Towards an equitable digital public health era: promoting equity through a health literacy perspective

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Abstract

Digital technologies shape the way in which individuals and health systems interact to promote health and treat illness. Their propensity to exacerbate inequalities is increasingly being highlighted as a concern for public health. Personal, contextual and technological factors all interact and determine uptake and consequent use of digital technologies for health. This article reviews evidence on the impact of digital technologies on health equity. Health literacy is presented as a lens through which to approach research and policy on access, uptake and use of digital technologies. In the short term, based on our review of published literature, we conclude that it is likely that digital technologies will increase health inequities associated with increased age, lower level of educational attainment and lower socio-economic status. Geographical inequity may increase as a result of poor infrastructure but may decrease if digital technologies can be effectively widely deployed to compensate for health workforce and health system deficiencies. Programmes to enhance health and digital literacy and monitoring of access, utilization and impact across all groups in society can help to ensure that digital technologies act to reduce rather than reproduce or exacerbate existent health inequalities.

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eHealth Literacy: Extending the Digital Divide to the Realm of Health Information

Efrat Neter, Esther Brainin (2012)

Background eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care. Objective The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes. Methods We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers. Results Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains. Conclusions The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers.

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Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

Siobhan O’Connor, Peter Hanlon, Catherine A O'Donnell … (2016)

Background Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. Methods PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. Results Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. Conclusion This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. Systematic review registration International Prospective Register of Systematic Reviews CRD42015029846 Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0359-3) contains supplementary material, which is available to authorized users.

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Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

D Judge, Johan J. P. Mackenbach, N Rasmussen … (2005)

To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. 451 386 non-institutionalised men and women 25-79 years old. Smoking status, daily quantity of cigarettes consumed by smokers. Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

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Journal

Journal ID (nlm-ta): Eur J Public Health

Journal ID (iso-abbrev): Eur J Public Health

Journal ID (publisher-id): eurpub

Title: The European Journal of Public Health

Publisher: Oxford University Press

ISSN (Print): 1101-1262

ISSN (Electronic): 1464-360X

Publication date (Print): October 2019

Publication date (Electronic): 18 November 2019

Publication date PMC-release: 18 November 2019

Volume: 29

Issue: Suppl 3 , Digitalization: Potentials and Pitfalls from a Public Health Perspective

Pages: 13-17

Affiliations

[1 ] Department of Health Services Management, University of Malta , Msida MSD 2080, Malta

[2 ] European Public Health Association , Utrecht, PO Box 1568, 3500 BN, The Netherlands

[3 ] Global Health Literacy Academy , Viengevej 100, 8240 Risskov, Denmark

[4 ] International Health Literacy Association , IHLA 7 Avenue De Lafayette 121026, Boston, MA 02112, USA

Author notes

Correspondence: Natasha Azzopardi-Muscat, Department of Health Services Management, University of Malta, Msida, MSD 2080, Malta, Tel: +35623401110, e-mail: Natasha.azzopardi-muscat@ 123456um.edu.mt

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Publisher ID: ckz166

DOI: 10.1093/eurpub/ckz166

PMC ID: 6859513

PubMed ID: 31738443

SO-VID: 1236c858-cf14-46aa-983b-61496f2fa7e1

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Towards an equitable digital public health era: promoting equity through a health literacy perspective

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Most cited references 22

eHealth Literacy: Extending the Digital Divide to the Realm of Health Information

Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

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