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The digital divide and its implications for health, services and conferences. And a prediction for the future…

This morning a group of early childhood professionals who use Twitter to share ideas about technology (the #ECETechChat group) were tackling the issue of the digital divide. 

Interestingly, it seems this concept has come to mean different things to different people.

For some, it refers to the overuse of technology by young children and is associated with disadvantage, as per these recent articles at the New York Times and the Huffington Post.

The digital divide has traditionally been associated with disadvantaged groups who do not have access or capacity to make the most of digital technologies – hence the emergence of terrific initiatives like this, providing free social media training for public housing residents in Melbourne.

But a recent analysis of the use of social media at an academic conference suggests the digital divide can also be an issue for the otherwise well-off.

This blog from the London School of Economics and Political Science, How social media enriches conferences for some but risks isolating others, documents plenty of positive comments about the use of social media at the conference, but also reveals concerns.

Some people who were not active social media users felt excluded from the conversations that were happening within the online platforms that delegates were using. As one person said: “If you have no social media account you are no one.”

Meanwhile, a new study (PDF alert) from Flinders University researchers warns of the potential for the digital divide to exacerbate health inequalities. Thanks to Croakey’s intern, Caroline Chen, for providing an overview of the findings below.

 ***

Digital services widens health gap

Caroline Chen writes:

The increasing use of digital Information and Communication Technologies (ICTs) to ‘empower consumers’ may actually be placing those most in need at a greater disadvantage, a recent study suggests.

The study, published in Australian Health Review, discusses research data on how digital ICTs are accessed and used by low income and disadvantaged persons. Pathways of ICT-skills acquisition, facilitators and barriers to usage, preferred methods of service-to-consumer contact and the subsequent implications for digitally-mediated health services in low socioeconomic contexts are also explored.

The global inclination toward ICT-mediated service and information provision has made access to ICTs a key factor in determining an individual’s capacity to fully participate in modern day society.

Many institutions have started to offer e-services and m-services to their consumers, accessible via computers and mobile phone devices. These have been developed with the intention of improving consumers’ convenience by providing information and assistance electronically, and to enhance interactive communication between service stake holders (providers-to-consumers and consumers-to-consumers). Such strategies are also favoured for their effectiveness in reducing costs and conserving output.

The provision and use of ICTs has spread considerably in all areas, including the health sector. However investigations into access across the population show that not everyone is benefitting as equally as expected.

Statistics have shown the 28% of all Australian households still do not have access to home internet and nearly half of them fall under the low income category, earning a total of less than $40,000 per year.

The study was a primary research analysis that aimed to augment the current literature on digital access and use, particularly with regards to health. The authors decided to specifically focus on low socioeconomic status (SES) groups and determine how associated inequalities can be minimized or prevented.

Compared to other population groups, low SES groups often suffer from poorer health and lack the means to access digital resources at will, thus placing them at a vulnerable position as health institutions start to adopt digitally-centered service models.

The qualitative study collected data from 80 individuals at nine focus groups in 2008 and 2009. Participants were aged 25 to 55 years old and were recruited from low SES and disadvantaged populations; they comprised a mix of men, women, people with employment and housing concerns, Aboriginal students and recent refugees.

All focus group discussions were conducted by two of the paper’s authors, and were recorded, transcribed and analysed. 74 of the 80 participants also completed a survey asking demographic and technological information. Assistance with reading and translating/interpreting was offered to those who required it.

Results of the study confirmed that its participants were appropriate representations of low income and disadvantaged persons, and revealed that access to and use of ICTs (computers, mobile phones and internet) varied in terms of extent, frequency, quality and effectiveness.

Many people preferred mobile phones over computers because they were less expensive, convenient, multifunctional and easy to use. Those without phone internet access reported frequent use of alternative facilities in the home, work, college or community settings. However the usefulness and availability of these resources are often limited as the user may not have the time or skills to access them at will.

Aboriginal participants mentioned that the elder members of their communities were not responsive to communication via mobile phones and the refugee participants talked about having to use the internet to access Australian news from non-Australian websites due to the lack of non-English options on local media.

Older participants reported difficulty with tasks that included manual dexterity (like pushing small buttons) and technological literacy, while financial affordability of any ICT-related device was raised by some of the younger participants.

Lack of confidence, skills and resources have been found to impede on the level to which people can benefit from ICTs. Most of the ICT-using participants were self-taught or had learned to do so with the help of friends – indicating social connections to be an important factor for confidence and skills development.

Some of the participants had reported gaining ICT skills through school and work, while others are still experiencing difficulties with basic skills such as mobile texting and internet searching. Reluctance and perceived lack of opportunities to learn technology-related skills were expressed by several people.

Factors that strongly influence digital access and use in low SES persons include:

  • The availability of resources such as stable housing, internet access, mobile connection, income, social connections and education.
  • Individual attributes such as confidence, self-perceived needs, technological skills and language skills.
  • Health status – which may function as either help or hindrance. For instance, poor manual dexterity in elder persons have been known to limit the use of technological devices but, on the other hand, health conditions are powerful motivators of technological learning; in particular those affiliated with internet searching.
  • Structure and systems of telecommunications companies in regards to contracts, plans and pre-paid conditions. While most of the population own and benefit from mobile phones, many are unable to afford services like calls and internet use, thereby limiting it as a reliable communications option.

Participants expressed varied levels of willingness to adopt digitally-mediated forms of communication with service providers. Whilst some welcomed the notion of electronic contact, most still preferred traditional forms of interaction like phoning or talking face-to-face, especially when a complex query is involved.

