Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion

Table of Contents

Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion

Understanding Social Determinants of Health (SDOH)

The Centers for Disease Control and Prevention (CDC) and the Healthy People 2030 initiative emphasize the critical role of social determinants of health (SDOH) in shaping health outcomes. These nonmedical influences include various aspects of the environments in which people live, such as access to healthcare, educational opportunities, financial stability, and the overall quality of neighborhoods (Broadband Internet Access Is a Social Determinant of Health! 2020). These factors highlight the profound impact that social and environmental conditions have on individual and population health. In this context, examining the potential inclusion of digital access and broadband connectivity as part of SDOH is both timely and necessary.

Should Digital Access and Broadband Be Added as SDOH?

In an increasingly interconnected world, having reliable internet access is essential for accessing healthcare services and health-related information. The COVID-19 pandemic underscored the importance of broadband in enabling remote healthcare delivery through telemedicine. Digital health tools such as electronic health records (EHRs), patient portals, and mobile health applications (mHealth) rely heavily on internet connectivity. Consequently, the case for recognizing digital inclusion and broadband access as key components of SDOH is strong (Sieck et al., 2021).

1. Impact on Healthcare Access

Digital connectivity plays a vital role in ensuring equitable access to healthcare services, a cornerstone of SDOH. Without consistent and reliable internet access, individuals face significant challenges in:

Participating in telemedicine for virtual consultations.

Using patient portals to review test results, manage prescriptions, or communicate with healthcare providers (Benda et al., 2021).

Utilizing mHealth applications for chronic disease management or health education.

For example, individuals in rural or low-income areas often lack broadband access, limiting their ability to benefit from telehealth and electronic health records. This contributes to widening disparities between these groups and urban or economically advantaged populations.

2. Digital Access and Health Literacy

Access to digital resources also influences educational opportunities and health literacy. Individuals without reliable internet may encounter difficulties in finding accurate health information, which can lead to delays in seeking care or the spread of misinformation. Many public health initiatives aimed at promoting healthy lifestyles or managing chronic illnesses are delivered through digital platforms, further emphasizing the need for equitable broadband access.

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3. Broadband, Economic Stability, and Health

Broadband connectivity is becoming an integral component of economic stability, as access to online job opportunities, education, and government services depends on reliable internet. Economic instability is already recognized as a significant SDOH, with direct correlations to poor health outcomes. Limited digital access can exacerbate financial insecurity, further worsening health disparities.

Digital Health Tools and Their Dependence on SDOH

Electronic Health Records (EHRs):

EHR systems enable healthcare providers and patients to maintain comprehensive and accessible records. However, individuals without internet access or digital literacy may struggle to engage with these tools, missing opportunities to track their health or address errors in their records. Healthcare providers serving marginalized communities may also face infrastructural challenges that limit the implementation of EHR-integrated care.

Mobile Health Applications (mHealth):

mHealth tools support preventive care and chronic disease management by allowing patients to monitor vital metrics. However, individuals in regions with poor internet infrastructure may be unable to utilize these technologies, leading to missed opportunities for improved health outcomes.

Telemedicine:

Telemedicine has revolutionized healthcare access, particularly in underserved and remote areas. Yet, its reliance on digital infrastructure means that those without internet access are excluded from its benefits. Geographic and economic factors are significant determinants of who can utilize these services.

Patient Portals:

Patient portals provide an avenue for individuals to actively participate in their healthcare by accessing records and communicating with providers. However, populations such as older adults, low-income families, and rural residents, who often experience greater health disparities, are least likely to benefit from these innovations due to barriers like digital illiteracy and lack of internet access.

Conclusion
Integrating digital inclusion and broadband access into the framework of SDOH is crucial for addressing modern healthcare needs. As digital tools like EHRs, telemedicine, and mHealth become integral to healthcare delivery, ensuring equitable internet access is vital to reducing health disparities. Recognizing digital inclusion as a social determinant of health would empower policymakers and healthcare organizations to tackle barriers to healthcare access and promote health equity. Broadband connectivity influences multiple domains of SDOH, including access to care, education, economic stability, and health literacy. Addressing the digital divide is essential to improving overall health outcomes and ensuring that all individuals, regardless of socioeconomic status or geographic location, have access to comprehensive healthcare services.

