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Rillig MC, Kasirzadeh A. AI Personal Assistants and Sustainability: Risks and Opportunities. Environ Sci Technol 2024; 58:7237-7239. [PMID: 38634356 DOI: 10.1021/acs.est.4c03300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Matthias C Rillig
- Freie Universität Berlin, Institute of Biology, 14195 Berlin, Germany
- Berlin-Brandenburg Institute of Advanced Biodiversity Research (BBIB), 14195 Berlin, Germany
| | - Atoosa Kasirzadeh
- The University of Edinburgh, Edinburgh Futures Institute, Edinburgh EH3 9EF, U.K
- Alan Turing Institute, London NW1 2DB, U.K
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Brecher AL, Herrgen J, Mueller T. DiGA in Primary Care and the Influence of Patient-Related Factors - Results of a Survey of Family Doctors. Stud Health Technol Inform 2024; 313:55-61. [PMID: 38682505 DOI: 10.3233/shti240012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND In 2019, the Digital Healthcare Act created the legal basis for prescribable mobile health applications, referred to as DiGA (in German: Digitale Gesundheitsanwendungen), as a novel healthcare delivery option in Germany [1, 2]. OBJECTIVES The aim of this study is to analyze the use of DiGA in primary care, focusing on the influence of socio-demographic characteristics of family doctors (FDs) and patient-related factors. METHODS Pen-and-paper survey among 97 FDs in the district of Giessen, Hesse, Germany. RESULTS 59.4% of surveyed FDs have already prescribed DiGA. The age and digital affinity of FDs as well as the location of their practice are significantly correlated with the level of information and willingness to use DiGA. Male und younger FDs rate their digital affinity higher. When deciding whether to prescribe DiGA, 72.9% of surveyed physicians take patient-related factors such as digital affinity, motivation, age and health literacy into consideration. CONCLUSION Socio-demographic characteristics of FDs and patient-related factors have an influence on the use of DiGA.
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Affiliation(s)
- Anna-Lena Brecher
- University of Applied Sciences - Faculity of Health Sciences, Giessen, Germany
| | - Julia Herrgen
- University of Applied Sciences - Faculity of Health Sciences, Giessen, Germany
| | - Tobias Mueller
- University of Applied Sciences - Faculity of Health Sciences, Giessen, Germany
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Lu SY, Yoon S, Yee WQ, Heng Wen Ngiam N, Ng KYY, Low LL. Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study. JMIR Aging 2024; 7:e52292. [PMID: 38662423 DOI: 10.2196/52292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. OBJECTIVE This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. METHODS This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ≥60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. RESULTS Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. CONCLUSIONS To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide.
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Affiliation(s)
- Si Yinn Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Center for Population Health Research and Implementation, SingHealth, Regional Health System, Singapore, Singapore
| | - Wan Qi Yee
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Nerice Heng Wen Ngiam
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
- TriGen Ltd, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- TriGen Ltd, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lian Leng Low
- Center for Population Health Research and Implementation, SingHealth, Regional Health System, Singapore, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Haimi M, Sergienko R. Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis. JMIR Aging 2024; 7:e52317. [PMID: 38656768 DOI: 10.2196/52317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/15/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. OBJECTIVE This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. METHODS We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. RESULTS Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. CONCLUSIONS Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Health Administration Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Clalit Research Institute, Tel Aviv, Israel
| | - Ruslan Sergienko
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Choy MA, O'Brien K, Barnes K, Sturgiss EA, Rieger E, Douglas K. Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study. J Med Internet Res 2024; 26:e50410. [PMID: 38602768 PMCID: PMC11046385 DOI: 10.2196/50410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. OBJECTIVE This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. METHODS We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. RESULTS In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. CONCLUSIONS While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.
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Affiliation(s)
- Melinda Ada Choy
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | - Kathleen O'Brien
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Katelyn Barnes
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | | | - Elizabeth Rieger
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Kirsty Douglas
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
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Bybee SG, Sharareh N, Guo JW, Luther B, Grigorian E, Wang CY, Wong B, Wallace AS. A Secondary Data Analysis of Technology Access as a Determinant of Health and Impediment in Social Needs Screening and Referral Processes. AJPM Focus 2024; 3:100189. [PMID: 38322000 PMCID: PMC10844665 DOI: 10.1016/j.focus.2024.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Introduction Although health systems increasingly integrate social needs screening and referrals into routine care, the effectiveness of these interventions and for whom they work remains unclear. Methods Patients (N=4,608) seen in the emergency department were screened for social needs (e.g., transportation, housing, food) and offered an opportunity to receive outreach from community service specialists. Results Among 453 patients with 1 or more social needs who requested assistance, outreach specialists connected with 95 (21.0%). Patients preferred to be contacted through their telephone (n=21, 60.2%), email (n=126, 28.0%), someone else's telephone (n=30, 6.7%), or first by telephone followed by email (n=23, 5.1%). Preferred contact method varied by patient age; endorsement of unmet transportation, housing, and utility needs; receipt of service outreach; and differences in emergency department utilization from the 6 months before the index visit to the 6 months after. Conclusions Because limited access to a stable telephone or internet connection may prevent patients from connecting with resource referrals, social needs interventions may not benefit the most underserved populations who are at the highest risk of negative health outcomes. Future research should investigate whether communication preferences are an important indicator of needs and how to adapt social needs screening and referral processes so that they are more accessible to populations who may experience more frequent disruptions in methods utilized for digital communication.
