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. 2024 Aug 1:26:e51355.
doi: 10.2196/51355.

Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity

Maura M Kepper  1 , Lauren A Fowler  2 , Isabelle S Kusters  3   4 , Jean W Davis  5 , Manal Baqer  6 , Sara Sagui-Henson  7 , Yunyu Xiao  8 , Adati Tarfa  9 , Jean C Yi  10 , Bryan Gibson  11 , Kristin E Heron  12   13 , Nicole M Alberts  14 , Marissa Burgermaster  15   16 , Veronica Ps Njie-Carr  17 , Lisa M Klesges  18
Affiliations

Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity

Maura M Kepper et al. J Med Internet Res. .

Abstract

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

Keywords: behavioral medicine; digital divide; digital health; health care access; health equity; implementation; mHealth; mobile health; mobile phone.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
A conceptual framework of drivers of inequitable access to digital health. Adapted from the health care access framework by Levesque et al [14].
Figure 2
Figure 2
A model for advancing digital health access to foster health equity adapted from the ConNECT framework and the health care access conceptual framework by Levesque et al [14]. The model considers health inequities in access, digital health implementation stages and actors, and the subsequent impact on sustained health behaviors and health outcomes and equity.
See this image and copyright information in PMC

References

    1. Alcaraz KI, Sly J, Ashing K, Fleisher L, Gil-Rivas V, Ford S, Yi JC, Lu Q, Meade CD, Menon U, Gwede CK. The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity. J Behav Med. 2017 Feb 10;40(1):23–38. doi: 10.1007/s10865-016-9780-4. https://europepmc.org/abstract/MED/27509892 10.1007/s10865-016-9780-4 - DOI - PMC - PubMed
    1. Pagoto S, Bennett GG. How behavioral science can advance digital health. Transl Behav Med. 2013 Sep 17;3(3):271–6. doi: 10.1007/s13142-013-0234-z. https://europepmc.org/abstract/MED/24073178 234 - DOI - PMC - PubMed
    1. Chunara R, Zhao Y, Chen J, Lawrence K, Testa PA, Nov O, Mann DM. Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. J Am Med Inform Assoc. 2021 Jan 15;28(1):33–41. doi: 10.1093/jamia/ocaa217.5899729 - DOI - PMC - PubMed
    1. Crawford A, Serhal E. Digital health equity and COVID-19: the innovation curve cannot reinforce the social gradient of health. J Med Internet Res. 2020 Jun 2;22(6):e19361. doi: 10.2196/19361. - DOI - PMC - PubMed
    1. Dixit N, Van Sebille Y, Crawford GB, Ginex PK, Ortega PF, Chan RJ. Disparities in telehealth use: how should the supportive care community respond? Support Care Cancer. 2022 Feb;30(2):1007–10. doi: 10.1007/s00520-021-06629-4. https://europepmc.org/abstract/MED/34668075 10.1007/s00520-021-06629-4 - DOI - PMC - PubMed

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