Supporting Examples
The COVID-19 pandemic revealed significant gaps in broadband access, particularly in rural and low-income communities, which limited the adoption of telehealth services.
Inadequate broadband coverage in rural areas continues to hinder telemedicine utilization, leaving many patients without access to remote healthcare options.

References

Broadband Internet Access Is a Social Determinant of Health! (2020). American Journal of Public Health, 110(8), 1123–1125.
PMC

Sieck, C. J., Sheon, A., Ancker, J. S., Castek, J., & Callahan, B. (2021). Digital inclusion as a social determinant of health. npj Digital Medicine, 4(1), 52.
PMC

Benda, N. C., Veinot, T. C., Sieck, C. J., Ancker, J. S., & Patel, V. (2021). Broadband Internet Access as a Social Determinant of Health. Health Promotion Practice, 22(5), 605–610.
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By Day 3 of Week 9 – Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion Instructions

Post a description of your views on whether or not digital inclusion or broad band access should be added as a key area to the social determinants of health. Be specific and provide examples that support your position. Explain how electronic health records, mobile health, patient portals, or telemedicine can impact and be impacted by the social determinants of health. Support your explanation with the required or optional resources.   

 

Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion Sample 2

The role of social determinants of health (SDOH) in pediatric mental health is significant, influencing access to care, treatment adherence, and overall well-being. Traditionally, SDOH have focused on economic stability, education, healthcare access, social context, and the physical environment (Centers for Disease Control and Prevention [CDC], 2022). However, with the increasing reliance on telemedicine, electronic health records (EHRs), mobile health (mHealth), and patient portals, broadband access and digital inclusion should be recognized as a key SDOH, particularly in pediatric mental health nursing.

One of the biggest challenges in pediatric mental health is the lack of equal access to digital healthcare services. Many families depend on telepsychiatry for therapy, medication management, and crisis intervention, yet some children do not have reliable internet access or the digital literacy needed to use these resources effectively (Ramsetty & Adams, 2020). This issue is particularly problematic for children in rural areas and low-income households, where broadband access is either limited or unavailable. Without reliable internet, families cannot access virtual therapy sessions, leading to missed appointments and gaps in care (Kruse et al., 2018).

Beyond telemedicine, digital barriers also limit engagement with patient portals, mobile health apps, and EHRs. Many mental health providers encourage families to use patient portals for appointment scheduling, access to therapy notes, and communication with providers. However, not all caregivers have the technological skills or resources to navigate these platforms, making it difficult to maintain continuity of care (Walker et al., 2022). Similarly, mHealth apps designed to help adolescents manage their mental health by tracking mood changes, setting medication reminders, and accessing coping strategies are not an option for children who lack smartphones or internet access at home.

Schools often serve as a primary source of mental health services for children, and many have introduced virtual counseling and behavioral health programs. However, students without internet access at home cannot participate in these services, further widening the gap between those who can and cannot receive mental health support (Bailey et al., 2023). This digital divide creates an imbalance in access to care, disproportionately affecting children who are already vulnerable due to socioeconomic factors.

Given these challenges, broadband access and digital inclusion should be formally recognized as a social determinant of health. Without reliable internet and digital literacy, many children and their families are unable to access vital mental health services, further deepening disparities. To address this issue, healthcare systems and policymakers should work to expand broadband infrastructure in rural and low-income communities, implement digital literacy programs for caregivers, increase funding for school-based telepsychiatry programs, and advocate for internet subsidy programs similar to the Affordable Connectivity Program (FCC, 2023).

Ensuring digital inclusion is essential for providing high-quality, equitable mental health care to children and adolescents. As mental health professionals, advocating for policy changes that recognize broadband access as an SDOH can help close the gap in pediatric mental healthcare and improve health outcomes for vulnerable populations. Should digital inclusion be formally recognized as an SDOH, and how do you see it impacting pediatric mental healthcare in the future?