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Affiliation(s)
- Sara G. Bybee
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Nasser Sharareh
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Brenda Luther
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | - Ching-Yu Wang
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, Utah
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Freeman E, Patel D, Odeniyi F, Pasquinelli M, Jain S. Where Do Oncology Patients Seek and Share Health Information? Survey Study. J Med Internet Res 2024; 26:e36441. [PMID: 38526546 PMCID: PMC11002738 DOI: 10.2196/36441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
- Eric Freeman
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Darshilmukesh Patel
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Folasade Odeniyi
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Mary Pasquinelli
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Shikha Jain
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR Dermatol 2024; 7:e51511. [PMID: 38517468 PMCID: PMC10998172 DOI: 10.2196/51511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
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Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
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Gordon NP, Zhang S, Lo JC, Li CF. The Digital Transition: Are Adults Aged 65 Years or Older Willing to Complete Online Forms and Questionnaires in Patient Portals? Perm J 2024; 28:68-75. [PMID: 38317596 PMCID: PMC10940229 DOI: 10.7812/tpp/23.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Patients are being encouraged to complete forms electronically using patient portals rather than on paper, but willingness of older adults to make this transition is uncertain. METHODS The authors analyzed data for 4105 Kaiser Permanente Northern California 2020 Member Health Survey respondents aged 65-85 years who answered a question about willingness to complete online forms and questionnaires using a patient portal. Data weighted to the Kaiser Permanente Northern California membership were used to estimate percentages of older adults willing to complete patient portal forms and questionnaires. Chi-square tests and log-Poisson regression models that included sociodemographic, internet use, and patient portal variables were used to identify factors predictive of willingness. RESULTS Overall, 59.6% of older adults were willing to complete patient portal forms, 17.6% were not willing, and 22.8% were not sure. Adults aged 75-85 (49.5%) vs 65-74 years (64.8%) and Black (51.9%) and Latino (46.5%) vs White (62.8%) adults were less likely to indicate willingness. In addition to racial and ethnic differences and younger age, higher educational attainment, use of the internet alone (vs internet use with help or not at all), having an internet-enabled computer or tablet, and having sent at least 1 message through the patient portal increased likelihood of being willing. CONCLUSIONS Health care teams should assess older adults' capabilities and comfort related to completion of patient portal-based forms and support those willing to make the digital transition. Paper forms and oral collection of information should remain available for those unable or unwilling to make this digital transition.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- The Permanente Medical Group, Oakland, CA, USA
| | - Sherry Zhang
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- The Permanente Medical Group, Oakland, CA, USA
| | - Christina F Li
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Ebekozien O, Fantasia K, Farrokhi F, Sabharwal A, Kerr D. Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all? Diabetes Obes Metab 2024; 26 Suppl 1:3-13. [PMID: 38291977 PMCID: PMC11040507 DOI: 10.1111/dom.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Digital health technologies are being utilized increasingly in the modern management of diabetes. These include tools such as continuous glucose monitoring systems, connected blood glucose monitoring devices, hybrid closed-loop systems, smart insulin pens, telehealth, and smartphone applications (apps). Although many of these technologies have a solid evidence base, from the perspective of a person living with diabetes, there remain multiple barriers preventing their optimal use, creating a digital divide. In this article, we describe many of the origins of these barriers and offer recommendations on widening access to digital health technologies for underserved populations living with diabetes to improve their health outcomes.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA
- Department of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Kathryn Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Farnoosh Farrokhi
- Alta Bates Summit Medical Centre, Sutter East Bay Medical Foundation, Oakland, California, USA
| | - Ashutosh Sabharwal
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA
| | - David Kerr
- Centre for Health System Research, Sutter Health, Santa Barbara, California, USA
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Choudhury A, Nimbarte A. Editorial: Mobile health interventions to address maternal health: ideas, concepts, and interventions. Front Digit Health 2024; 6:1378416. [PMID: 38486918 PMCID: PMC10937536 DOI: 10.3389/fdgth.2024.1378416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Avishek Choudhury
- Industrial and Management Systems Engineering, West Virginia University, Morgantown, WV, United States
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Ferraris G, Coppini V, Monzani D, Grasso R, Kirac I, Horgan D, Pietrobon R, Galvão V, Pravettoni G. Addressing disparities in European cancer outcomes: a qualitative study Protocol of the BEACON project. Front Psychol 2024; 15:1252832. [PMID: 38469221 PMCID: PMC10925749 DOI: 10.3389/fpsyg.2024.1252832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Health disparities represent a crucial factor in cancer survival rates, awareness, quality of life, and mental health of people receiving a cancer diagnosis and their families. Income, education, geographic location, and ethnicity are some of the most important underlying reasons for health disparities in cancer across Europe. Costs of healthcare, access to information, psycho-oncological support options, integration of cancer research and innovative care, and multidisciplinary cancer teams are the main target areas when it comes to addressing disparities in the cancer context. As part of the Beacon Project (BEACON), we developed a protocol for a qualitative study to explore and identify any relevant reasons for cancer inequalities and disparities in Europe. Methods Our four stakeholders namely, cancer patients, healthcare providers, researchers, and policymakers will be recruited online, facilitated by collaborative efforts with cancer organizations from various European countries, including but not limited to Italy, Croatia, Estonia, and Slovenia. Qualitative online focus group discussions for each stakeholder will be conducted and transcribed. Subsequently, thematic analysis will be used to identify reasons and aspects that may contribute to the existing disparities in cancer outcomes at various levels of engagement and from different stakeholders' perspectives. Results from focus groups will inform a subsequent Delphi study and a SWOT analysis methodology. Discussion Although advances in medical research, cancer screening and treatment options are constantly progressing, disparities in access to and awareness of healthcare in cancer patients are even more noticeable. Thus, mapping the capacity and capability of cancer centres in the European Union, creating decision support tools that will assist the four stakeholders' information needs and improving the quality of European cancer centres will be the main objectives of the BEACON project. The current protocol will outline the methodological and practical procedures to conduct online focus group discussions with different stakeholders.
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Affiliation(s)
- Giulia Ferraris
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Veronica Coppini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Psychology, Educational Science and Human Movement (SPPEFF), University of Palermo, Palermo, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Iva Kirac
- Genetic Counseling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Denis Horgan
- European Alliance for Personalized Medicine, Maribor, Slovenia
| | | | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Choi NG, Marti CN, Choi BY. Associations of Depression/Anxiety with Technology Use, Discontinued Use, and Nonuse in Older Adults. Clin Gerontol 2024:1-13. [PMID: 38372144 DOI: 10.1080/07317115.2024.2318478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To examine correlates of the changes in technology use among older adults and the associations of depression/anxiety symptoms with technology use changes. METHODS We used the 2019-2021 U.S. National Health and Aging Trends Study (N = 3,063; age 70+). We fitted multinomial logistic regression models to examine: (1) correlates of never use and discontinued use versus use of email/texting and the internet during the 3-year study period; and (2) associations of past-month depression/anxiety symptoms in 2021 with use and discontinued use versus never use of email/texting and social network site (SNS). RESULTS The findings show age, socioeconomic, and health barriers to technology use. Email/texting and SNS use in 2021, compared to never use in all 3 years, was associated with a lower likelihood of moderate/severe depression/anxiety symptoms in 2021 (RRR = 0.54, 95% CI = 0.37-0.81 for email/texting use; RRR = 0.56, 95% CI = 0.33-0.97 for SNS use). Video calls with family/friends were not associated with depression/anxiety symptoms. CONCLUSIONS The findings expand the existing knowledge base regarding potential impact of technology use on mental health beyond the early months of the COVID-19 pandemic. CLINICAL IMPLICATIONS More concerted efforts are warranted to help older adults' technology uptake and continued use and to promote mental health benefits of technology use.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, Delaware, USA
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Yu CC, Tou NX, Low JA. Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study. JMIR Form Res 2024; 8:e46824. [PMID: 38319700 PMCID: PMC10879980 DOI: 10.2196/46824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. OBJECTIVE This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. METHODS A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. RESULTS Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. CONCLUSIONS The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology.
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Affiliation(s)
- Chou Chuen Yu
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Nien Xiang Tou
- Geriatric Education and Research Institute, Singapore, Singapore
| | - James Alvin Low
- Geriatric Education and Research Institute, Singapore, Singapore
- Khoo Teck Puat Hospital, Singapore, Singapore
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15
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Söderberg D, Bonn SE, Sjöblom L, Dahlgren A, Muli I, Amer-Wåhlin I, Bertilson BC, Farrokhnia N, Hvitfeldt H, Taloyan M, Hägglund M, Trolle Lagerros Y. Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden. Telemed J E Health 2024. [PMID: 38394275 DOI: 10.1089/tmj.2023.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65-69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19-0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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Affiliation(s)
- Daniel Söderberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Anna Dahlgren
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Irene Muli
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Bo C Bertilson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hvitfeldt
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Hägglund
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden
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16
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Chou FL, Donovan DJ, Weller RJ, Fremed MA, Glickstein JS, Krishnan US. Disparities in resource utilisation by families of children with cardiac conditions. Cardiol Young 2024; 34:325-333. [PMID: 37415565 DOI: 10.1017/s1047951123001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds. METHODS A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children's Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers' levels of education (fewer than 16 years vs. 16 years or more) and patients' medical insurance types (public vs. private) were compared with regard to the utilisation of resources. RESULTS Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively). CONCLUSION Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.
