It’s easy to take a reliable internet connection for granted, but for many people that’s out of reach. 22.3% of Americans in rural areas lack access to high-speed internet, according to the U.S. Department of Agriculture (USDA).
That figure doesn’t account for all the people who live in areas with adequate access but simply can’t afford it. Of 24 million offline households included in a 2022 internet use survey conducted by the National Telecommunications and Information Administration (NTIA), 18% said they don’t have internet because of cost concerns.
A lack of broadband connection can not only limit one’s job opportunities and income potential, but potentially their health. Deemed the “digital divide,” the issue has led to a chasm between the health outcomes of those with internet access and those without. While there are many benefits to digital tools, it’s vital to ensure that those affected by the digital divide—low-income, rural and geriatric patients—don’t get left behind.
In this article, learn more about the digital divide, its causes, and how to address the problem, with insights from Sermo physician community members.
The digital divide in the patient population
Health information technology (HIT), such as online patient scheduling portals and telemedicine platforms, are intended to improve healthcare through more convenience and efficiency. The problem is, not everyone is able to access these tools.
The digital divide seems to be hitting certain demographics harder; women, Black people, and low-income people have a lower probability of completing a telehealth visit, according to one study. The authors noted that these groups may face barriers preventing them from in-person visits as well, not just telehealth appointments. For example, childcare responsibilities often fall disproportionately on women, and can monopolize their available time.
“The digital divide is affecting patient populations, particularly underserved populations, due to limited broadband access, low digital literacy, and cultural mismatches in technology design,” writes a family medicine doctor on Sermo.
The greater Sermo community has also taken note of the digital divide. In one poll, 36% of respondents said they’d noticed the digital divide impacting their patients significantly, and another 38% noticed a slight impact. 45% of those doctors said they’ve noticed the digital divide widening over time.
Some members spoke to the impact in their own communities. “I work with a relatively deprived population, many elderly and others younger with poor literacy, which impacts on their ability to use digital technology,” writes a general practitioner. “Many of the patients I work with are geriatric, and while some adapt very well, others have cultural, educational, and even physical limitations in accessing technology,” adds a family medicine doctor.
Identifying and overcoming barriers to digital health access
Patients affected by the digital divide can face very different challenges depending on their situation. Finding effective solutions requires understanding the various barriers causing the digital divide:
- No smartphone or device access: Many people can’t afford a smart device, or they might have an old one that isn’t compatible with newer apps.
- Limited mobile data or broadband: People living in poverty or living in rural areas may not have broadband access at all, or have limited use. “In my country, the cost of internet and access to it is relatively expensive,” writes a GP from Mexico on Sermo.
- Low digital literacy: Especially in older patients, a lack of technological knowledge can be a real hurdle. In a poll of physicians on Sermo, this was the most common barrier that members noticed, accounting for 37% of respondents. “The digital divide is affecting my patient and practice significantly,” writes one GP. “Most patients do not access and maximally use the healthcare system as it should because of digital illiteracy.”
- Language and cultural barriers: Patients have better outcomes when they communicate directly with providers in their first language rather than using a translator, and cultural differences can affect aspects of the process. When providers speak their language and understand their culture, they receive higher quality care. Cultural competence goes beyond language, it also means providers understand and respect cultural norms, health beliefs, and communication styles. Without this, digital health tools and platforms may feel inaccessible or alienating to certain communities
- Cognitive or physical impairments: Disabilities can prevent people from using health information technologies (HIT). Visual, hearing, mobility, or processing challenges may limit how easily someone can navigate an app or patient portal, especially if accessibility features are not built into the design.
You can use the above challenges to guide you in addressing the digital divide with your patients. You might collect data on aspects like broadband access and common languages in your area to identify the issues you need to solve. It’s also important to ensure all HIT you implement is user-friendly and meets accessibility standards, such as those laid out by the WHO or the ADA in the United States.
Practical strategies for bridging the divide in your practice
Once you research and understand the top obstacles your community faces, you can start moving toward solutions. You and your staff can implement these strategies to help bridge the gap:
- Offer in-person alternatives: Some patients can’t or don’t want to use HIT, so it’s important to maintain in-person services as an option.
- Provide technology assistance: For patients with digital literacy issues, you can walk them through device or app set-up and teach them how to use the tools they need. You can also provide pamphlets with FAQs and troubleshooting instructions. In a Sermo poll, patient education was the most common approach members said they use to address the digital divide, capturing 31% of the vote.
- Utilize accessible tools: Always ensure any HIT tools and programs you use adhere to accessibility standards for patients with disabilities.
- Use plain language: Explain any tools and information with simple language that’s easy for patients of any educational level or technical familiarity to comprehend. This also helps to reduce miscommunication as a result of language barriers.
- Hire multi-lingual & multicultural staff: When you hire staff in your practice that demographically represent the local population in both culture and language, it can make a world of difference to understanding and acceptance of digital tools.
- Suggest your local library: Many libraries across the U.S. rent Wi-Fi hot spots and devices for free. Some even offer digital literacy classes. Your patients may not be aware that this is an option. However, it’s not a perfect solution as many people may not be able to go to the library due to the same financial, cultural, or physical/cognitive barriers that limit their access to technology, but it’s a step in the right direction.
Addressing systemic issues creating the digital divide
Doctors see the problems their patients face firsthand. Poll results reveal that the Sermo community is split as to which strategies they think will be most effective in addressing the digital divide. 25% voted for improving access to digital devices, 21% said improving broadband internet affordability, and literacy training and increasing technical support each received 20% of votes.
Many of the issues contributing to the digital divide can’t be solved by doctors alone. It bears mentioning that today’s physicians face time pressures requiring them to see as many patients as possible in a day. Realistically, you may not have the time to implement some of the strategies above, like assisting patients with device setup.
If you do have the bandwidth and want to take action, you can advocate for public policies to expand broadband access and subsidize device ownership. Many politicians are members of older generations and may be unfamiliar with the benefits of modern technology. You can explain how HIT benefits patients and the negative consequences of the digital divide.
Or, advocate for higher industry standards for accessible design. Communicate the benefits of providing people with disabilities access to technology, including their ability to join the workforce, pay taxes, and require fewer social assistance programs.
Key takeaways
Health information technology provides benefits, but many people are missing out on those advantages for a variety of reasons. As a physician, you have an opportunity to be a leader, educator, and advocate in the best interest of your community, including those most disadvantaged.
More equitable and inclusive healthcare is a cause worth championing. When you advocate for the right policies and the implementation of tools, it can make a difference in shrinking the digital divide. You can also make an immediate difference in your own practice by identifying and addressing the barriers your patients may face in accessing HIT.
If you’re looking for other ways you can make a difference in medicine, consider joining Sermo for free to take part in polls and discussions that shape the way medical issues are discussed and addressed. Discuss your ideas and opinions with global peers and learn from what’s working in other communities from the physicians who are leading the change.