References

Bailey, L. C., Razzaghi, H., Burrows, E. K., Bunnell, H. T., Nelson, D. M., & Berry, J. G. (2023). Barriers to telehealth access among U.S. children with mental health conditions. Journal of the American Academy of Child & Adolescent Psychiatry, 62(1), 56-65. https://doi.org/10.1016/j.jaac.2022.06.009

Centers for Disease Control and Prevention. (2022). Social determinants of health. U.S. Department of Health & Human Services. https://www.cdc.gov/socialdeterminants

Federal Communications Commission. (2023). Affordable connectivity program. https://www.fcc.gov/acp

Kruse, C. S., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare, 24(1), 4-12. https://doi.org/10.1177/1357633X16674087

Ramsetty, A., & Adams, C. (2020). Impact of the digital divide in the age of COVID-19. Journal of the American Medical Informatics Association, 27(7), 1147-1148. https://doi.org/10

Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion Sample 3

The role of social determinants of health (SDOH) in pediatric mental health is significant, influencing access to care, treatment adherence, and overall well-being. Traditionally, SDOH have focused on economic stability, education, healthcare access, social context, and the physical environment (Centers for Disease Control and Prevention [CDC], 2022). However, with the increasing reliance on telemedicine, electronic health records (EHRs), mobile health (mHealth), and patient portals, broadband access and digital inclusion should be recognized as a key SDOH, particularly in pediatric mental health nursing.

One of the biggest challenges in pediatric mental health is the lack of equal access to digital healthcare services. Many families depend on telepsychiatry for therapy, medication management, and crisis intervention, yet some children do not have reliable internet access or the digital literacy needed to use these resources effectively (Ramsetty & Adams, 2020). This issue is particularly problematic for children in rural areas and low-income households, where broadband access is either limited or unavailable. Without reliable internet, families cannot access virtual therapy sessions, leading to missed appointments and gaps in care (Kruse et al., 2018).

Beyond telemedicine, digital barriers also limit engagement with patient portals, mobile health apps, and EHRs. Many mental health providers encourage families to use patient portals for appointment scheduling, access to therapy notes, and communication with providers. However, not all caregivers have the technological skills or resources to navigate these platforms, making it difficult to maintain continuity of care (Walker et al., 2022). Similarly, mHealth apps designed to help adolescents manage their mental health by tracking mood changes, setting medication reminders, and accessing coping strategies are not an option for children who lack smartphones or internet access at home.

Schools often serve as a primary source of mental health services for children, and many have introduced virtual counseling and behavioral health programs. However, students without internet access at home cannot participate in these services, further widening the gap between those who can and cannot receive mental health support (Bailey et al., 2023). This digital divide creates an imbalance in access to care, disproportionately affecting children who are already vulnerable due to socioeconomic factors.

Given these challenges, broadband access and digital inclusion should be formally recognized as a social determinant of health. Without reliable internet and digital literacy, many children and their families are unable to access vital mental health services, further deepening disparities. To address this issue, healthcare systems and policymakers should work to expand broadband infrastructure in rural and low-income communities, implement digital literacy programs for caregivers, increase funding for school-based telepsychiatry programs, and advocate for internet subsidy programs similar to the Affordable Connectivity Program (FCC, 2023) Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion.

Ensuring digital inclusion is essential for providing high-quality, equitable mental health care to children and adolescents. As mental health professionals, advocating for policy changes that recognize broadband access as an SDOH can help close the gap in pediatric mental healthcare and improve health outcomes for vulnerable populations. Should digital inclusion be formally recognized as an SDOH, and how do you see it impacting pediatric mental healthcare in the future?

References
Bailey, L. C., Razzaghi, H., Burrows, E. K., Bunnell, H. T., Nelson, D. M., & Berry, J. G. (2023). Barriers to telehealth access among U.S. children with mental health conditions. Journal of the American Academy of Child & Adolescent Psychiatry, 62(1), 56-65. https://doi.org/10.1016/j.jaac.2022.06.009

Centers for Disease Control and Prevention. (2022). Social determinants of health. U.S. Department of Health & Human Services. https://www.cdc.gov/socialdeterminants

Federal Communications Commission. (2023). Affordable connectivity program. https://www.fcc.gov/acp

Kruse, C. S., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare, 24(1), 4-12. https://doi.org/10.1177/1357633X16674087

