Broadband Internet Access Is a Social Determinant of Health!

Benda, Natalie C.; Veinot, Tiffany C.; Sieck, Cynthia J.; Ancker, Jessica S.

doi:10.2105/ajph.2020.305784

Cited by 208 publications

(160 citation statements)

References 1 publication

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“…Therefore, the perspectives on vaccine hesitancy presented in this paper are not wholly representative of the perspectives of all people in Canada. All users included in this study represent people in Canada with broadband internet access, which, as the COVID-19 pandemic has illustrated, is an important determinant of health [ 33 ]. As such, we likely missed the perspectives of those who face challenges when accessing the internet.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

Griffith¹,

Marani²,

Monkman³

2021

J Med Internet Res

189

176

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Background With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. Objective The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods We screened 3915 tweets from public Twitter profiles in Canada by using the search words “vaccine” and “COVID.” The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

Griffith¹,

Marani²,

Monkman³

2021

J Med Internet Res

189

176

View full text Add to dashboard Cite

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“…For instance, a pilot program delivering tablets to patients cared for by the US Department of Veterans Affairs has been successful in addressing concerns related to diagnosis and technology [ 40 ]. Further, municipality-level internet and broadband for all could address access issues [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation

Saliba‐Gustafsson¹,

Miller-Kuhlmann²,

Kling³

et al. 2020

J Med Internet Res

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Background Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

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“…Having access to broad band internet and knowledge about use of technology during COVID19 have become determinants of health outcomes as also noted by others. 8,9 There was a significant increase in the documentation of vital signs, number of systems evaluated during the physical exam, DSD compared to BSD. This was likely multifactorial-increasing knowledge about telemedicine practice with time, higher provider acceptance, new targeted coaching and education for providers as noted in Figure e4, and the proliferation of resources to support neurological examination.…”

Section: Joshi Page 16mentioning

confidence: 99%

Quality and Safety Analysis of 2,999 Telemedicine Encounters During the COVID-19 Pandemic

et al. 2021

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Abstract:Objective:To examine if telemedicine remains safe and of high quality despite rapid expansion of services by comparing telemedicine encounters prior to and during COVID 19 pandemic.Methods:Pre-post study investigating 2999 telemedicine encounters: 2/1/2020 - 5/15/2020. 2919 completed visits before and after strict social distancing implementation were analyzed for patient and provider characteristics, encounter characteristics (history, physical exam, etc) and quality and safety metrics (phone calls <=7 days post visit, visit- cause specific hospital admission or mortality <=30 days after visit). Stratified analysis of 3 groups for outcomes (young age, neuromuscular diagnosis and new encounters) was performed.Results:Patients ranging from 1 month old to 33 years were seen. Rural patients were less likely to be seen during pandemic compared to urban patients(8 % vs 90% p< 0.0001); teaching clinic and specialty clinic encounters increased significantly during pandemic ( 8% vs 3% ; p=0.005), documentation of at least two systems on exam was noted significantly more frequently during pandemic ( 13% vs 7%; p=0.009). No deaths were reported. There were no differences pre/ during pandemic for safety or telemedicine failure metrics within entire group and high-risk subgroupsConclusions:Despite a markedly and rapidly expanded scope of ambulatory telemedicine care during the COVID19 pandemic, telemedicine remained a safe and high-quality option for pediatric neurology patients. Additionally, populations perceived as high risk for telemedicine (the very young, new patients and those with neuromuscular diagnoses) can benefit from telemedicine visits, particularly when access to in-person care is limited.

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Broadband Internet Access Is a Social Determinant of Health!

Cited by 208 publications

References 1 publication

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation

Quality and Safety Analysis of 2,999 Telemedicine Encounters During the COVID-19 Pandemic

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