[DDHealth Protocol: Justification, design and implementation of a cross-sectional survey of sociodemographic health, health literacy and digital divide in 2,000 adults aged fifty to seventy-nine residing in Spain in 2022]. / Protocolo de la DDHealth: Justificación, diseño y realización de una encuesta transversal de salud sociodemográfica, alfabetización sanitaria y brecha digital en 2.000 adultos de cincuenta a setenta y nueve años residentes en España en 2022.

Socioeconomic inequalities in health persist in Spain. The DDHealth project aims to address two timely innovative aspects that have been postulated to contribute to socioeconomic inequalities in health. DDHealth aims to address two innovative and timely aspects that have been proposed to contribute to socioeconomic health inequalities. The first one is the socioeconomic digital divide, which refers to the greater capabilities and opportunities to access technology and use the internet among higher social classes compared to lower ones. The second aspect is health literacy, which refers to individuals' capacity to meet and understand the complex demands of health promotion and maintenance in modern society. The study conducted over 2,000 interviews among residents in Spain aged between fifty and seventy-nine years old from March to April 2022, using a computer-assisted telephone interviewing (CATI) approach. The questionnaire comprises four different modules: sociodemographic; digital divide; health; health literacy. The anonymized data are available through the following link: https://dataverse.csuc.cat/dataset.xhtml?persistentId=doi:10.34810/data765. DDHealth enables addressing innovative dimensions concerning the social determinants of health in Spain. The data are available to external researchers for scientific purposes upon request of a reasonable research proposal.

Las desigualdades socioeconómicas en salud persisten en España. La encuesta DDHealth se propone para dar respuesta a parte de las razones que explican las desigualdades socioeconómicas en salud. DDHealth pretende abordar dos aspectos innovadores y oportunos que se ha postulado que contribuyen a las desigualdades socioeconómicas en salud. El primero es la brecha digital socioeconómica, que se refiere a que las capacidades y posibilidades de acceder a la tecnología y usar internet son mayores entre las clases sociales altas en comparación con las bajas. La segunda es la alfabetización sanitaria, que se refiere a la capacidad de los individuos para satisfacer y comprender las complejas demandas de promoción y mantenimiento de la salud en la sociedad moderna. El estudio llevó a cabo más de 2.000 entrevistas entre residentes en España de entre cincuenta y setenta y nueve años de edad entre marzo y abril de 2022, utilizando un enfoque de entrevista telefónica asistida por ordenador (CATI). El cuestionario tiene cuatro módulos diferentes: sociodemográfico; brecha digital; salud; alfabetización sanitaria. Los datos anonimizados están disponibles a través del enlace: https://dataverse.csuc.cat/dataset.xhtml?persistentId=doi:10.34810/data765. La DDHealth permite abordar dimensiones innovadoras acerca de los determinantes sociales de la salud en España. Los datos de la DDHealth están disponibles para investigadores externos con fines científicos previa solicitud de una propuesta de investigación razonable.

The persistent educational digital divide and its impact on societal inequality.

Computers and the Internet are widely recognized as fundamental to academic and future success on both the individual and the societal level. Moreover, the academic success of school-age children is now increasingly tied to access to educational technology, a reality that became even more apparent during the pandemic. While academic performance is viewed as the major outcome of using educational technology, this study looks at a crucial early stage in the educational technology value chain, specifically; 1) to what extent do students use computers and the Internet in their homes and at school and 2) what is the extent and nature of disparities in student access to educational technology. This study was conducted using the national CPS 2019 Computer and Internet Use Survey of 23,064 school age children. We used bivariate tables and multivariate logistic regression analysis to analyze the data. Results indicate that substantial disparities in the use of educational technology exist in the U.S. Overall, 28.0% of school age children reported they did not use the Internet at school or at home and another 22.8% reported using the Internet at home but not at school. Significantly, individual and community demographic characteristics and household and school technology resources contribute to these disparities. It is clear that if fundamental educational technology and the resources needed to effectively achieve academic success are unavailable in the home, then they must be provided in schools. Without educational technology and resources, the societal value added through growing use of this technology will not materialize for our students. We conclude that committing to increasing educational technology resources in the schools will have multiple future societal benefits and improve the effectiveness of the educational technology value chain.

Research on the impact of digital economy on labor resource allocation: Evidence from China.