Ramsetty, A., & Adams, C. (2020). Impact of the digital divide in the age of COVID-19. Journal of the American Medical Informatics Association, 27(7), 1147-1148. https://doi.org/10.1093/jamia/ocaa078

Walker, D. M., Sieck, C. J., Menser, T., Huerta, T. R., & Scheck McAlearney, A. (2022). Examining barriers and facilitators to patient portal adoption using electronic health record audit logs. Journal of the American Medical Informatics Association, 29(4), 638-646. https://doi.org/10.1093/jamia/ocab295

.1093/jamia/ocaa078

Walker, D. M., Sieck, C. J., Menser, T., Huerta, T. R., & Scheck McAlearney, A. (2022). Examining barriers and facilitators to patient portal adoption using electronic health record audit logs. Journal of the American Medical Informatics Association, 29(4), 638-646. https://doi.org/10.1093/jamia/ocab295

 

Reply – Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion

Digital Inclusion and Broadband Access in Social Determinants of Health
     The social determinants of health (SDOH) are the conditions in which people are born, grow, learn, work and live, and the way these conditions disrupt or support health, morbidity and mortality across populations. The five general categories of SDOH are economic stability, education, social and community context, health and healthcare, and neighborhood and environment (Office of Disease Prevention and Health Promotion [ODPHP], 2022). But with the growing reliance on digital tools in healthcare, people should also consider digital inclusion and broadband access as part of the SDOH. Lack of access to digital technologies worsens health inequities because people cannot use telemedicine, patient portals, and electronic health records (EHRs) effectively (Latulippe et al., 2020).
     The use of EHRs, mobile health (mHealth), patient portals, and telemedicine has revolutionized the healthcare system because they have improved the convenience of care and patient involvement. For example, telemedicine helps in increasing healthcare accessibility to people in rural and disadvantaged areas by reducing the problems of transportation and lack of sufficient number of providers. But the advantages of these technologies are not felt equally by all as people with limited or no access to broadband connection or digital skills are not in a position to fully benefit from these technologies (Ramsetty & Adams, 2020). Moreover, patient portals and mHealth applications allow people to take care of their health and communicate with their healthcare providers in a more proactive manner. This means that the already disadvantaged populations may continue to be disadvantaged in healthcare participation and outcomes due to the digital divide (Perzynski et al., 2017).
     Digital inclusion of all individuals, i.e., ensuring that all people have access to affordable internet connection, devices, and digital skills training, is an important determinant of health equity. Broadband access should also be included in the SDOH to develop policies that can help in reducing the digital divide in health and improve the outcome. In this way, the digital divide can be reduced and healthcare providers can be able to offer more support to the needy and improve the communication between patients and providers through technological means.

References

Latulippe, K., Hamel, C., & Giroux, D. (2020). Social health inequalities and eHealth: A literature review with qualitative synthesis of theoretical and empirical studies. Journal of Medical Internet Research, 22(7), e17017. https://doi.org/10.2196/17017

Office of Disease Prevention and Health Promotion. (2022). Social determinants of health. Healthy People 2030. Retrieved from https://health.gov/healthypeople/priority-areas/social-determinants-health

Perzynski, A. T., Roach, M. J., Shick, S., Callahan, B., Gunzler, D., Cebul, R., & Kaelber, D. C. (2017). Patient portals and broadband internet inequality. Journal of the American Medical Informatics Association, 24(5), 927-932. https://doi.org/10.1093/jamia/ocx020

Ramsetty, A., & Adams, C. (2020). Impact of the digital divide in the age of COVID-19. Journal of the American Medical Informatics Association, 27(7), 1147-1148. https://doi.org/10.1093/jamia/ocaa078

Discussion Post

Should Digital Inclusion Be Added to Social Determinants of Health (SDOH)?

The five key social determinants of health (SDOH)—economic stability, education, healthcare access, neighborhood and environment, and social/community context—overlook a crucial factor in today’s healthcare system: digital inclusion and broadband access. In an increasingly digital healthcare landscape, broadband access is essential for equitable health outcomes. This post argues for the addition of digital inclusion as a formal SDOH and explores its relationship with telemedicine, electronic health records (EHRs), patient portals, and mobile health (mHealth).