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Affiliation(s)
- Francisca L Chou
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Denis J Donovan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel J Weller
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Fremed
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha S Krishnan
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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17
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Liu J, Lou Y, Cheung ESL. Beyond Dichotomy and Stability: ICT Use Among Asian American Older Adults During the COVID-19 Pandemic. J Appl Gerontol 2024; 43:170-181. [PMID: 37807902 DOI: 10.1177/07334648231204781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
This study examined the effect of the COVID-19 pandemic on information and communications technology (ICT) use and the typology of ICT users among older Chinese and Korean Americans. Survey data were collected from 513 Chinese and Korean older adults in New York City. We measured ICT use for social contact, grocery shopping, health care, and COVID-19 information seeking. In the study sample, ICT use for online shopping with others, contact with doctors, and telehealth significantly increased during the pandemic. Three groups of ICT users were identified: limited, users, expanding users, and active users. Older Chinese Americans and those with better English proficiency were more likely to be expanding and active ICT users. The patterns and heterogeneity of ICT use among older Asian Americans are multifaceted and dynamic beyond dichotomy and stability. The findings of this study offer helpful guidance for future development of ICT-based interventions for older Asian Americans.
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Affiliation(s)
- Jinyu Liu
- Diana R. Garland School of Social Work, Baylor University, Waco, TX, USA
| | - Yifan Lou
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
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18
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Long SE, Lama Y, D'Angelo H. Digital Communication Inequalities Among U.S. Adults Reporting Current Cigarette Use. Am J Prev Med 2024; 66:307-314. [PMID: 37793558 PMCID: PMC10842098 DOI: 10.1016/j.amepre.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION To reduce tobacco-related health problems, it is critical to reach people who smoke with smoking cessation information and treatment. However, digital communication inequalities may limit access to online information sources. METHODS Digital device ownership, high-speed internet access, and online health information-seeking were examined among adults reporting current smoking in the Health Information National Trends Survey (n=847). Data were collected in 2019 and 2020 and analyzed in 2022. Multivariable logistic regression models examined associations between demographics, digital technology access, and online health information-seeking. RESULTS Only 47.6% (95% CI 39.0%, 56.3%) of adults aged 65+, 54.2% of Black/African American adults (95% CI 37.8%, 69.8%), and 59.6% with high school or less education (95% CI 51.5%, 67.1%) reported high-speed internet access (vs. 74.0% overall, 95% CI 68.9%, 78.6%). Inequalities in device ownership, high-speed internet access, and online health information-seeking were found by education and income. Adults with high school or less education (vs. college or more) had 78% lower odds of digital device ownership (aOR 0.22, 95% CI 0.08, 0.59) and 75% lower odds of high-speed internet access (aOR 0.25, 95% CI 0.09, 0.71). High-speed internet access (vs. no digital device or high-speed internet) was associated with 4.9 times greater odds of online health information-seeking (95% CI 1.81, 13.4). CONCLUSIONS Digital communication inequalities among adults who smoke exist. Understanding digital technology access among lower income populations could inform the development and delivery of interventions and health communication strategies to improve health outcomes among this population.
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Affiliation(s)
| | - Yuki Lama
- National Cancer Institute, Rockville, Maryland
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19
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Osae SP, Chastain DB, Young HN. Access to Media and Emerging Technologies: An Evolving Opportunity for Pharmacists to Contribute to Improving Health Outcomes. J Pharm Pract 2024; 37:9-10. [PMID: 36602310 DOI: 10.1177/08971900221149159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmon P Osae
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Henry N Young
- Kroger Professor Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy Athens, GA, USA
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20
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Li Q, Yang C, Zhao Z, Yang C, Chen Z, Huang D, Yin W. The relationship between Internet use and loneliness of middle-aged and older adult people: the moderating effect of residence. Front Public Health 2024; 12:1284180. [PMID: 38356943 PMCID: PMC10864488 DOI: 10.3389/fpubh.2024.1284180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives The proportion of middle-aged and older adult people exposed to the Internet continues to grow. Internet use may have an impact on the mental health of the older adult, especially loneliness. This study analyzed the relationship between Internet use and presence of loneliness. Methods A total of 550 person aged 45 years and above were randomly selected from a province in eastern China at the end of 2022. The outcome variable was presence of loneliness, as measured by self-report. Descriptive analysis, chi-square test and binary logistic analysis were used to analyze the data. Results 58.3% of respondents use the Internet. Internet use could reduce the possible of reported loneliness in middle-aged and older adult people (OR = 0.652, 95%CI: 0.465, 0.940), and residence played a moderating role in the relationship between them. Middle-aged and older adults who used the Internet for 1-3 h (OR = 0.464, 95%CI: 0.275, 0.784) and 3-5 h (OR = 0.484, 95%CI: 0.247, 0.946) were less likely to felt lonely than those who used the Internet for less than 1 h per day. In addition, middle-aged and older adult people using the Internet to contact relatives and friends (OR = 0.488, 95%CI:0.292, 0.818), read the news (OR = 0.485, 95%CI:0.277, 0.848), assets management (OR = 0.297, 95%CI:0.109, 0.818) were less likely to report loneliness, while those who made online payment (OR = 3.101, 95%CI:1.413, 6.807) were more likely to report loneliness. Conclusion There is a significant negative correlation between Internet use and presence of loneliness, but different Internet duration and content have different effects on loneliness in middle-aged and older adult people. We should pay attention to the impact of Internet use on loneliness in middle-aged and older adult people.
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Affiliation(s)
- Qiusha Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Chunxiao Yang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Zixuan Zhao
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Chenxiao Yang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Dongmei Huang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Wenqiang Yin
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
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21
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Nadkarni A, Rodriguez C, Freeman S, Brodeur K, Duquette A, Audette E, Mittal L. Assessment of a Digital Health Coordination Program to Mitigate Telehealth Access Disparities. Telemed J E Health 2024. [PMID: 38241487 DOI: 10.1089/tmj.2023.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Objective: Patients with digital disparity experience challenges with utilizing and accessing virtual care. This study implemented a digital coordination program for patients in outpatient psychiatry. Methods: Clinicians referred patients to a digital health coordinator who provided training to enhance virtual access. Outcomes were patient sociodemographics, barriers to digital health care utilization, change in completed video visits, and clinician satisfaction. Results: The patient cohort included 44 patients with a mean age of 59.8, 75% female, 73% Caucasian, and 84% non-Hispanic. The median household income was less than $25,000. The most common barrier to completing a video visit was difficulty using Zoom. The proportion of completed to scheduled video visits increased in 27% of patients. In such patients, the mean increase in completed visits was 32%. A majority of referring providers (64%) reported increased meaningfulness of work. Conclusion: This pilot proactively identified disparities in virtual care access and mitigated digital literacy barriers, boosting meaningfulness of work for clinicians.
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Affiliation(s)
| | | | | | - Kara Brodeur
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Leena Mittal
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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22
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Spanakis P, Wadman R, Walker L, Heron P, Mathers A, Baker J, Johnston G, Gilbody S, Peckham E. Measuring the digital divide among people with severe mental ill health using the essential digital skills framework. Perspect Public Health 2024; 144:21-30. [PMID: 35929589 PMCID: PMC10757390 DOI: 10.1177/17579139221106399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Amid the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk of digital exclusion. This risk might not abate by the end of the pandemic. This article seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion. METHODS Two hundred and forty-nine adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time that the EDS is benchmarked in people with SMI. RESULTS 42.2% had no Foundation Skills, and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home. CONCLUSION A significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support to ensure people retain access to key services and develop digital skills and confidence. To our knowledge, this is the first time this has been described using the EDS framework. Services, including the National Health Service (NHS), need to be aware of and mitigate the risks.
