Impact of COVID-19 on the digital divide: a rapid review

Abstract

ObjectiveThe increased reliance on digital technologies to deliver healthcare as a result of the COVID-19 pandemic has meant pre-existing disparities in digital access and utilisation of healthcare might be exacerbated in disadvantaged patient populations. The aim of this rapid review was to identify how this ‘digital divide’ was manifest during the first wave of the pandemic and highlight any areas which might be usefully addressed for the remainder of the pandemic and beyond.DesignRapid review and narrative synthesis.Data sourcesThe major medical databases including PubMed and Embase and Google Scholar were searched alongside a hand search of bibliographies.Eligibility criteriaOriginal research papers available in English which described studies conducted during wave 1 of the COVID pandemic and reported between 1 March 2020 and 31 July 2021.ResultsThe search was described using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and identified nine studies. The results are presented within a refined framework describing the three key domains of the digital divide: (1) digital access, within which one study described continuing issues with internet connectivity among vulnerable patients in the UK; (2) digital literacy, where seven studies described how ethnic minorities and the elderly were less likely to use digital technologies in accessing care; (3) digital assimilation, where one study described how video technologies can reduce feelings of isolation and another how elderly black males were the most likely group to share information about COVID-19 on social media platforms.ConclusionsDuring the early phase of the pandemic in the developed world, familiar difficulties in utilisation of digital healthcare among the elderly and ethnic minorities continued to be observed. This is a further reminder that the digital divide is a persistent challenge that needs to be urgently addressed when considering the likelihood that in many instances these digital technologies are likely to remain at the centre of healthcare delivery.

What are patients’ first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19

“…47 Although those at the ‘right’ side (younger and IT-literate people) of the digital divide in Denmark are benefitting much more from online healthcare communication than those at the ‘wrong’ side (eg, ethnic minorities and older people), 45 and might also be those who are selected by healthcare professionals to use VCs, Denmark’s status as digital forerunner might create greater opportunities for VC roll out, and for equity of access to healthcare, than in other developed countries (eg, UK, USA and China), where COVID-19 has widened the digital divide in disadvantaged patient populations. 48 49 The low uptake of VC in general practice in Denmark might therefore be more attributable to organisational barriers and challenges within general practice, an aspect highlighted by other international authors, 50 than difficulties in utilisation of digital technologies among disadvantaged patient groups. A study about Danish GPs’ awareness of the increased digitalisation of society and how this development impacts on their attitudes towards health technology in general, and VC in particular, would add interesting and relevant knowledge for those who wish to implement VC in primary care, for example, neighbouring countries.…”

“…A new study conducted for the organisation ‘Danish Patients’ shows that four out of 10 older people between 60 and 80 years of age wish to be able to choose a digital consultation with their GP if the problem can be handled as well digitally as by physical attendance46 and another recent investigation shows that 55% of Danes wish for more digital dialogue with their health services 47. Although those at the ‘right’ side (younger and IT-literate people) of the digital divide in Denmark are benefitting much more from online healthcare communication than those at the ‘wrong’ side (eg, ethnic minorities and older people),45 and might also be those who are selected by healthcare professionals to use VCs, Denmark’s status as digital forerunner might create greater opportunities for VC roll out, and for equity of access to healthcare, than in other developed countries (eg, UK, USA and China), where COVID-19 has widened the digital divide in disadvantaged patient populations 48 49. The low uptake of VC in general practice in Denmark might therefore be more attributable to organisational barriers and challenges within general practice, an aspect highlighted by other international authors,50 than difficulties in utilisation of digital technologies among disadvantaged patient groups.…”

Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment

“…Despite the increasing availability of telemedicine and its many advantages, older adults experience high barriers to access compared to younger adults [ 9 , 10 ]. A Pew Research report published in 2017 demonstrates that, while there is increasing internet and home broadband use among older adults, increasing age is still associated with a lack of confidence in using electronic devices [ 11 ].…”

Examining disparities relating to service reach and patient engagement with COVID-19 remote home monitoring services in England: a mixed methods rapid evaluation

“…The pandemic has also led to changes to the way that health services are delivered at an unprecedented pace 7,8 , with a rapid adoption of digital technology and an acceleration of the move towards remote monitoring models of care. Little is known whether and how this shift might affect existing health disparities [9][10][11] . Inequalities can be introduced at all stages of the planning and delivery of health interventions, including: access to the intervention, diagnostic accuracy, patient uptake and adherence 12 .…”