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TitleDigital disparities: designing telemedicine systems with a health equity aim.
AuthorsSamuels-Kalow, M; Jaffe, T; Zachrison, K
JournalEmergency medicine journal : EMJ
Publication Date1 Jun 2021
Date Added to PubMed7 Mar 2021
AbstractThe use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.
TitleTelemedicine and the battle for health equity: Translating temporary regulatory orders into sustained policy change.
AuthorsKassamali, B; Haddadi, NS; Rashighi, M; Cavanaugh-Hussey, M; LaChance, A
JournalJournal of the American Academy of Dermatology
Publication Date1 Dec 2020
Date Added to PubMed12 Aug 2020
TitleSocial Determinants of Potential eHealth Engagement Among People Living with HIV Receiving Ryan White Case Management: Health Equity Implications from Project TECH.
AuthorsMarhefka, SL; Lockhart, E; Turner, D; Wang, W; Dolcini, MM; Baldwin, JA; Roig-Romero, RM; Lescano, CM; Glueckauf, RL
JournalAIDS and behavior
Publication Date1 May 2020
Date Added to PubMed13 Dec 2019
AbstractEvaluate the relationships between social characteristics of Floridian persons living with HIV (PLWH) and both use of digital technologies and willingness to use eHealth for HIV-related information. Ryan White case managers (Nā€‰=ā€‰155) from 55 agencies in 47 Florida counties administered a survey to PLWH (Nā€‰=ā€‰1268) from June 2016-April 2017. Multilevel logistic regression models were used to identify correlates of technology use and willingness. Use of mobile phones with text messaging was high (89%). Older (vs. younger) adults and non-Hispanic blacks (vs. whites) were less likely to use most technologies. These groups, along with Hispanics (vs. whites) were less likely to express willingness to use technologies for HIV-related information in models adjusting for use. Among PLWH in Florida, eHealth-related inequities exist. Willingness to engage in HIV-related eHealth is affected by social determinants, even when considering technology access. Although eHealth may reduce some healthcare inequities, it may exacerbate others.
TitleAdvancing health equity and access using telemedicine: a geospatial assessment.
AuthorsKhairat, S; Haithcoat, T; Liu, S; Zaman, T; Edson, B; Gianforcaro, R; Shyu, CR
JournalJournal of the American Medical Informatics Association : JAMIA
Publication Date1 Aug 2019
Date Added to PubMed25 Jul 2019
AbstractHealth disparity affects both urban and rural residents, with evidence showing that rural residents have significantly lower health status than urban residents. Health equity is the commitment to reducing disparities in health and in its determinants, including social determinants. This article evaluates the reach and context of a virtual urgent care (VUC) program on health equity and accessibility with a focus on the rural underserved population. We studied a total of 5343 patient activation records and 2195 unique encounters collected from a VUC during the first 4 quarters of operation. Zip codes served as the analysis unit and geospatial analysis and informatics quantified the results. The reach and context were assessed using a mean accumulated score based on 11 health equity and accessibility determinants calculated for each zip code. Results were compared among VUC users, North Carolina (NC), rural NC, and urban NC averages. The study concluded that patients facing inequities from rural areas were enabled better healthcare access by utilizing the VUC. Through geospatial analysis, recommendations are outlined to help improve healthcare access to rural underserved populations.
TitleImproving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access.
AuthorsMcBride, B; O'Neil, JD; Hue, TT; Eni, R; Nguyen, CV; Nguyen, LT
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed27 Sep 2018
AbstractEthnic minority women (EMW) in Vietnam experience disproportionately high infant and maternal mortality rates due to low social status, poverty and remoteness from health centres. This project piloted and evaluated a low-cost mobile health (mHealth) intervention called mMom utilizing behaviour change communication (BCC) to improve access to maternal, newborn and child health (MNCH) services and health equity among EMW living in remote areas. The mMom intervention built an integrated mHealth platform which sent timely MNCH information and BCC text messages to participants, and engaged health workers towards increasing their interaction and building demand for quality natal care. Mid-term and final qualitative evaluations were conducted to assess the intervention's acceptability and impact. In evaluations, all participants expressed satisfaction with the quality, timeliness and convenience of the messages, and health workers reported increased efficiency and quality of care. The use of BCC increased care-seeking from EMW and strengthened relationships with health providers. The mMom project demonstrated the acceptability of mHealth in a remote Vietnamese region with a high proportion of disadvantaged EMW. The messages promoted increased contact between participants and health providers, which holds potential to address the marginalization of EMW from the health system. behaviour change communication, eHealth, ethnic minorities, health equity, mHealth, MNCH, mobile health, Vietnam.
TitleHealth Equity and Telemedicine in Gastroenterology and Hepatology.