Digital Inclusion’s Role in Health Equity

Broadband access is vital for telemedicine, which connects rural and underserved patients to care. A study by Hong et al. (2021) highlighted that reliable internet improves chronic disease management and access to care. Without broadband, patients face delays and disparities, particularly in rural and low-income areas. Programs like the FCC’s Affordable Connectivity Program (ACP) aim to close this gap, but more widespread efforts are needed  Digital Inclusion and Broadband Access as Social Determinants of Health NURS-6051 Module 4: Week 9: Discussion.

Impact of Digital Tools on SDOH

  1. Telemedicine: Telehealth reduces barriers such as transportation and time. However, limited internet access prevents marginalized populations from reaping its benefits.
  2. Electronic Health Records (EHRs): EHRs promote care coordination but rely on patients’ ability to engage digitally. Areas with inadequate broadband infrastructure cannot fully utilize EHR systems.
  3. Patient Portals: Research by Lyles et al. (2020) found lower adoption rates of patient portals among older adults, minority groups, and lower-income individuals, reinforcing health inequities.
  4. Mobile Health (mHealth): Apps for disease management, such as those for diabetes, are highly effective but inaccessible to those lacking smartphones or broadband.

Addressing the Digital Divide

Adding digital inclusion as a SDOH would focus policies on improving broadband infrastructure, affordability, and digital literacy. These factors directly impact healthcare access, patient engagement, and overall health outcomes. Digital literacy training combined with affordable broadband would help ensure that all populations can benefit from advancements in health technology.

Conclusion

Digital inclusion and broadband access should be formalized as a SDOH to address the growing reliance on technology in healthcare. Policies targeting infrastructure, affordability, and digital literacy will help bridge gaps in health equity and ensure that underserved populations can access and engage with vital digital health resources.

References

  • Hong, Y. R., Huo, J., Desai, R., Cardel, M., & Mainous, A. G. (2021). Telemedicine utilization and barriers among US adults: A cross-sectional analysis of the COVID-19 pandemic. Journal of General Internal Medicine, 36(8), 2470–2478. https://doi.org/10.1007/s11606-021-06747-3
  • Lyles, C. R., Sarkar, U., & Osborn, C. Y. (2020). Getting a technology-based diabetes intervention ready for prime time: A review of usability testing studies. Current Diabetes Reports, 20(6), 20-25. https://doi.org/10.1007/s11892-020-01302-w
Reply 

Digital Inclusion and Broadband Access as Social Determinants of Health

I strongly believe that digital inclusion and broadband access should be added as key areas to the social determinants of health (SDOH). The digital divide—disparities in access to and use of technology—has increasingly become a significant factor in health equity, particularly as healthcare systems become more reliant on digital tools. For example, electronic health records (EHRs), mobile health applications, telemedicine, and patient portals all hold the potential to either bridge or widen the gap in health access, depending on whether or not individuals have the digital resources to use them effectively.

Rationale for Including Digital Access as a Social Determinant of Health

Access to Health Information and Services

Mobile Health

Telemedicine

Digital Inclusion and Social Determinants of Health: A Reciprocal Relationship

The social determinants of health (SDOH) refer to the conditions in which people are born, grow, live, work, and age, which can include factors like socioeconomic status, education, physical environment, employment, and access to healthcare. Digital inclusion fits within this framework because it affects people’s access to essential services, including healthcare, education, and employment opportunities. In particular:

Income and Socioeconomic Status

education

geography

How Digital Tools Can Be Impacted by Social Determinants of Health

low access to technology

economic barriers

limited digital literacy

References

Benda, N. C., Veinot, T. C., Sieck, C. J., & Ancker, J. S. (2020). Broadband internet access is a social determinant of health. American Journal of Public Health, 110(8), 1123–1125. https://doi.org/10.2105/AJPH.2020.305784Links to an external site.

Centers for Disease Control and Prevention (CDC). (2022). Barriers to digital health adoption. Retrieved from www.cdc.GovLinks to an external site.

Federal Communications Commission (FCC). (2020). Broadband deployment in underserved areas. Retrieved from www.fcc.govLinks to an external site.

