AHCJ – Association of Health Care Journalists

11/13/2024 | News release | Distributed by Public on 11/13/2024 16:42

Digital determinants of health important with growing technology usage

Photo by Polina Tankilevitch via Pexels

As health journalists, many of us have written about or are familiar with social determinants of health (SDOH) - how the places where people are born, live, learn, work, play, worship and age affect health, functioning, and quality-of-life outcomes and health risks. More recently, some experts have referred to digital determinants of health (DDOH), a term that relates to how a person's ability and preference to interact with and use certain types of health information technology could affect their health outcomes and well-being, according to TechTarget.

Although health IT scholars are still refining the definition of DDOH, it is clear there is a strong link between social and digital determinants of health, the TechTarget story said. For example, a patient with limited English proficiency might not be able to use a health system's patient portal if it is offered only in English. Language proficiency is a social determinant, but the patient portal being offered only in one language could be considered a digital determinant of health.

It's a good reminder for journalists covering new technology offerings from hospitals/health systems and technology companies to inquire about how access for all patients is being ensured.

Digital determinants of health could include factors like:

  • Ease of use
  • Usefulness
  • Interactivity
  • Digital literacy
  • Digital accessibility such as broadband access
  • Digital availability
  • Digital affordability
  • Algorithmic bias

People with better digital health literacy, an ability to effectively interact with digital technology, are more informed and empowered in managing their health using digital apps, equipment, platforms and telemedicine, wrote authors of a January 2024 article in PLOS Digital Health.

This, in turn, is positively associated with better health-seeking behaviors, health knowledge and attitudes. But certain populations remain challenged. This includes some older adults with lower educational status or income, who may struggle due to declining functional status, or some people with physical disabilities who may not be able to interact with a virtual interface.

"These unique challenges need custom solutions to ensure that persons with disabilities are not left behind," the authors wrote.

More about digital determinants of health

Access to digital tools is increasingly important to health outcomes, Kevin Vigilante, M.D., MPH, wrote in Forbes in 2023. These tools include online portals that patients can use to access their electronic health records, telehealth/virtual care visits, devices like wireless blood pressure monitors that transmit data, online health care content, mobile health care apps and more.

As these technologies become more widely embraced, there is a risk that people who lack digital access will be further victimized by a widening digital divide, and could "suffer from an exacerbation of health disparities," Vigilante wrote.

One issue is lack of broadband access. Internet access is increasingly recognized as a "super determinant" of health, according to a 2023 article by Yosselin Turcios, MPH, with the Substance Abuse and Mental Health Services Administration (SAMHSA).

Yet, some 19 million people in the United States (some in rural areas and some in pocketed, segregated urban areas) still lack access to reliable broadband service. One report noted in the article said that high-speed internet use rates were lower in households where the main renter/owner is 65 or older, had a disability, or was Hispanic, African American, Native American or Alaska Native. Only five in 10 households with incomes below $25,000 had wired, high-speed internet service.

Another is a so-called digital literacy gap, or a deficit of the digital skills necessary to use devices and apps, Vigilante wrote in Forbes.

"Altogether, the health care industry is at an inflection point where the next decade of work will either improve equity across society through digital health or further worsen and cement the current divides," authors of a 2023 paper on strategies and solutions to address DDOH across underinvested communities wrote in PLOS Digital Health.

Recommendations from the literature

Numerous solutions have been proposed, from subsidies for internet access to making devices available in community settings like libraries and pharmacies. Some also recommend including an assessment of digital tools and resources as part of the social history taken in a patient visit, in order to tailor digital access and training.

Health IT developers and their hospital/health system customers should be mindful of DDOH when assessing tools for their patient populations. One example is the use of a patient portal vendor that allows for the selection of information in multiple languages to serve a multilingual patient population, the TechTarget story said. They also could ensure that any patient portal or other mobile apps can work on simpler, lower-cost smartphones or when not connected to the internet.

A literature review by the authors of the 2023 PLOS Digital Health paper found some of the following recommendations to address DDOH in a variety of populations, including: caregivers who speak a different language or come from a different cultural background than the majority; patients living in an environment whose characteristics influence health; people with mental or behavioral health concerns; people experiencing issues defined by sexual orientation; persons with a major chronic illness; and patients with significant barriers to health care services.

Solutions included a variety of recommendations:

  • Policy: Recommendations focused on accessibility and how to pay for making digital health care accessible to underinvested communities, such as ensuring payment parity between in-person, video and telephone-based medical visits. Another payment solution promoted was the creation of reimbursements/billing codes for additional services to make telemedicine more inclusive, such as interpreter services and time spent helping patients adapt to video-enabled telehealth. Beyond payment, authors noted, is a need for greater attention to cybersecurity for centers that collect personal health information, as security breaches could hold higher negative consequences for patients with disabilities, chronic diseases, housing/food insecurity, etc.
  • Design/development: Recommendations included using wearable activity trackers to reduce the barrier of manual data input for patients, and collaborating with users from historically underinvested communities when designing technology solutions. They also suggested allowing for low-tech options like text messaging versus emails. Datasets used in machine learning/artificial intelligence algorithms should accurately reflect the population.
  • Implementation/adoption: Recommendations included offering complementary trainings and technology reimbursements; selecting digital health solutions where patient data can be reported via web, phone or paper; and designing AI programs that could adjust prompts based on patient responses regarding health behaviors.

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