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Digital Divide Goes Beyond Broadband, Rests with Digital Health Literacy

Folks are using the internet, but not for digital health engagement, a sign that the digital divide is about more than just broadband but also about digital health literacy.

New data is shedding light on the digital divide in healthcare, with researchers from The Ohio State University revealing that it’s not just broadband access stymying connectivity for marginalized groups. Rather, digital health literacy and language access will be necessary to support digital health equity.

Access to digital health tools has become increasingly important in a modernized medical landscape, with the advent of digital health records, patient portals, and connected health changing the way consumers engage with their health.

That was never more obvious than during the COVID-19 pandemic, when primary care offices had to shutter their doors to conserve resources and try to stem the spread of the virus. Patients and providers alike leaned on digital health tools to support continuity of care and chronic disease management remotely.

But for as much promise as digital health showed during that period, experts still lamented the digital divide, or the difference between folks who could and could not actually utilize those health technologies.

Some pointed to the high cost of some digital health tools and other technologies as driving a wedge between the technological haves and have-nots, while others blamed the age-old problem of broadband access, which can be a barrier for folks who are low-income or who live in more remote regions of the country.

But that tech access and internet connectivity aren’t really the problems at hand, the OSU researchers found. Looking at a Bhutanese refugee community near Columbus, Ohio, the researchers were able to zero in on the challenges faced by a traditionally underserved group exposed to numerous social determinants of health.

Although this group was very low-income, with an average annual income at $35,000, nearly all had access to the internet (94.5 percent).

Even still, folks included in the observational study weren’t utilizing online resources, indicating to researchers that it’s not access to hardware or broadband that’s driving the digital divide in healthcare.

“We can’t just give people access to the internet and say the problem is solved,” Jeffrey Cohen, the lead author of the study and a professor of anthropology at The Ohio State University, said in a press release. “We found that there are social, cultural and environmental reasons that may prevent some communities from getting all the value they could out of internet access.”

Language barriers, for example, were particularly onerous for study participants. Only around a quarter of participants said they were proficient in English, and despite access to community language interpreters, internet users said the content they engaged with was “mostly gibberish.”

That considerably skewed how people used the internet. Eight in 10 said they used the internet to communicate with family and friends and 68 percent utilized social media, but the internet was virtually useless for digital health engagement. Three-quarters of study participants said they never used the internet to access telehealth, despite having predispositions for certain chronic illnesses like cardiovascular disease and diabetes.

“People had access to the internet, and this information was available to them, but they couldn’t use it,” Cohen explained. “That is not a technological issue, but it is part of the digital divide.”

The study did not reveal any direct solutions to the digital divide problem, but it did underscore the need to look deeply at community needs. While industry calls to make digital health tools and broadband more accessible have been helpful, they do not speak to the whole problem.

English language supports will be essential to closing the digital health gap and, ultimately, addressing health equity in an increasingly digitized medical space.

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