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Affiliation(s)
- P Spanakis
- Department of Health Sciences, University of York, ARRC Building, Heslington, York YO10 5DD, UK Department of Psychology, University of Crete, Rethymnon, Greece
- School of Psychology, Mediterranean College, Athens, Greece
| | - R Wadman
- Department of Health Sciences, University of York, York, UK
| | - L Walker
- Department of Health Sciences, University of York, York, UK
| | - P Heron
- Department of Health Sciences, University of York, York, UK
| | - A Mathers
- The Good Things Foundation, Sheffield, UK; Royal Society of Arts, London, UK
| | - J Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - G Johnston
- Independent Peer Researcher, Clackmannan, UK
| | - S Gilbody
- Department of Health Sciences, University of York, York, UK
| | - E Peckham
- Department of Health Sciences, University of York, York, UK
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23
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Robinson SA, Bamonti P, Richardson CR, Kadri R, Moy ML. Rural disparities impact response to a web-based physical activity self-management intervention in COPD: A secondary analysis. J Rural Health 2024; 40:140-150. [PMID: 37166231 DOI: 10.1111/jrh.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE This secondary exploratory analysis examined rural-urban differences in response to a web-based physical activity self-management intervention for chronic obstructive pulmonary disease (COPD). METHODS Participants with COPD (N = 239 US Veterans) were randomized to either a multicomponent web-based intervention (goal setting, iterative feedback of daily step counts, motivational and educational information, and an online community forum) or waitlist-control for 4 months with a 12-month follow-up. General linear modeling estimated the impact of rural/urban status (using Rural-Urban Commuting Area [RUCA] codes) on (1) 4- and 12-month daily step-count change compared to waitlist-control, and (2) intervention engagement (weekly logons and participant feedback). FINDINGS Rural (n = 108) and urban (n = 131) participants' mean age was 66.7±8.8 years. Rural/urban status significantly moderated 4-month change in daily step counts between randomization groups (p = 0.041). Specifically, among urban participants, intervention participants improved by 1500 daily steps more than waitlist-control participants (p = 0.001). There was no difference among rural participants. In the intervention group, rural participants engaged less with the step-count graphs on the website than urban participants at 4 months (p = 0.019); this difference dissipated at 12 months. More frequent logons were associated with greater change in daily step counts (p = 0.004); this association was not moderated by rural/urban status. CONCLUSIONS The web-based intervention was effective for urban, but not rural, participants at 4 months. Rural participants were also less engaged at 4 months, which may explain differences in effectiveness. Technology-based interventions can help address urban-rural disparities in patients with COPD, but may also contribute to them unless resources are available to support engagement with the technology.
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Affiliation(s)
- Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia Bamonti
- Department of Research & Development, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Reema Kadri
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Howell K, Alvarado G, Waymouth M, Demirci J, Rogers R, Ray K, Uscher-Pines L. Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study. J Med Internet Res 2023; 25:e50191. [PMID: 38157241 PMCID: PMC10787326 DOI: 10.2196/50191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. OBJECTIVE We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. METHODS We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health-funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation's equity-centered model. RESULTS Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. CONCLUSIONS While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations.
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Affiliation(s)
| | | | | | - Jill Demirci
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Kristin Ray
- University of Pittsburgh, Pittsburgh, PA, United States
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25
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Zuckerman KE, Rivas Vazquez LA, Morales Santos Y, Fuchu P, Broder-Fingert S, Dolata JK, Bedrick S, Fernandez J, Fombonne E, Sanders BW. Provider perspectives on equity in use of mobile health autism screening tools. Autism 2023:13623613231215399. [PMID: 38078430 DOI: 10.1177/13623613231215399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
LAY ABSTRACT Families may find information about autism online, and health care and education providers may use online tools to screen for autism. However, we do not know if online autism screening tools are easily used by families and providers. We interviewed primary care and educational providers, asking them to review results from online tools that screen for autism. Providers had concerns about how usable and accessible these tools are for diverse families and suggested changes to make tools easier to use.
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Samadbeik M, Bastani P, Fatehi F. Bibliometric analysis of COVID-19 publications shows the importance of telemedicine and equitable access to the internet during the pandemic and beyond. Health Info Libr J 2023; 40:390-399. [PMID: 36373187 PMCID: PMC9877810 DOI: 10.1111/hir.12465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pandemics highlight the increasing role of information and communications technology for improving access to health care. This study aimed to present a bibliometric analysis of the concept of digital divide reported in the published articles concerning the coronavirus disease 2019 (COVID-19) pandemic. METHODS To conduct this bibliometric analysis of research topics and trends, we used VOSviewer software. We developed a search strategy to retrieve peer-reviewed publications related to 'digital divide in the COVID-19 era' from the Scopus database. RESULTS In total, 241 publications on the topic of digital divide and COVID-19 were retrieved from Scopus database between 2020 and 2021. The analysis of keywords co-occurrence of research topics revealed four main clusters including: 'telemedicine', 'Internet access and Internet use', 'e-learning' and 'epidemiology'. Seven characteristic categories were examined in these research topics, including: sociodemographic, economic, social, cultural, personal, material and motivational. CONCLUSION 'Telemedicine' and 'Internet access and Internet use' as the largest clusters are connected to topics addressing inequalities in online health care access. Thus, policymakers should develop or modify policies in more egalitarian Internet access for all community members not only during a pandemic like the COVID-19 but also at regular times.
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Affiliation(s)
- Mahnaz Samadbeik
- Social Determinants of Health Research CenterLorestan University of Medical SciencesKhorramabadIran
- School of Allied Medical SciencesLorestan University of Medical SciencesKhorramabadIran
| | - Peivand Bastani
- School of Dentistry, UQ Oral Health CentreThe University of QueenslandBrisbaneAustralia
| | - Farhad Fatehi
- School of Psychological SciencesMonash UniversityMelbourneAustralia
- Centre for Health Services ResearchThe University of QueenslandBrisbaneAustralia
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Dobson R, Stowell M, Warren J, Tane T, Ni L, Gu Y, McCool J, Whittaker R. Use of Consumer Wearables in Health Research: Issues and Considerations. J Med Internet Res 2023; 25:e52444. [PMID: 37988147 DOI: 10.2196/52444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.
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Affiliation(s)
- Rosie Dobson
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Melanie Stowell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lin Ni
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yulong Gu
- School of Health Sciences, Stockton University, Galloway, NJ, United States
| | - Judith McCool
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
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Cho H, Choi M, Lee H. Mobile Internet Use and Life Satisfaction Among Older Adults: The Moderating Effect of Living Alone. J Appl Gerontol 2023:7334648231216383. [PMID: 37982396 DOI: 10.1177/07334648231216383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
This study, informed by the principle of the Conservation of Resources (COR) theory, evaluated the relationships between mobile internet use frequency, living arrangement, and life satisfaction in older adults. We used data from the 2021 Digital Divide Survey in South Korea, conducting a secondary analysis on 2105 participants aged 65 or above who accessed the internet in the last month. Multiple linear regression models were performed. Compared to the older adults who lived with others, those living alone showed a stronger positive association between their use of the mobile internet for daily services, information production and sharing, social participation, and life satisfaction. These findings align with the principle of the COR theory, suggesting that older adults living alone due to a loss in resources are more likely to benefit from mobile internet use, indicating the potential effectiveness of promoting mobile internet use as a strategy to enhance their life satisfaction.
