Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey

Abstract

Background Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions.

Can mobile-health applications contribute to long-term increase in physical activity after medical rehabilitation?–A pilot-study

“…Hence, there still seem to be various barriers to using mobile health applications. In particular, (obese) individuals of lower socio-economic status might be disinclined to using digital interventions because of a lower e-health literacy [ 25 , 35 ]. Previous studies provide contradictory results to this issue.…”

“…In addition, the use of digital interventions may depend on patient-related socio-economic factors such as age, education, and ethnicity. A number of studies suggest that digital health tools should be adopted along with social determinants of health, such as income and education, which may result in a digital health divide, therefore increasing differences in the ability to achieve an improved health outcome due to the use of digital technologies [ 25 , 26 ]. Consequently, this may enhance existing social health inequities, which would not be conducive to current public health efforts [ 27 ].…”

Narrowing the Digital Divide: A Framework for Creating Telehealth Equity Dashboards (Preprint)

“…[1] However, disparities in access to and adoption of digital healthcare persist among Black, Hispanic, public-insured, low-income, and rural populations. [2,3] This "digital divide" risks worsening health disparities in these populations. [4] As such, Crawford et al created the Digital Health Equity Framework (DHEF) to guide the design and implementation of future digital health interventions by taking into consideration the digital determinants of health at the root of these disparities.…”

Digital Health Interventions for Promoting Healthy Aging: A Systematic Review of Adoption Patterns, Efficacy, and User Experience

“…Out of the remaining 398 papers, Reports were evaluated to determine their eligibility. Out of a total of 176, only 15 were chosen for the complete text evaluation [19,[34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Figure 1 provides an explanation of the PRISMA flow diagram.…”

“…If designed accessibly and widely adopted, digital health technologies could help address global aging challenges [19]. Benefits may include facilitating aging in place, reducing hospital and institutional resource use, and enabling early detection of health status changes through enhanced infrastructure for remote care, monitoring and therapy [20].…”