Reply
Main Discussion
Social Determinants of Health: The Role of Digital Inclusion

Health outcomes are shaped by medical care and social, economic, and environmental factors that impact people’s daily lives. These factors, known as social determinants of health (SDOH), include access to healthcare, education, economic stability, social context, and the built environment (CDC, 2022). With technology now playing a central role in healthcare, digital inclusion—reliable broadband access, access to digital devices, and digital literacy—has become essential to equitable health outcomes. Recognizing digital inclusion as a key area within the SDOH framework would help address disparities in access to healthcare technologies.

Digital Inclusion as a Social Determinant of Health

Digital inclusion is critical for ensuring everyone benefits from modern healthcare systems. Broadband internet access, for instance, makes using telehealth services, patient portals, and mobile health tools possible. However, communities without reliable internet—often in rural or low-income areas—are left behind. During the COVID-19 pandemic, many patients could not participate in telehealth appointments simply because they lacked broadband access. This limitation further widened health disparities, especially for those with chronic conditions who needed ongoing care (Benda et al., 2020).

Addressing digital inclusion as part of SDOH could promote investments in infrastructure and digital literacy initiatives. For example, expanding broadband access in underserved areas would allow more people to use digital health tools. At the same time, community-based training programs could help individuals develop the skills needed to engage with these technologies.

How SDOH Impacts Digital Health Tools

  1. Electronic Health Records (EHRs):
    EHRs improve how health information is shared and accessed, but they are most effective when patients can engage with their records. For individuals without internet access or digital literacy, using patient portals to view test results or communicate with providers becomes a challenge, limiting the benefits of EHR systems.
  2. Mobile Health (mHealth):
    mHealth apps provide tools for managing chronic diseases and tracking health behaviors. However, their benefits are inaccessible to individuals who lack reliable internet or smartphones. For instance, a diabetes management app can be a valuable tool but requires connectivity to function effectively (Sieck et al., 2021).
  3. Patient Portals:
    Patient portals empower individuals to schedule appointments, check lab results, and message healthcare providers. Yet, broadband disparities prevent many from using these platforms, particularly in rural or low-income areas. This creates a significant barrier to healthcare engagement for already underserved populations.
  4. Telemedicine:
    Telemedicine has transformed healthcare by making it easier to access care remotely, but it also highlights existing inequalities. Patients cannot attend virtual visits without broadband access, leaving them reliant on in-person care that may not always be available or affordable (Benda et al., 2020). Addressing these disparities would make telemedicine more equitable for all.

    Conclusion

    Digital inclusion is essential for ensuring everyone can access and benefit from digital health tools. Expanding broadband access and improving digital literacy would help close the gaps in healthcare equity and allow more people to take advantage of tools like telemedicine, patient portals, and mobile health apps. By recognizing digital inclusion as a key part of the SDOH framework, policymakers and healthcare leaders can work toward creating a more equitable healthcare system.

References

Benda, N. C., Veinot, T. C., Sieck, C. J., & Ancker, J. S. (2020). Broadband internet access is a social determinant of health. American Journal of Public Health, 110(8), 1123–1125. https://doi.org/10.2105/AJPH.2020.305784

Centers for Disease Control and Prevention. (2022). Social determinants of health. Retrieved from https://www.cdc.gov/about/sdoh/index.html

Sieck, C. J., Sheon, A., Ancker, J. S., Castek, J., Callahan, B., & Siefer, A. (2021). Digital inclusion as a social determinant of health. NPJ Digital Medicine, 4(1), 52. https://doi.org/10.1038/s41746-021-00413-8

 

Reply

In this discussion we will explore the critical role of digital inclusion and broadband access within the context of social determinants of health.