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Affiliation(s)
- Hyeonmi Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
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Zhang K, Song Q, Burr JA. Internet use and loneliness among older Chinese adults. Aging Ment Health 2023:1-8. [PMID: 37922191 DOI: 10.1080/13607863.2023.2278713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/26/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES This study examined the association between Internet use and loneliness among Chinese older adults (aged 60+) over a two-year period using nationally representative survey data from China. METHODS Using data from the 2016 and 2018 waves of the China Longitudinal Ageing Social Survey (N = 8,059), we estimated difference-in-differences regression models to assess the association between Internet use and levels of loneliness over time. RESULTS Compared to Internet non-users, Chinese older adults who were new Internet users, as well as those who were continuous Internet users, reported lower levels of loneliness over time (B = -0.21, p < 0.001 and B = -0.16, p < 0.001, respectively). Conversely, those Chinese older adults who used the Internet in wave 1 but then disengaged from using the Internet in wave 2 demonstrated an upward trend in loneliness over time, similar to Internet non-users (the estimate of difference-in-differences was non-significant for the comparison between disengaged-users and non-users: B = -0.03, p = 0.42). CONCLUSION This study provided new evidence to support the potential benefits of Internet use for reducing the risk of loneliness among Chinese older adults. The findings suggested that supporting current Internet users to remain digitally engaged is as important as encouraging Internet non-users to cross the digital divide.
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Affiliation(s)
- Kunyu Zhang
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Qian Song
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
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Tolentino DA, Costa DK, Jiang Y. Determinants of American Adults' Use of Digital Health and Willingness to Share Health Data to Providers, Family, and Social Media: A Cross-sectional Study. Comput Inform Nurs 2023; 41:892-902. [PMID: 37310724 PMCID: PMC10713855 DOI: 10.1097/cin.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
With the global pandemic driving the adoption of digital health, understanding the predictors or determinants of digital health usage and information sharing gives an opportunity to advocate for broader adoption. We examined the prevalence and predictors of digital health usage and information-sharing behaviors among American adults. Data were from the Health Information National Trends Survey 5 Cycle 4. More than two-thirds used a digital resource for health-related activities (eg, to check test results). About 81% were willing to share their digital data with their provider, 75% with family, and 58% with friends. Only 14% shared health information on social media. Gender, education, device types, and performance expectancy of digital health were common factors associated with both digital health usage and information-sharing behaviors. Other predictors included rurality, patient portal access, income, and having a chronic disease. Of note, we found that Asian American Pacific Islanders, compared with Whites, were less likely to share information with providers. Performance expectancy was a significant determinant of information sharing. Those diagnosed with diabetes were 4% less likely to share information with their providers. With the growing digital divide, there is a need to advocate for more usable and accessible digital health to assist with person-centered care.
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Affiliation(s)
| | | | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor
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Schepens Niemiec SL, Lee E, Saunders R, Wagas R, Wu S. Technology for activity participation in older people with mild cognitive impairment or dementia: expert perspectives and a scoping review. Disabil Rehabil Assist Technol 2023; 18:1555-1576. [PMID: 36067094 PMCID: PMC9986344 DOI: 10.1080/17483107.2022.2116114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This two-phased study aimed to collate, summarize and characterize - through the lens of an occupation-based, person-centred framework - ongoing research and practice featuring activity participation-supportive digital health technology (DHT) for direct use by older persons with mild cognitive impairment or Alzheimer's disease and related dementias (PwMCI/ADRD). MATERIALS AND METHODS Phase 1: Using scoping review procedures, PubMed, MEDLINE and PsycInfo were searched to identify primary research studies. Phase 2: Semi-structured interviews were completed with MCI/ADRD expert stakeholders identified through publicly available biographies and snowball referral. Thematic analysis was used to identify, synthesize and cross-compare emergent themes from both data sources that were subsequently organized into core facets of the Human Activity Assistive Technology (HAAT) model. RESULTS The scoping review resulted in 28 studies, which were primarily feasibility work with small sample sizes. Interviewed experts (N = 17) had 4+ years of MCI/ADRD experience, came from a variety of settings, and held myriad roles. Real world and research-based use of DHTs held some commonalities, particularly around support for social participation and instrumental activities of daily engagement. No DHT for sleep or work/volunteerism were noted in either phase. People with milder MCI/ADRD conditions were most often targeted users. Soft technology strategies facilitating implementation centred on product design (e.g., prompting software, customisability, multimedia/multisensory experiences), instructional methods and technology partner involvement. CONCLUSIONS This study demonstrates that although DHT supportive of activity participation is being studied and integrated into the lives of PwMCI/ADRD, there are still key opportunities for growth to meet the needs of diverse MCI/ADRD end users.Implications for rehabilitationMainstream digital health technologies (DHTs) are being utilized by persons with mild cognitive impairment and Alzheimer's disease and related dementias (PwMCI/ADRD) in everyday life, in limited capacities, to support social participation, leisure, health management and instrumental activities of daily living (IADL).Innovative research-based technologies to be used directly by PwMCI/ADRD are under development, particularly to facilitate management of ADL, social participation and IADL in persons with mild-to-moderate forms of cognitive impairment.Soft technology strategies to support technology implementation with MCI/ADRD target users include close attention to design of the technology (e.g., customisability, sensory stimulators and prompting features), instructional strategies that promote learning and motivation and involvement of technology partners to facilitate engagement with the technology.Future studies will require more robust research designs with transparent reports of participant characteristics and facilitative instructional methods to expand DHT's potential to account for and better meet the needs of diverse MCI/ADRD communities in real-world contexts.
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Affiliation(s)
- Stacey L. Schepens Niemiec
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Elissa Lee
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Raquel Saunders
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rafael Wagas
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
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Kim YK, Ang S. Older Adults With Functional Limitations and Their Use of Telehealth During COVID-19. Res Aging 2023; 45:609-619. [PMID: 36562247 PMCID: PMC9790857 DOI: 10.1177/01640275221147642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the association between functional limitations and telehealth use among older Medicare beneficiaries in 2020. We use logistic regression models to estimate associations between functional limitations and the use of technological tools (i.e., computers, Internet, telehealth). We consider Internet use and informal technological support as moderators for telehealth use. Respondents (N = 3151; Mage = 78.31) with more functional limitations were more likely to use video-based telehealth. Net of functional limitations, those with a consistent Internet use were more likely to use emails/texts/portal messages to communicate with a healthcare provider. Further, more functional limitations were associated with a higher probability of using emails/texts/portal messages, but only among respondents who received informal technological support. Healthcare access may have been more difficult for older adults with functional limitations during the COVID-19 pandemic, especially for those with little prior experience with the Internet, or those without friends/family to provide technological support.
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Affiliation(s)
| | - Shannon Ang
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
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Tay Wee Teck J, Butner JL, Baldacchino A. Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review. J Telemed Telecare 2023:1357633X231195607. [PMID: 37661829 DOI: 10.1177/1357633x231195607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
- Forward Leeds and Humankind Charity, Durham, UK
| | - Jenna L Butner
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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Mai F, Ko DG, Shan Z, Zhang D. The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. J Med Internet Res 2023; 25:e44981. [PMID: 37384810 PMCID: PMC10414031 DOI: 10.2196/44981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. OBJECTIVE We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines? METHODS We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). RESULTS Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001). CONCLUSIONS Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.