This paper establishes a coherent framework for delineating the nexus between the digital economy and the subjective efficacy of labor resource allocation. It elucidates the theoretical underpinnings of the digital economy's impact and its channel effects on the efficiency of labor allocation. Within the digital economy landscape, the phenomena of survivorship bias, digital divide, and algorithmic hegemony wield substantial sway over the efficiency of labor market allocation. Empirical analysis, conducted through a cross-sectional data model, validates the theoretical framework. The findings demonstrate that the digital economy markedly diminishes the subjective efficiency of labor allocation. Notably, this inhibitory effect is more pronounced among female workers, households with multiple residences, the non-unmarried demographic, and individuals over the age of 40, with the most pronounced effect observed among those aged over 60. In the examination of the causative mechanisms, it is discerned that the digital economy attenuates the subjective efficiency of labor allocation by workers through three conduits: alterations in social and economic status, shifts in living standards, and modifications in workplace comfort.

Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study.

BACKGROUND: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. OBJECTIVE: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. METHODS: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. RESULTS: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. CONCLUSIONS: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.

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

BACKGROUND: 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. METHOD: 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. RESULTS: 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'. CONCLUSIONS: 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.

The digital divide in rural and regional communities: a survey on the use of digital health technology and implications for supporting technology use.

OBJECTIVE: A digital divide exists for people from rural and regional areas where they are less likely and confident to engage in digital health technologies. The aim of this study was to evaluate the digital health literacy and engagement of people from rural and regional communities, with a focus on identifying barriers and facilitators to using technology. RESULTS: Forty adults living in rural/regional areas completed a survey consisting of the eHealth Literacy Scale (eHEALS) with additional items surveying participants' experience with a range of digital health technologies. All participants had used at least one digital health technology. Most (80%) participants had an eHEALS score of 26 or above indicating confidence in online health information. Commonly reported barriers to digital health technology use centred on product complexity and reliability, awareness of resources, lack of trust, and cost. Effective digital health technology use is becoming increasingly important, there may be a need to prioritise and support people with lower levels of digital health literacy. We present opportunities to support community members in using and accessing digital health technology.

Digital Redlining-The Invisible Structural Determinant of Health.

This Viewpoint describes digital redlining as racialized inequities in access to technology infrastructure, including access to health care, education, employment, and social services.

Cultural capital, the digital divide, and the health of older adults: a moderated mediation effect test.

BACKGROUND: It is of great practical significance to study the intrinsic relationship between cultural capital, digital divide, cognitive ability, and health of older adults in the dual social context of population aging and the digital era. METHODS: We analyzed data from the 2020 China Family Panel Studies (CFPS) initiated by the China Center for Social Science Surveys at Peking University. Physical health, mental health, and memory health were set as indicators of older adults, and the relationship between cultural capital, digital divide, cognitive ability, and health of older adults was examined by hierarchical regression with moderated mediated effect methods. RESULTS: Improvement in the health of older adults is associated with an increase in the level of cultural capital; cultural capital may bridge the digital divide faced by older adults, which in turn promotes the improvement of the health of older adults; the higher the level of cognitive ability, the stronger the effect of cultural capital on the digital divide, and at the same time, the stronger the mediating effect of the digital divide; cultural capital has a more pronounced effect on the health of older male adults living in the city. CONCLUSIONS: The results of the study show that cultural capital can have a positive impact on the health of older adults, but there is urban-rural heterogeneity and gender heterogeneity, in which the digital divide plays a mediating role, and the enhancement of the cognitive ability of older adults will be conducive to the improvement of their health, so the health of older adults should be promoted by improving the level of their cultural capital and the ability of older adults to use digital technology, thus provide references for the protection of health of older adults.

[Social inequality in the context of digital health applications: digital divides in access, use, effectiveness, and privacy]. / Soziale Ungleichheit im Zusammenhang mit digitalen Gesundheitsanwendungen: Digitale Spaltungen in den Bereichen Zugang, Nutzung, Wirksamkeit und Privatsphäre.

Given the massive increase in digital health tools, the question about the impact of these tools on health equity has gained importance. The aim of this narrative review is to discuss the extent and central aspects of the digital divide. To illustrate the extent of the digital divide, we draw on data from the Liter@te study, which interviewed low-literacy individuals regarding their use of digital health tools and their digital health literacy. The results of the Liter@te study are compared with population surveys conducted in parallel. Four areas can be distinguished in relation to digital divides: access, use, effectiveness, and privacy. Inequalities can be observed in all four areas. While differences in access or material infrastructure, as well as in usage patterns and the required literacies, have already been investigated in some studies, the data basis for a comprehensive assessment of the unequal effects of digital health tools in different population groups is still lacking. Digital divides in the area of privacy protection is an emerging field. However, transparent and understandable privacy measures will undoubtedly be an important prerequisite for the widespread use of digital health tools. Overall, in addition to a better data base, involvement of disadvantaged population groups in the development of digital health interventions is necessary.