AuthorsWegermann, K; Patel, Y; Wilder, J
JournalClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Publication Date1 Aug 2021
Date Added to PubMed7 May 2021
TitleeHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity.
AuthorsRichardson, B; Goldberg, L; Aston, M; Campbell-Yeo, M
JournalJournal of clinical nursing
Publication Date1 Nov 2018
Date Added to PubMed3 Jul 2018
AbstractTo explore whether and how eHealth resources targeted to families during the perinatal period effectively reach a diverse population or further oppress marginalised groups. eHealth is often intended to reach a broad population, thus health content must be relatively generalised which limits the ability to tailor health education and interventions to individual needs. Generalisation of health information has historically represented a hegemonic depiction of the health consumer, especially within the perinatal period, often disregarding the diversity that exists in the world and perpetuating heteronormative constructs within healthcare systems as a result. A critical review of the literature regarding perinatal eHealth resources was conducted using a feminist poststructuralist approach for analysis. Included literature addresses the development, implementation and/or evaluation of perinatal eHealth resources. This approach uncovered hegemonic discourses related to the current state of perinatal eHealth resources. Nurses and midwives have the unique advantage of interacting and understanding diverse populations. Thus, nurses and midwives are integral to the development, implementation and evaluation of eHealth resources to reduce social health inequity. This paper acts as an exemplar on how to apply feminist poststructuralism to highlight inequities that exist and identifies strategies for nurses and midwives to become involved in the development of eHealth resources or advocate for greater visibility within current resources.
TitleDigital health, gender and health equity: invisible imperatives.
AuthorsSinha, C; Schryer-Roy, AM
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed18 Oct 2018
AbstractA growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind.
TitleTowards Developing an eHealth Equity Conceptual Framework.
AuthorsAntonio, MG; Petrovskaya, O
JournalStudies in health technology and informatics
Publication Date1 Dec 2019
Date Added to PubMed12 Feb 2019
AbstractEarly implementation of electronic health records and patient portals had great promise of addressing the widening disparities in health. However, recent research has found that not only are these disparities persisting, but the differences in health outcomes between populations are increasing. Addressing this gap specific to ehealth calls for attention to health equity. Health equity approaches reveal the systematic and societal structures that contribute to preventable and unjust outcomes for different populations. To conceptualize and apply a health equity approach within ehealth, we propose the eHealth Equity Framework (eHEF). Derived from the World Health Organization's conceptual framework for actions on the social determinants of health, eHEF can be useful for public health practitioners, researchers, policymakers and information technology designers to keep health equity agenda at the forefront of all stages of health information technology lifecycle.
TitleCo-designing eHealth and Equity Solutions: Application of the Ophelia (Optimizing Health Literacy and Access) Process.
AuthorsCheng, C; Elsworth, GR; Osborne, RH
JournalFrontiers in public health
Publication Date1 Dec 2020
Date Added to PubMed18 Dec 2020
AbstractBackground: The unequal access, challenges and outcomes related to using technology have created the digital divide, which leads to health inequalities. The aim of this study was to apply the Ophelia (Optimizing Health Literacy and Access) process, a widely used systematic approach to whole of community co-design, to the digital context to generate solutions to improve health and equity outcomes. Methods: This was a mixed method study. A cross-sectional survey was undertaken at 3 health organizations in Victoria, Australia using the eHealth Literacy Questionnaire (eHLQ) as a needs assessment tool. Cluster analysis was conducted to identify subgroups with varying eHealth literacy needs. These data, combined with semi-structured interviews with clients, were used to generate vignettes representing different eHealth literacy profiles. The vignettes were presented at co-design workshops with clients and health professionals to generate solutions for digital health services improvement. Expert validation and proof-of-concept testing was explored through mapping the process against Ophelia guiding principles. Results: The cluster analyses identified 8 to 9 clusters with different profiles of eHealth literacy needs, with 4 to 6 vignettes developed to represent the eHealth literacy strengths and weaknesses of clients at each of the 3 sites. A total of 32, 43, and 32 solutions across 10 strategies were co-created based on ideas grounded in local expertise and experiences. Apart from digital solutions, non-digital solutions were frequently recommended as a strategy to address eHealth literacy needs. Expert validation identified at least half of the ideas were very important and feasible, while most of the guiding principles of the Ophelia process were successfully applied. Conclusion: By harnessing collective creativity through co-design, the Ophelia process has been shown to assist the development of solutions with the potential to improve health and equity outcomes in the digital context. Implementation of the solutions is needed to provide further evidence of the impact of the process. The suggested inclusion of non-digital solutions revealed through the co-design process reminds health organizations and policymakers that solutions should be flexible enough to suit individual needs. As such, taking a co-design approach to digital health initiatives will assist in preventing the widening of health inequalities.
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