Digital Access as a Structural Determinant
of Health

While looking at Ribble’s Nine Elements of Digital Citizenship, I found that the first of the nine elements of Digital Citizenship, Digital Access, stood out to me. This element encompasses digital inclusion, exclusion, home access, equitable access, and equal opportunity and rights amongst other things. Its relevance is particularly significant to the work I am currently engaged in.

I work as an instructional designer for a medical institution in Chicago. This hospital serves patients throughout one of the US’s largest underserved communities, Chicago’s South Side. My work involves collaborating in the training of social workers who assist patients who are victims of violence. So, while I do not interact with patients directly, I do work in training those who do. After completing the course readings in Module One, I decided to explore the state of digital access in the communities where our patients reside.

I was not surprised to find that there is a a steep digital divide in Chicago, with inequalities most impacting those living in the communities of our patients. In a recent study by the Data Science Institute of the University of Chicago found that in Chicago, about 80 percent of households are connected to the internet, however when the data is broken down into the 77 community areas of the city, it reveals deep, local inequities. (DSI, 2022). The data showed internet connectivity as low as 57% in some southside neighborhoods, with many of the neighborhoods we serve averaging around 65% connectivity. (DSI, 2022).

What I wonder is how does this digital divide impact our patients regarding health equity? There is already a steep racial and socioeconomic divide in access to healthcare in the US.  With the accelerated digitization of health care during the pandemic, combined with both staff shortages and increasing costs of health care in the US; telehealth presents an opportunity for greater access to healthcare for all Americans. This being said, the digital divide could negate that opportunity for underserved populations.

I found some insightful articles online (linked below) exploring the digital divide and its impacts on healthcare in marginalized communities, and found that unsurprisingly, health inequalities are only further exacerbated by the lack of accessibility of technology. However, I was pleasantly surprised to find that the gap in access to digital health resources such as patient portals has been shrinking since the pandemic, in particular with mobile app access.

When I consider how to apply this knowledge in my work context, I plan to discuss with the TTA lead and Program Director the possibility of adding a chapter on digital access to the structural and social determinants of health training. Addressing digital access issues in staff training is essential to better serve our patients and meet their health needs.

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Sources:

Mai, F., Ko, D. G., Shan, Z., & Zhang, D. (2023). The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. Journal of medical Internet research, 25, e44981. https://doi.org/10.2196/44981

Maria, A. A., Zi-Yi Choo, Rahman, A., Ho, K., Benning-Shorb, J., Lenti, G., Wei, W. L. (2021/10//). Digitally disconnected: Qualitative study of patient perspectives on the digital divide and potential solutions. JMIR Human Factors, 8(4) doi:https://doi.org/10.2196/33364Wang ML, Gago CM, Rodriguez K.

Digital Redlining—The Invisible Structural Determinant of Health. JAMA. 2024;331(15):1267–1268. doi:10.1001/jama.2024.1628

Hadjiat Y (2023) Healthcare inequity and digital health–A bridge for the divide, or further erosion of the chasm? PLOS Digit Health 2(6): e0000268. https://doi.org/10.1371/journal. pdig.0000268

University of Chicago. (2021). Understanding Chicago’s digital divide: What does census data tell us? Internet Equity Initiative. https://internetequity.uchicago.edu/data-story/understanding-chicagos-digital-divide-what-does-census-data-tell-us/