Digital Inclusion as a Key Social Determinant of Health

I strongly advocate for the inclusion of digital inclusion and broadband access as a fundamental social determinant of health. Here’s why:

  • Amplifies Existing Health Disparities: Lack of reliable internet access and digital literacy disproportionately affects marginalized communities, including low-income individuals, racial and ethnic minorities, rural residents, and the elderly. This digital divide exacerbates existing health inequities by limiting access to essential health information, services, and care.
  • Enables Proactive Health Management: Digital tools empower individuals to take charge of their health. Patient portals facilitate appointment scheduling, medication refills, and secure communication with providers. Telemedicine expands access to care, especially in underserved areas, and enables remote monitoring of chronic conditions.
  • Facilitates Health Research and Innovation: Digital platforms enable researchers to collect and analyze vast amounts of health data, identify trends, and develop targeted interventions. This data-driven approach can revolutionize healthcare delivery and improve population health outcomes. A study shed light on the need for more theoretical studies (Mulligan 2023).

Impact on Electronic Health Records (EHRs), Mobile Health (mHealth), Patient Portals, and Telemedicine

  • EHRs: Reliable internet access is crucial for the secure and efficient use of EHRs. Limited connectivity can hinder data entry, retrieval, and sharing, leading to fragmented care and potential errors.
  • mHealth: Mobile health applications rely on stable internet connections for data transmission, app updates, and user engagement. Poor connectivity can limit the effectiveness of mHealth interventions and exacerbate health disparities.
  • Patient Portals: Patient portals require internet access for patients to access their health information, communicate with providers, and schedule appointments. Lack of access can hinder patient engagement and self-management. The following study outlines how this facilitates keeping patients engaged in their healthcare (Lyles 2020).
  • Telemedicine: Telemedicine heavily relies on broadband connectivity for video consultations, data transfer, and remote monitoring. Inadequate internet access can disrupt consultations, compromise data security, and limit the reach of telemedicine services.

Examples:

  • A rural community with limited broadband access may experience difficulties accessing telehealth services, leading to delayed diagnoses and treatment for critical conditions.
  • A low-income family without internet access may struggle to schedule appointments, refill prescriptions, and access health information through patient portals.
  • A minority community with low digital literacy may face challenges navigating online health resources and understanding health information.

Addressing the Digital Divide

To mitigate these challenges, policymakers, healthcare providers, and community organizations must collaborate to:

  • Expand broadband infrastructure in underserved areas. A study revealed this can be a two-edged sword—benefits in terms of patient participation; drawbacks in terms of general use (Valentin-Sivico 2023).
  • Provide affordable internet access programs.
  • Offer digital literacy training and support.
  • Integrate digital health equity considerations into healthcare policies and programs.

By recognizing digital inclusion as a critical social determinant of health and taking proactive steps to address the digital divide, we can ensure equitable access to healthcare and improve health outcomes for all.

References

Lyles, C. R., Nelson, E. C., Frampton, S., Dykes, P. C., Cemballi, A. G., & Sarkar, U. (2020). Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Annals of internal medicine, 172(11 Suppl), S123–S129. https://doi.org/10.7326/M19-0876

Mulligan K. (2023). Digital inclusion, online participation and health promotion: promising practices from community-led participatory journalism. Global health promotion, 30(2), 35–39. https://doi.org/10.1177/17579759221126150

Valentín-Sívico, J., Canfield, C., Low, S. A., & Gollnick, C. (2023). Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecommunications policy, 47(4), 102499. https://doi.org/10.1016/j.telpol.2023.102499

Initial Post

Social Determinants of Health (SDoH) are outside factors that are nonmedical that directly affect a person’s health (CDC, 2024).  These factors are access to quality education, access to quality healthcare, neighborhood and built environment, social and community context, and economic stability (Wang et al., 2024).  Access to broadband or digital inclusion should be listed as a key area to SDoH.  This inclusion would allow those that do not have access to quality healthcare, transportation, or safe neighborhoods to walk in, the ability to access primary care through telemedicine.  This would increase underserved communities’ access to quality healthcare.  It would also allow those in low-income households’ access to information through the internet on where the nearest grocery store is located, access to applications for Medicaid or food assistance programs, and educational material for children.