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Affiliation(s)
- Feng Mai
- School of Business, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Dong-Gil Ko
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Zhe Shan
- Department of Information Systems and Analytics, Miami University, Oxford, OH, United States
| | - Dawei Zhang
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA, United States
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Kim KK, McGrath SP, Solorza JL, Lindeman D. The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community. Appl Clin Inform 2023; 14:644-653. [PMID: 37201542 PMCID: PMC10431973 DOI: 10.1055/a-2096-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. OBJECTIVES The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. METHODS ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. RESULTS Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). CONCLUSION The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
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Affiliation(s)
- Katherine K. Kim
- MITRE Corporation, Health Innovation Center, McLean, Virginia, United States
- Department of Public Health Sciences, Division of Health Informatics, University of California Davis, School of Medicine, Sacramento, California, United States
| | - Scott P. McGrath
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
| | - Juan L. Solorza
- Livingston Community Health, Livingston, California, United States
| | - David Lindeman
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
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Kung CSJ, Steptoe A. Internet use and psychological wellbeing among older adults in England: a difference-in-differences analysis over the COVID-19 pandemic. Psychol Med 2023; 53:5356-5358. [PMID: 36177888 PMCID: PMC9551182 DOI: 10.1017/s0033291722003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Longitudinal evidence on how Internet use affects the psychological wellbeing of older adults has been mixed. As policymakers invest in efforts to reduce the digital divide, it is important to have robust evidence on whether encouraging Internet use among older adults is beneficial, or potentially detrimental, to their wellbeing. METHODS We observe depressive symptoms and loneliness of adults aged 50 + in the nationally representative English Longitudinal Study of Ageing, from before (2018/19) to during the coronavirus disease 2019 (COVID-19) pandemic (June/July and November/December 2020). Our quasi-experimental difference-in-differences strategy compares within-individual wellbeing changes between older adults who desired to use the Internet more but experienced barriers including lack of skills, access, and equipment, with regular Internet users who did not desire to use the Internet more. To reduce selection bias, we match both groups on demographic and socioeconomic characteristics that are predictive of Internet use. We assume that in the absence of COVID-19 - a period of increased reliance on the Internet - the wellbeing trajectories of both groups would have followed a common trend. RESULTS Compared with matched controls (N = 2983), participants reporting barriers to Internet use (N = 802) experienced a greater increase in the likelihood of depressive symptoms from before to during the pandemic, but not worse loneliness levels. This effect was stronger for women, those aged above 65 years, and those from lower-income households. CONCLUSIONS Besides enabling access to digital services, efforts to ensure older adults continue to be engaged members of an increasingly digital society could deliver returns in terms of a buffer against psychological distress.
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Affiliation(s)
- Claryn S. J. Kung
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Research Department of Epidemiology and Public Health, University College London, London, UK
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Abstract
The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." This current journal issue has the theme of structural determinants of health. In 2016 (Creative Nursing Vol. 22), we published 49 articles in four issues addressing Determinants of Health: Social Determinants, Structural Determinants, Caregiver Determinants, and Global Determinants. This editorial presents the highlights of those four journal issues, then connects each of the articles in this current issue to the theme; these articles reveal the systems and structures that support our caring from many angles, levels, and perspectives. Readers are challenged to recognize the potential, embedded in every system and structure, for disparities in the provision of our care.
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Nakayama LF, Binotti WW, Link Woite N, Fernandes CO, Alfonso PG, Celi LA, Regatieri CV. The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data. J Med Internet Res 2023; 25:e42483. [PMID: 37477958 PMCID: PMC10403759 DOI: 10.2196/42483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/09/2022] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. OBJECTIVE This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. METHODS Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. RESULTS Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48%) than rural areas (35,715/67,077, 53.24%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63%) White respondents having access, compared to 22,234 of 28,272 (78.64%) Black respondents, 113,518 of 148,191 (76.6%) multiracial respondents, and 2887 of 3755 (76.88%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44%), 27,209 of 30,782 (88.39%), and 27,035 of 31,226 (86.58%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35%) and 74,314 of 99,476 (74.7%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95% CI 0.716-0.756; P<.01) had a positive association with internet access. CONCLUSIONS Brazil's diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care.
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Affiliation(s)
- Luis Filipe Nakayama
- Department of Ophthalmology, São Paulo Federal University, Sao Paulo, Brazil
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - William Warr Binotti
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, MA, United States
| | | | - Chrystinne Oliveira Fernandes
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Informatics, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biostatistics, School of Public Health, Harvard TH Chan, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Taipale S, Oinas T. Mobile phone use before and during the COVID-19 pandemic – a panel study of older adults in seven countries. Mob Media Commun 2023:20501579231185479. [PMCID: PMC10331323 DOI: 10.1177/20501579231185479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The aim of this study was to investigate the changes in older adults’ mobile phone use from before to during the COVID-19 pandemic. The media displacement and digital divide approaches served as the theoretical frameworks of the study. The data were drawn from the 2018 and 2020 waves of the Aging + Communication + Technology cross-national longitudinal panel study. The sample consisted of older Internet users, aged 62 to 96 (in 2018), from Austria, Canada, Finland, Israel, the Netherlands, Romania, and Spain, who participated in both waves (N = 4,398). Latent class analysis and latent transition analysis with multinomial regression models were the main methods applied to the data. With regard to the findings, three mobile phone function use profiles—Narrow Use, Medium Use, and Broad Use—were identified from the data. Lower age, being married, higher income, and place of residence (in 2018) predicted belonging to the three profiles, while country differences in the prevalence of the profiles were substantial. Between 2018 and 2020, transition from one profile to another was relatively rare but typically toward the “Broad Use” category. Profile transitions were most common in Romania, while stability was highest in Finland, Israel, and Canada. In addition, gender, age, marital status, and place of residence predicted the likelihood of changing from one profile to another between 2018 and 2020. The results suggest that older adults’ mobile phone function use is relatively stable over a two-year time span. While new mobile phone functions are adopted, they seem to augment the spectrum of mobile usage rather than displace older similar functionalities. In addition, demographic, socioeconomic, and country-level digital divides, although slightly modified over time, remain significant among older adults.
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Affiliation(s)
- Sakari Taipale
- Department of Social Sciences and Philosophy, University of Jyvaskyla, Finland
| | - Tomi Oinas
- Department of Social Sciences and Philosophy, University of Jyvaskyla, Finland
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Nozaki I, Tsukada M, Sothy P, Rattana K, Williams K. Introduction and roll-out of self-learning App for midwifery during the COVID-19 pandemic and its sustainability in Cambodia. Glob Health Med 2023; 5:178-183. [PMID: 37397944 PMCID: PMC10311676 DOI: 10.35772/ghm.2023.01021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Similar to other countries, coronavirus disease (COVID-19) pandemic significantly impacted not only the ability of midwives to deliver high quality maternal care, but also their ability to access professional development opportunities, including in-service training in Cambodia. In response, we developed a Cambodian version of Safe Delivery App (SDA), aligned to Cambodia's clinical guidelines. The SDA is a free digital job aid and learning platform for skilled birth attendants developed by Maternity Foundation that works offline and is used in more than 40 countries after adapting to the country context. In the year and a half since its launch in June 2021, SDA has become established in Cambodia, with more than 3,000 people, accounting for nearly half the number of midwives in Cambodia, downloading and using it on their devices, and 285 people having completed its self-learning modules. The review of the introduction process revealed that publicity on the professional association's social networking sites, in-person in-depth hands-on training, and troubleshooting in a managed social networking group were useful in promoting the use of the application, and that the Continuing Professional Development Program accreditation has been a strong motivator for completing the self-study program. On the other hand, the COVID-19 pandemic has led to increased use of digital tools, but it is important to prevent the expansion of the digital divide when implementing new digital tools, including SDA.
