethnicity and the intersecting effects of race/ethnicity with other marginalized identities related to gender, income, education, and occupation on the first- and second-level digital divide. RESEARCH DESIGN AND METHODS: Utilizing a nationally representative sample of older community dwellers from the National Health and Aging Trends Study, we conducted weighted logistic regressions at 3 time points (2011/2013, 2015, and 2019). The first-level digital divide was measured by access to working phones or computers/laptops; the second-level divide was measured by 7 activities in personal task, social, and health-related Internet use. RESULTS: The first-level racial/ethnic digital divide became nonsignificant in 2019, whereas the disparities in all second-level measures persisted. The intersecting effects of race/ethnicity with low education and/or low income became nonsignificant in 2019 for personal-task use. However, the interactions with low education and/or low income became significant for social and health-related use in 2015 and/or 2019. DISCUSSION AND IMPLICATIONS: This study highlights the persistence of the second-level racial/ethnic digital divide among older community dwellers in the United States, especially the exacerbated social and health-related digital divide for people of color with low socioeconomic status. By considering intersections of marginalized social identities, policymakers and stakeholders should develop targeted strategies to bridge the digital divide, promote health outcomes, and reduce health disparities.


Assuntos
Exclusão Digital , Etnicidade , Classe Social , Humanos , Feminino , Masculino , Idoso , Estados Unidos , Etnicidade/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Idoso de 80 Anos ou mais , Fatores Sexuais , Envelhecimento , Pessoa de Meia-Idade
16.
Cyberpsychol Behav Soc Netw ; 27(8): 550-561, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38916122

RESUMO

The global shift to remote work during the COVID-19 pandemic has intensified scholarly attention to remote workers' well-being. Although existing studies explore the varied impacts of remote work, there is a gap in understanding remote workers' well-being through the lenses of social disparity and the digital divide. Extending digital divide scholarship to the remote work context, this study disentangles why some remote workers experience better well-being than others. We conducted a two-wave longitudinal panel study in South Korea during the COVID-19 pandemic (Wave 1: February 2021, Wave 2: October 2021). Among the 501 participants who participated in both waves, we found that individuals with lower education levels were less likely to have remote work opportunities. We focused our further analyses on a subset of 144 employees who had remote work opportunities within organizations with typical hierarchical structures. We found that socioeconomic status (SES) did not directly influence remote workers' well-being but indirectly influenced it by contributing to the diversity in using information and communication technologies (ICTs). Workers with higher SES or more diversity in using ICTs demonstrated lower vulnerability and more effectiveness in maintaining their well-being in virtual organizational communication situations. This study highlights social disparities in remote workers' well-being, which arise from the complex interplay of SES either indirectly influencing the diversity in ICT usage or interacting with virtual organizational communication satisfaction and duration. This study advances remote work scholarship by restructuring theoretical discussions on social stratification and the digital divide reproduced within the evolving work environment.


Assuntos
COVID-19 , Exclusão Digital , Humanos , Masculino , Feminino , COVID-19/psicologia , COVID-19/epidemiologia , República da Coreia , Adulto , Estudos Longitudinais , Teletrabalho , Pessoa de Meia-Idade , Felicidade , SARS-CoV-2 , Classe Social , Satisfação Pessoal
17.
Front Public Health ; 12: 1418627, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38912273

RESUMO

Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying the challenges these populations face in accessing healthcare. Bridging this digital divide is essential, as digital access and literacy are social determinants of health that can impact digital health use and access to care. This article discusses the potential of leveraging community Wi-Fi and spaces to improve digital access and digital health use, as well as the challenges and opportunities associated with this strategy. The existing limited evidence has shown the possibility of using community Wi-Fi and spaces, such as public libraries, to facilitate telehealth services. However, privacy and security issues from using public Wi-Fi and spaces remain a concern for librarians and healthcare professionals. To advance digital equity, efforts from multilevel stakeholders to improve users' digital access and literacy and offer tailored technology support in the community are required. Ultimately, leveraging community Wi-Fi and spaces offers a promising avenue to expand digital health accessibility and use, highlighting the critical role of collaborative efforts in overcoming digital health disparities.


Assuntos
Telemedicina , Humanos , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Exclusão Digital , Saúde Digital
19.
J Am Med Inform Assoc ; 31(7): 1583-1587, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38741288

RESUMO

INTRODUCTION: The transition to digital tools prompted by the pandemic made evident digital disparities. To address digital literacy gaps, we implemented a system-wide digital navigation program. METHODS: The Digital Access Coordinator (DAC) program consists of 12 multilingual navigators who support patients in enrolling and using the patient portal and digital tools. We implemented the program in our primary care network which consists of 1.25 million patients across 1211 clinicians. RESULTS: From May 2021 to November 2022, the DACs completed outreach to 16 045 patients. Of the 13 413 patients they reached, they successfully enrolled 8193 (61%) patients in the patient portal. Of those patients they enrolled, most patients were of Other race, Hispanic ethnicity, and were English-speaking (44%) and Spanish-speaking patients (44%). Using our embedded model, we increased enrollment across 7 clinics (mean increase: 21.3%, standard deviation: 9.2%). Additionally, we identified key approaches for implementing a digital navigation program. CONCLUSION: Organizations can support patient portal enrollment, a key part of digital health equity, by creating and prioritizing digital navigation programs.


Assuntos
Portais do Paciente , Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Equidade em Saúde , COVID-19 , Navegação de Pacientes/organização & administração , Exclusão Digital
20.
J Med Syst ; 48(1): 56, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38801505

RESUMO

The rapid growth of internet users in China presents opportunities for advancing the "Healthy China 2030" initiative through online health education. Platforms like "Shanghai Health Cloud" and "National Health Information Platform" improve health literacy and management, enhancing overall public health. However, challenges such as the digital divide and the spread of unverified health information hinder progress. Addressing these issues requires enhancing digital infrastructure, employing advanced technologies for information validation, and setting high standards for online health services. Integrated efforts from various sectors are essential to maximize the benefits of online health education in China.


Assuntos
Educação em Saúde , Letramento em Saúde , Internet , China , Humanos , Educação em Saúde/organização & administração , Educação a Distância/organização & administração , Educação a Distância/métodos , Exclusão Digital
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