Some participants perceive the move to electronic services as a means of institutions cost-shifting to the consumer – a pressurizing process which causes those who do not wish to follow suit to be on the receiving end of stigmatisation and stress.

The differences in technology use across the Australian population bears implications for equitable access to health services and information provision.

The results obtained from the study’s focus groups suggest that ICT-mediated service initiatives should consider whether the whole target population has the resources and skills to access and use the service; that additional training and resources should be provided to all who may require them and ensure society inequalities are not further exacerbated.

Services are cautioned against pressuring unwilling consumers to use ICT services as doing so is likely to create unwelcome stigma and feelings of distrust. As a result, consumers often opt out of services and cause further damage to their health.

The researchers say that unless appropriate measures are taken to provide low income and disadvantaged persons with the appropriate training and resources, ICT-mediated communications can become a new barrier to health service access.

While there are a number of initiatives that provide digital skill training to specific subgroups such as elder Aboriginal Australians, initiatives that cater to mainstream, low income, working age persons whose communication needs are equally important are seemingly lacking.

The authors of the article strongly advise institutions that decide to implement digitally-mediated programs to consider the needs of all population subgroups by consulting consumers during program planning phases and taking into consideration previously established research findings.

Further research on how to bridge communication gaps across the population should be conducted and could be aided by studying examples from developing countries where illiteracy rates are high and approaches require a combination of digital and traditional communications.

Due to health issues being a popular motivational factor for consumers to start ICT use, service providers are also encouraged to view this as an opportunity for consumer up-skilling.

• Newman, L., Biedrzycki, K., Baum, F. (2012) Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services. Aust Health Rev. 2012 May;36(2):125-9.

***

PS from Croakey…The future is online

While concerns about the digital divide are valid, it is likely that most of the world’s people will be online in the future. That is the view of Rajiv N Rimal, an associate professor in the department of Health, Behavior and Society at the Johns Hopkins University Bloomberg School of Public Health.

In an interview for the Bulletin of the World Health Organization, Rimal  says that he works with people in sub-Saharan Africa who have never been online in their lives.

He says: “That’s a big chunk of the population in many countries. There is a danger they could be left behind, and the responsibility is on the larger public health community to provide access for the people who don’t have access.”

But for those with access, he says, “social media has forced doctors to act on the same level as their patients, not to use a top-down approach. In that way, the effect is very positive.”

He adds:

“It is inevitable that everybody will be connected via electronic media and here’s why: even in very resource-poor countries, there is now a movement to do things online. Even things like dealing with local and central government, where you had to use a pencil and paper, have changed and that is no longer an option.

What that means is that people are forced to get online. In the next 10 years, my guess is that there would be very few pockets of people in the world for whom not being online is an option.”

 

 

Comments 2

  1. Busuttil David says:

    This is a very interest article.

    I work for a Remote Area Aboriginal Health Organisation.

    I believe the NBN will actually increase the divide further. Where the majority of Australians will have access to fibre to the premises, those who live in very remote regions will have to put up with the inferior satellite. Many of the are Aboriginal Australians who have more to gain than most from e-health.

    In addition, existing ADSL connections can actually be taken away 10 years after the satellite is launched. So we could end up with inferior connections to what we currently have.

  2. ron batagol says:

    The issue raised is one of the most critically important ones, not only in the health arena but, as alluded to by these commentators, in rapidly-emerging 21st century lifestyle, communication changes and more, and in modes of accessing and reaching out for external assistance and day-to-day interaction in every area of daily life.. Frankly, despite the optimism of Croakey and others, I’m not too sure that we can effectively and willingly “bring across” those who are on the other side of the digital divide, any time soon, without some basic and obvious changes . However, I do agree it can only be achieved with a two-way understanding and empathy towards those who, for whatever reasons, are “digital media/communication disadvantaged”. Unfortunately, at present we frequently seem to think that erecting roadblocks rather than bridges will somehow force them to join us in the emerging digital revolution. Just two or three examples of these roadblocks could be very easily addressed. For instance, which management rocket scientist convinced the business world at-large that eliminating the lowest paid people in organisations, namely those who used to direct phone calls to the appropriate departments, in favour of multiple arbitrarily structured numeric phone options , would improve efficiency, increase sales and, most importantly, promote customer satisfaction? It is the exception rather than the rule, to come across a Website (especially with regard to events) where someone is actually allocated to, and routinely performs, the simple task of removing obsolete notifications to make it easier to search?(eg.details for “forthcoming” 2009 and 2010 Melbourne Grand Prix are still on their Website- just one of countless examples!!)

    Finally, in every cafe and coffee shop each and every day, the “digitally disadvantaged” see people supposedly enjoying each others’ company, with their backs turned, talking to another person on their mobiles. Yes, it may sometimes be business, but mostly, purely social and, frankly, just very bad manners!!

    And yet we expect the disadvantaged and uninitiated to willingly embrace the new technology? We need to think a lot more about reviewing the basic structure, functions, courtesy “rules” and user-friendliness of the “new age systems” that we are developing.

    At the end of the day, people, from time immemorial, have, and I suggest always will, crave for and embrace human one-to-one interaction as a preferred choice, whether it’s medical needs, social interaction, or business requirements. Because, guess what? It makes them feel important and personally empowed. The trick is how we can incorporate this basic human need into our emerging communication developments in the future, so as to encourage those who have not yet become part of the new communication revolution to learn to use and it and find out about what this wonderful new world can do for them, rather than “force them to get online” as has been suggested!

    And I express these concerns from a standpoint of an “oldie” who embraces and uses all of the vast range armoury of the wonderful technological revolution that we have created each and every day! . BUT, most importantly, for me, it’s always a tool, not a master!! That’s as it should be!

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