Telemedicine is greatly impacted by and can impact social determinants of health.  Wang et al. (2024) explains that telemedicine reduces financial and transportation barriers to in-person visits; however, smartphone/computer ownership and reliable internet/broadband services greatly impact the potential benefits of this service.  Additionally, SDoH of quality education access may greatly impact use of telemedicine as the majority of applications used in telemedicine require at least a 9th grade reading level (Wang et al., 2024).  As up to 20% of those in underserved communities may only have a 5th grade reading level, attempting to download and read what is needed to start a telemedicine visit may be difficult (Wang et al., 2024).  Positively, social and community context is impacted by allowing family members to be available at appointments, increasing support for patients (Wang et al., 2024).  Although there are some obstacles to overcome, telemedicine may be a plausible way to fill the gaps to increased use of primary care.

References

CDC. (2024, January 17). Social Determinants of Health (SDOH). https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html

Wang, C.P., Mkuu, R., Andreadis, K., Muellers, K.A., Ancker, J.S., Horowitz, C., Kaushal, R., & Lin, J.J. (2024). Examining and addressing telemedicine disparities through the lens of the Social Determinants of Health: A qualitative study of patient and provider during the COVID-19 pandemic. AMIA Annual Symposium. p. 1287-1296. https://pmc.ncbi.nlm.nih.gov/articles/PMC10785927/#:~:text=Although%20telemedicine%20may%20help%20to,SDOH%20remains%20to%20be%20determined.

Reply 

In my current practice, I see first-hand how beneficial telemedicine services are for our patients when they live many hours away from our center. Sometimes, a patient’s transportation has failed them, so telehealth served as a reasonable option. Since social determinants of health (SDOH) impact patient’s health (Office of Disease Prevention and Health Promotion, n.d.), it makes sense that digital inclusion and broadband access should be added to the five key areas of SDOH to ensure healthcare is accessible to everyone.

Sharma and Patten (2022) suggest patient engagement and outcomes improve when mobile health, patient portals, and telehealth are incorporated into their care, which positively impacts SODH. However, telemedicine can negatively impact SDOH when this technology is not accessible without digital access and/or broadband access. For mobile technology, 40 percent of low-income patients rely on pre-paid data plans or public Wi-Fi access. Unfortunately, pre-paid plans often do not provide sufficient data for everyday use, and telehealth and public WI-FI lack privacy and security in public spaces (Sieck et al., 2021).

Reference

Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Healthy People 2030. U.S. Department of Health and Human Services.  https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

Sharma, P., & Patten, C. A. (2022). A Need for Digitally Inclusive Health Care Service in the United States: Recommendations for Clinicians and Health Care Systems. The Permanente journal, 26(3), 149–153. https://doi.org/10.7812/TPP/21.156

Sieck, C.J., Sheon, A., Ancker, J.S. et al. Digital inclusion as a social determinant of health. npj Digit. Med. 4, 52 (2021). https://doi.org/10.1038/s41746-021-00413-8

Reply 

I feel Digital inclusion and broadband access are both important to social determinants of health (SDOH), as the internet is heavily relied upon for necessary services and opportunities. Digital inclusion is a major help that guides healthcare, education, and economic opportunities, that play a vital role in everyday life. For example, an individual in a rural community could complete an online certification program to secure a better-paying job, improving their family’s financial and health status (Pew Research Center, 2021). By using connected devices, patients can transmit health data to their healthcare providers, allowing prompt interventions and decreasing the need for clinic visits.

Broadband helps facilitate health through delivery of telemedicine, which allows remote consultations, chronic disease management, and mental health support particularly for individuals in underserved areas. Broadband access can greatly lessen the necessity for travel, improving access to healthcare and promoting equity. Broadband also assists with online education and remote work opportunities which enhances financial stability. For example, during periods of remote learning, children from homes without broadband often fell behind academically, creating long-term educational and health inequities (Federal Communications Commission, 2020).

While Digital inclusion and broadband access can enhance healthcare access, education, and chronic disease management. Their success is contingent on factors like health literacy and access. These non-medical factors help influence health outcomes, such as access to education, economic stability, healthcare, and safe environments.

References

Centers for Disease Control and Prevention (CDC). (2022). Barriers to digital health adoption. Retrieved from www.cdc.Gov

Federal Communications Commission (FCC). (2020). Broadband deployment in underserved areas. Retrieved from www.fcc.gov

Pew Research Center. (2021). Broadband access and economic oppurtunities. Retrieved from www.pewresearch.org

 

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