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Affiliation(s)
- Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Expert of JICA technical cooperation project, Tokyo, Japan
| | - Minori Tsukada
- Expert of JICA technical cooperation project, Tokyo, Japan
| | - Pech Sothy
- National Maternal Child Health Center, Phnom Penh, Cambodia
| | - Kim Rattana
- National Maternal Child Health Center, Phnom Penh, Cambodia
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Fung KK, Hung SSL, Lai DWL, Shum MHY, Fung HW, He L. Access to Information and Communication Technology, Digital Skills, and Perceived Well-Being among Older Adults in Hong Kong. Int J Environ Res Public Health 2023; 20:6208. [PMID: 37444058 PMCID: PMC10340767 DOI: 10.3390/ijerph20136208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Population aging is a major concern worldwide. Active aging should be promoted by increasing the social participation of older adults and enabling them to remain involved in the community. Research has demonstrated the utility of digital resources for addressing the needs of older adults, which include networking, entertaining, and seeking health-related information. However, the digital divide among older adults (i.e., the "gray digital divide") is increasingly being recognized as a social problem that may be related to poor well-being. To obtain updated local data on the prevalence of Internet access and usage and their relationship with perceived well-being, we conducted telephone interviews with a random sample of 1018 older adults in Hong Kong from January to July 2021 (This research has received funding support from the Interdisciplinary Research Matching Scheme, Hong Kong Baptist University). We found that only 76.5% of the participants had Internet access at home, a mobile phone data plan, or both, whereas 36.3% had never used Internet services and 18.2% had no digital devices. A younger age, male gender, higher education level, living with others, and higher self-perceived social class were associated with material access to digital devices and everyday use of Internet services. Participants who accessed the Internet every day had higher levels of life satisfaction and self-rated physical and mental health than those who rarely or never used the Internet. Hierarchical multiple regression analysis revealed that digital skills were significantly associated with self-rated mental health even when controlling for demographic variables (including age, gender, education level, and self-perceived social class). This study contributes to the limited body of literature on the relationship between Internet use, digital skills, and perceived well-being. Our findings highlight the importance of addressing the digital divide even in cities with high penetration of information and communication technology, such as Hong Kong. We also discuss our insights into the use of timely interventions for older adults to address the gray digital divide.
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Affiliation(s)
- Kwok-kin Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China; (K.-k.F.)
| | - Shirley Suet-lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China; (K.-k.F.)
| | - Daniel W. L. Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China
| | - Michelle H. Y. Shum
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China; (K.-k.F.)
| | - Hong-wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China; (K.-k.F.)
| | - Langjie He
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China; (K.-k.F.)
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Berkowsky RW, Seifert A, Hale TM. Editorial: Benefits and challenges to using health-related information and communication technologies among older adults. Front Public Health 2023; 11:1224606. [PMID: 37383265 PMCID: PMC10295735 DOI: 10.3389/fpubh.2023.1224606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Ronald W. Berkowsky
- Health Sciences Program, California State University Channel Islands, Camarillo, CA, United States
| | - Alexander Seifert
- School of Social Work, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Timothy M. Hale
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, United States
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Campbell R, Gregory K, Goodman-Williams R, Engleton J, Javorka M. Organizational Readiness and Response During COVID-19: Reflections From a Sexual Assault Agency Serving a Predominately African American Community. Violence Vict 2023; 38:328-344. [PMID: 37348957 DOI: 10.1891/vv-2021-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic forced victim service organizations to establish new service provision protocols to include remote/telehealth services. We conducted N = 12 qualitative interviews with sexual assault advocates working in an urban agency in a predominately African American U.S. city to understand how they adapted services to meet the needs of their community. A thematic analysis revealed this organization was under-prepared for prolonged interruption of in-person services. Even though this agency was able to create telehealth options, many clients did not have the financial and technological resources to utilize these services. Advocates reported that survivors expressed a strong preference for in-person services, which afford more privacy and confidentiality. The pervasive digital divide within this urban community limited survivors' access to comprehensive services and jeopardized their safety.
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Affiliation(s)
- Rebecca Campbell
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Katie Gregory
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | | | - Jasmine Engleton
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - McKenzie Javorka
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Molina F, Soulos PR, Brockman A, Oldfield BJ. Clinical and Sociodemographic Factors Associated with Telemedicine Engagement in an Urban Community Health Center Cohort During the COVID-19 Pandemic. Telemed J E Health 2023; 29:875-885. [PMID: 36355045 PMCID: PMC10277987 DOI: 10.1089/tmj.2022.0389] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Objective: To examine chronic diseases, clinical factors, and sociodemographic characteristics associated with telemedicine utilization among a safety-net population. Materials and Methods: We conducted a retrospective cohort study of adults seeking care in an urban, multisite community health center in the Northeast United States. We included adults with ≥1 outpatient in-person visit during the pre-COVID-19 period (March 1, 2019-February 29, 2020) and ≥1 outpatient visit (in-person or telemedicine) during the COVID-19 period (March 1, 2020-February 29, 2021). Multivariable logistic regression models estimated associations between clinical and sociodemographic factors and telemedicine use, classified as "any" (≥1 visit) and "high" (≥3 visits). Results: Among 5,793 patients who met inclusion criteria, 4,687 (80.9%) had any (≥1) telemedicine visit and 1,053 (18.2%) had high (≥3) telemedicine visits during the COVID-19 period. Older age and Medicare coverage were associated with having any telemedicine use. Older and White patients were more likely to have high telemedicine use. Uninsured patients were less likely to have high telemedicine use. Patients with increased health care utilization in the pre-COVID-19 period and those with hypertension, diabetes, substance use disorders, and depression were more likely to have high telemedicine engagement. Discussion: Chronic conditions, older patients, and White patients compared with Latinx patients, were associated with high telemedicine engagement after adjusting for prior health care utilization. Conclusion: Equity-focused approaches to telemedicine clinical strategies are needed for safety-net populations. Community health centers can adopt disease-specific telemedicine strategies with high patient engagement.
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Affiliation(s)
- Fabiola Molina
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, New Haven, Connecticut, USA
| | | | - Benjamin J. Oldfield
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Fair Haven Community Health Care, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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Kimak A, Woźniacka A. How old is too old to work for physicians? Postepy Dermatol Alergol 2023; 40:368-371. [PMID: 37545835 PMCID: PMC10399665 DOI: 10.5114/ada.2023.128977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 08/08/2023] Open
Abstract
The healthcare systems throughout the world are facing numerous problems, including aging and shortages of medical staff. Although senior medical practitioners are important to the healthcare, their competency may decline with age. A major problem experienced nowadays by some elderly practitioners is digital exclusion caused by difficulties with adopting new technologies. Some attempts are being made to determine the optimum moment to retire, considering its possible impact on the safety and wellbeing of patients, as well as on the health system and human resource allocation. Until legal regulations are adopted, the age-related screening programs can be used to determine the optimal retirement age.