The digital divide: David vs. Goliath.

There is a global danger that hides in the shadows and is changing the way continuing care operators care for residents. Today, to provide that same historical level of resident care, a group of techno-soldiers are not just a nice-to-have, but are a must, to protect our critical Information Technology (IT) infrastructure. There is little doubt that technology has enabled us to provide better care. Electronic medical records, human resources information systems, and voice over Internet communications systems have created great efficiencies in operations. However, global cybercriminals lurk in the same technologies that support us. Continuously attempting to rob our private information and hold us ransom, or play havoc with our IT systems impeding our provision of care. How can a continuing care operator, an already funding-challenged industry balance the costs of protecting their IT infrastructure against this growing massive threat? Compounding the issue, rising insurance expectations for continuing care operators to continuously enhance their IT safety controls against evolving cyberterrorism. This is the story of the Good Samaritan Society/Canada (Good Samaritan) digital transformation journey. Our digital roadmap sets Good Samaritan up to rise above the ongoing barrage of cyberattacks and loss of insurance. This is a digital divide story of David vs. Goliath.

Toward a Humane Metaverse: Challenges and Opportunities.

The metaverse, an emerging digital universe blurring the lines between reality and virtuality, offers a view into a future where human interaction transcends physical boundaries. In this article, we analyze the multidimensional facets of the metaverse, scrutinizing the landscape of challenges and opportunities it offers. The article delves into the challenges faced by human society in adapting to the metaverse, including the digital divide, ethical dilemmas, the level of trust, and the potential erosion of social and physical reality. Amid the allure of boundless creativity, questions arise about the very essence of human experience-identity, empathy, social relationships, life satisfaction, and the nature of reality itself. The metaverse, with all its complexities, challenges us to redefine the boundaries of human interaction, urging us to tread cautiously while embracing the limitless possibilities it presents. As we venture "toward a humane metaverse," we must navigate the intricate interplay of technology and humanity, shaping a future where the virtual realm enhances, rather than diminishes, the richness of the human experience.

Health Disparities, Clinical Trials, and the Digital Divide.

In the past few years, there have been rapid advances in technology and the use of digital tools in health care and clinical research. Although these innovations have immense potential to improve health care delivery and outcomes, there are genuine concerns related to inadvertent widening of the digital gap consequentially exacerbating health disparities. As such, it is important that we critically evaluate the impact of expansive digital transformation in medicine and clinical research on health equity. For digital solutions to truly improve the landscape of health care and clinical trial participation for all persons in an equitable way, targeted interventions to address historic injustices, structural racism, and social and digital determinants of health are essential. The urgent need to focus on interventions to promote health equity was made abundantly clear with the coronavirus disease 2019 pandemic, which magnified long-standing social and racial health disparities. Novel digital technologies present a unique opportunity to embed equity ideals into the ecosystem of health care and clinical research. In this review, we examine racial and ethnic diversity in clinical trials, historic instances of unethical research practices in biomedical research and its impact on clinical trial participation, and the digital divide in health care and clinical research, and we propose suggestions to achieve digital health equity in clinical trials. We also highlight key digital health opportunities in cardiovascular medicine and dermatology as exemplars, and we offer future directions for development and adoption of patient-centric interventions aimed at narrowing the digital divide and mitigating health inequities.

Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion.

Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all.

Brecha digital en cuidadores de pacientes pediátricos de 0 a 12 años. Diseño y validación de un cuestionario / The digital divide among caregivers of pediatric patients aged 0 to 12 years. Design and validation of a questionnaire

Introducción. Las estrategias sanitarias basadas en tecnologías de la información y la comunicación (TIC) podrían perpetuar la inequidad en salud, especialmente en poblaciones vulnerables. Existen escasas herramientas validadas para evaluar el acceso a las TIC en pediatría en nuestro medio. Objetivos. Construir y validar un cuestionario para evaluar el acceso a las TIC para cuidadores de pacientes pediátricos. Describir las características de acceso a las TIC y evaluar si existe correlación entre los tres niveles de la brecha digital. Población y métodos. Construimos y validamos un cuestionario que luego administramos a cuidadores de niños entre 0 y 12 años. Las variables de resultado fueron las preguntas del cuestionario para los tres niveles de brecha digital. Además, evaluamos variables sociodemográficas. Resultados. Administramos el cuestionario a 344 cuidadores. El 93 % poseía celular propio y el 98,3 % utilizaba internet por red de datos. El 99,1 % se comunicaba a través de mensajes de WhatsApp. El 28 % había realizado una teleconsulta. La correlación entre las preguntas fue nula o baja. Conclusión. Por medio del cuestionario validado, evaluamos que los cuidadores de pacientes pediátricos de 0 a 12 años poseen en su mayoría celular, se conectan por red de datos, se comunican principalmente a través de WhatsApp y obtienen pocos beneficios a través de TIC. La correlación entre los diferentes componentes del acceso a las TIC fue baja.

