JMIR Publications

ABSTRACT

Background:

The digital health divide for socioeconomic disadvantage describes a pattern where socioeconomically disadvantaged patients, who are already marginalised through reduced access to face-to-face healthcare, are additionally hindered through low access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential to improving the digital health divide. Patients with chronic disease and within primary care are a key research area for patient-initiated digital health access as the intersection between initial help-seeking and patient self-management.

Objective:

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. We first qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease, and then secondly quantitatively measured some of those findings by designing and administering a survey of 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 of 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% of survey participants were found to have never used a form of digital health, while 10.7% were low-medium frequency users and 48.5% 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 one cohort or even one person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centred care that continues to recognise complex individual needs of and barriers facing each patient should be part of addressing the digital health divide.