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Affiliation(s)
- Agnieszka Kimak
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Anna Woźniacka
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
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Bünning M, Schlomann A, Memmer N, Tesch-Römer C, Wahl HW. Digital Gender Gap in the Second Half of Life is Declining: Changes in Gendered Internet Use Between 2014 and 2021 in Germany. J Gerontol B Psychol Sci Soc Sci 2023:7176037. [PMID: 37218293 PMCID: PMC10394992 DOI: 10.1093/geronb/gbad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES The main purpose of the study has been to examine changes in Internet use among men and women in three age groups (mid-life, early old age, and advanced old age) between 2014 and 2021. We tested two hypotheses: The complementary hypothesis posits that online activities reproduce gender differences in offline activities. The compensatory hypothesis posits that women are catching up over time in male-typed activities as Internet access approaches saturation for both genders. METHODS We used representative, longitudinal data from the German Ageing Survey (DEAS) collected in 2014, 2017, 2020, and 2021 (n=21,505, age rage 46-90 years). We ran logistic regressions on Internet access and Internet use for four differently gender-typed activities: social contact (female-typed), shopping (gender neutral), entertainment (male-typed), and banking (male-typed). RESULTS Between 2014 and 2021, women drew level with men in Internet access. Gender differences in all four forms of Internet use declined considerably between 2014 and 2021. Women overtook men in using the Internet for social contact. In older age groups, men held the lead regarding online banking. During the COVID-19 crisis, women caught up to men in Internet use, especially for entertainment. DISCUSSION Overall time trends support the complementary hypothesis. By contrast, the finding that women have been catching up in in some male-typed online activities during the COVID-19 pandemic, supports the compensatory hypothesis.
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Affiliation(s)
| | - Anna Schlomann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Nicole Memmer
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Hans-Werner Wahl
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Addeo F, D'Auria V, Delli Paoli A, Punziano G, Ragnedda M, Ruiu ML. Measuring digital capital in Italy. Front Sociol 2023; 8:1144657. [PMID: 37274604 PMCID: PMC10235697 DOI: 10.3389/fsoc.2023.1144657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023]
Abstract
Introduction This paper aims to theoretically and empirically investigate the concept of digital capital in the Italian context. Digital Capital can be conceived as independent individual capital whose lack within a population can be a cause of digital inequality. Our paper draws from recent works that have measured the Digital Capital as a combination of digital access and digital competences, and have tested this operational definition through an online survey on a UK sample. The results of such research proved the construct validity of the operational definition, thus showing that Digital Capital could be empirically measured. However, a measurement model needs to be tested and validated over time and in different socio-cultural contexts in order to be refined and strengthened, and eventually disseminated on a large scale. Method This is the reason why this paper will show the results of a funded research project (named DigiCapItaly) carried out to test the validity of the Digital Capital measure in a different country, i.e., Italy. The data were collected with an online survey using a representative sample (by age, gender and geographical area) of individuals living in Italy aged 18 years or more. The creation of a composite index to measure Digital Capital followed a two-stage Principal Component Analysis approach. Results First, the paper provides a methodological framework for facing challenges and pitfalls in operationalizing and assessing a complex concept in social research. Secondly, results show that Digital Capital operational definition works in Italy as well as in the UK, thus legitimizing its recognition as an independent capital.
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Affiliation(s)
- Felice Addeo
- Department of Politic and Communication Sciences, University of Salerno, Fisciano, Italy
| | - Valentina D'Auria
- Department of Politic and Communication Sciences, University of Salerno, Fisciano, Italy
| | - Angela Delli Paoli
- Department of Humanities, Philosophy and Education, University of Salerno, Fisciano, Italy
| | - Gabriella Punziano
- Department of Social Sciences, University of Naples–Federico II, Naples, Italy
| | - Massimo Ragnedda
- Department of Arts, Northumbria University, Newcastle, United Kingdom
| | - Maria Laura Ruiu
- Department of Social Sciences, Northumbria University, Newcastle, United Kingdom
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Ameen S, Wong MC, Yee KC, Nøhr C, Turner P. The Inverse Data Law: Market Imperatives, Data, and Quality in AI Supported Care. Stud Health Technol Inform 2023; 302:428-432. [PMID: 37203710 DOI: 10.3233/shti230166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Over the last decade, the explosion of "Big Data" and its fusion with AI has led many to believe that the development and integration of AI systems in healthcare will usher in a transformative revolution that democratises access to high quality healthcare and collectively improve patient outcomes. However, the nature of market forces in the evolving data economy, has started to show evidence that the opposite is more likely to be true. This paper argues that there is a poorly understood "Inverse Data Law" that will exacerbate the widening health divide between affluent and marginalised communities because: (1) data used to train AI systems favour individuals that are already engaged with healthcare, who have the lowest burden of disease, but the highest purchasing power; and (2) data used to drive market decisions around investment in AI health technology favours tools that increase the commodification of healthcare through over-testing, over-diagnosis, and the acute and episodic management of disease, over tools that support the patient to prevent disease. This dangerous combination is more likely to cripple efforts towards preventative medicine, as data collection and utilisation tends to be inversely proportional to the needs of the patients served - the inverse data law. The paper concludes by introducing important methodological considerations in the design and evaluation of AI systems to promote systems improvement for marginalised users.
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Affiliation(s)
- Saleem Ameen
- Tasmanian School of Medicine, University of Tasmania, Australia
| | - Ming Chao Wong
- School of Information and Communication Technology, University of Tasmania, Australia
| | - Kwang Chien Yee
- Tasmanian School of Medicine, University of Tasmania, Australia
| | | | - Paul Turner
- School of Information and Communication Technology, University of Tasmania, Australia
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Mancuso N, Mansergh G, Stephenson R, Horvath KJ, Hirshfield S, Bauermeister JA, Chiasson MA, Downing MJ, Sullivan PS. Factors associated with mobile app-based ordering of HIV self-test kits among men who have sex with men in Atlanta, Detroit and New York City: an exploratory secondary analysis of a randomized control trial. J Int AIDS Soc 2023; 26:e26100. [PMID: 37221941 DOI: 10.1002/jia2.26100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self-test kits are becoming more available around the United States via web and app-based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self-test kit utilization among MSM in M-cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. METHODS We conducted an exploratory secondary analysis of self-report and in-app data collected from the intervention arm of the M-Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self-test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). RESULTS Over half of the 417 intervention participants ordered an HIV self-test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18-2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13-1.70). There was no difference in HIV self-test kit ordering by income, race/ethnicity or age. CONCLUSIONS HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self-test kits in reaching populations with suboptimal testing rates and shows that self-testing may supplement community-based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM.
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Affiliation(s)
- Noah Mancuso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gordon Mansergh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health and Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin J Downing
- Department of Psychology, Lehman College, CUNY, Bronx, New York, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Brainin E, Neter E. Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study. JMIR Aging 2023; 6:e40004. [PMID: 37121572 PMCID: PMC10173039 DOI: 10.2196/40004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age. OBJECTIVE This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. METHODS We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. RESULTS We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. CONCLUSIONS Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients.
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Affiliation(s)
- Esther Brainin
- Ruppin Academic Center, Department of Behavioral Sciences, Faculty of Community and Social Sciences, Emek Hefer District, Israel
| | - Efrat Neter
- Ruppin Academic Center, Department of Behavioral Sciences, Faculty of Community and Social Sciences, Emek Hefer District, Israel
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