Introduction. Health care strategies based on information and communication technologies (ICTs) may perpetuate health inequity, especially among vulnerable populations. In our setting, there are few validated tools to assess access to ICTs in pediatrics. Objectives. To develop and validate a questionnaire to assess ICT access among caregivers of pediatric patients. To describe the characteristics of ICT access and assess whether there is a correlation among the three levels of the digital divide. Population and methods. We developed and validated a questionnaire and then administered it to the caregivers of children aged 0­12 years. The outcome variables were the questions in the three levels of the digital divide. We also assessed sociodemographic variables. Results. We administered the questionnaire to 344 caregivers. Among them, 93% had their own cell phone and 98.3% had Internet access via a data network; 99.1% communicated via WhatsApp messages; 28% had had a teleconsultation. The correlation among the questions was null or low. Conclusion. The validated questionnaire allowed us to establish that the caregivers of pediatric patients aged 0­12 years mostly own a mobile phone, access the Internet via a data network, communicate mainly through WhatsApp, and obtain few benefits through ICTs. The correlation among the different components of ICT access was low.

A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service.

Objectives The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31-0.36, P P Conclusion There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this.

Mechanisms and heterogeneity in the construction of network infrastructure to help rural households bridge the "digital divide".

Addressing the digital divide that plagues rural areas has become an important issue in narrowing the urban-rural gap and achieving common prosperity. This article examines the impact of network infrastructure on rural households' ability to cross the digital divide by using the "broadband rural" strategy as a proxy variable for network infrastructure and combining data from the China Family Panel Studies (CFPS) with a score propensity matched difference-in-differences model (PSM-DID). The results show that network infrastructure can help farmers cross the access and use divide, but does not contribute significantly to crossing the ability divide in the current period. A triple difference model (DDD) was introduced to test the effect of network technology training on the contribution of network infrastructure to the ability gap, and the ability gap needs to be based on the use gap, so there is a delay in the response of the ability gap to policy. Further analysis reveals that network infrastructure mainly facilitates non-farm occupational groups to cross the capability divide, and facilitates middle-aged and young people to cross the digital divide, and does not have significant effects on groups involved in agricultural work and older people. In view of this, the network infrastructure should be continuously promoted, public service training on digital skills should be organized, electronic products and information services should be created exclusively for the elderly group and the group involved in agricultural production, and the ability of farmers to apply the network to their production life should be strengthened.

The age-based digital divide in an increasingly digital world: A focus group investigation during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Previous research has identified numerous benefits of information and communication technology (ICT) on the well-being of older adults. However, it has been increasingly recognized that older adults do not necessarily catch up with the rapidly digitalized society, known as the 'age-based digital divide'. The progress of digitalization has been accelerated during the COVID-19 pandemic, which may have widened the digital divide. This study aimed to gain a better understanding of their living experience and concerns about digital exclusion during the pandemic. The perceptions of older adults in Hong Kong, a highly digitalized, metropolitan city, towards the digital age and its impact on their daily living during the COVID-19 pandemic were explored. RESEARCH DESIGN AND METHODS: We conducted 12 focus group interviews with 77 community-dwelling older adults during the COVID-19 pandemic. Data were analyzed using thematic analysis, applying both organization, reduction, and refinement. RESULTS: Four themes were identified: 1) Diversified means to access community information; 2) Facilitated daily living through the usage of ICTs; 3) Concerns about age-related decline in function; and 4) Fear of digital exclusion and accelerated digitalization during the pandemic. The results indicate that ICT provided numerous benefits to the daily life of older adults, but our participants also expressed concerns about age-related losses and the fear of digital exclusion due to the ongoing digitalization of society. DISCUSSION AND IMPLICATIONS: Our findings indicated that older adults do not necessarily benefit from technological innovations, which are becoming more pervasive during the pandemic. To create age-friendly environments that cater to the needs of all members of society in the digital age, policymakers and service providers should provide diverse choices for older adults, rather than relying solely on one-size-fits-all technological solutions.