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Tag: digital divide

Crossing the Digital Divide: A Content Analysis of Mainstream Australian Mental Health Websites for Languages Other Than English

Murray KE, Musumeci CJ, Cassidy E. Crossing the digital divide: A content analysis of mainstream Australian mental health websites for languages other than English. Health Soc Care Community 2022;30(6):e4831-e4839. doi:10.1111/hsc.13890

Online mental health services are an effective way to provide support while individuals wait for access to face-to-face therapeutic care. As the wait time for access to face-to-face mental health care increases, so too does the use of government-sponsored digital mental health platforms. The Australian government funds mental health websites to promote access to these online services. This article assessed the accessibility of these websites for non-English speaking/literate users. Of the thirty-three websites that provided access to mental health tools and educational materials, only four had translation options available. While non-English translation was available on four websites, only two displayed the translation option directly on the homepage. A search was required to access translation options on the other two websites. The authors also assessed websites for inclusion of content tailored to culturally and linguistically diverse (CALD) communities. A total of 1100 unique content subsections were found across the 33 websites. Eight subsections were specific to CALD communities and only 9 websites even mentioned CALD communities in relation to mental health. Overall, the authors suggest that digital mental health tools should strive to be more inclusive of language barriers in Australian populations.

An Emerging Framework for Digital Mental Health Design with Indigenous Young People: A Scoping Review of The Involvement of Indigenous Young People in The Design and Evaluation of Digital Mental Health Interventions

Povey J, Raphiphatthana B, Torok M, et al. An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions. Syst Rev 2023;12(1):108. doi:10.1186/s13643-023-02262-w

This scoping review provides an overview of the current literature on digital mental health interventions tailored for Indigenous young people. All analyzed research was conducted in the United States (n = 8), New Zealand (n = 6), Australia (n = 7), or Canada (n = 3). Primarily, studies were formative, design, and feasibility designs that used qualitative methods (58%). Pilot or efficacy studies using quantitative methods were less common (41%). To assess best practice processes all studies were scored using The Aboriginal and Torres Strait Islander QAT. These scores were used to develop an emerging framework for developing digital mental health resources with Indigenous young people. The first of the four principles of the framework is Indigenous governance. Including Indigenous leadership in all aspects of study design and developing interventions based on needs specifically identified by the community promoted engagement, better-tailored study processes, and improved overall project success. Engaging Indigenous youth through the iterative process of design, development, and review of informed adaptations to protocols increased recruitment, data quality, and acceptability. Studies using capacity-strengthening activities displayed higher engagement and more successful partnerships between researchers and Indigenous youth. It is important to note that agreements to protect existing or created Ingenious knowledges were rarely reported and are recommended for future research. While all studies reported initial benefits to the Indigenous communities, long-term sustainable changes were rarely reported. Future research developing digital mental health interventions tailored for Indigenous young people should include governance, tailor engagement strategies, foster partnerships, and plan for sustainable knowledge translation.


Digital Health Interventions for All? Examining Inclusivity Across All Stages of The Digital Health Intervention Research Process

Krukowski RA, Ross KM, Western MJ, et al. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials. 2024;25(1):98. doi:10.1186/s13063-024-07937-w

This article provides a commentary on the barriers and potential solutions for appropriately conducting digital health research in diverse populations. The article reiterates the importance of increasing diversity across all phases of research to prevent digital interventions from widening, rather than bridging existing health disparities. To have research that accurately represents the population, diverse samples need to be recruited. Some potential barriers at the recruitment stage are trust concerns and a lack of awareness of the recruitment effort. The authors suggest broadening recruitment strategies and making specific strategies to inform multiple communities about the purpose of the research. During the initial enrollment process, lack of internet access, proper technology, and lengthy screening processes prevent individuals from enrolling in digital health studies. Those who do make it through recruitment face extensive time commitments that interfere with daily life, an inability to maintain the response requirements outlined in the study design, or difficulty understanding the content provided by the intervention. To reduce these barriers the authors suggested using more flexible protocols, getting end-user feedback on content, and focusing on strategies to increase user engagement e.g. quizzes. Once the data is collected, it is important to note that effectiveness measures are infrequently tailored to culturally diverse populations and provide inadequate support. The authors suggest that new definitions of effectiveness should include measures of inclusivity. This would require testing new digital health interventions in populations that more accurately represent the end users of the intervention. Finally, the authors acknowledge the insufficient incentives, human connection, and time for most working adults to engage in digital health research. They suggest testing retention strategies with diverse subgroups and providing updated recommendations for future research.


Reducing Intervention and Research-Induced Inequalities to Tackle the Digital Divide in Health Promotion

Konig LM, Krukowski RA, Kuntsche E, Busse H, Gumbert L, Gemesi K, Neter E, Mohamed NF, Ross K, John-Akinola Y, Cooper R, Allmeta A, Silva AM, Forbes CC, Western MJ. Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion. Int J Equity Health 2023;22(1):249. doi:10.1186/s12939-023-02055-6

This article summarizes discussions from an international expert workshop held in Kulmbach, Germany. The international representatives discussed the challenges facing the field of digital health in regards to social inequality. The primary goal was to outline global methods for improving digital health for all without widening already existing health disparities. Two main themes emerged during the workshop: intervention-induced inequalities and research-induced inequalities. To address intervention-induced inequalities the authors suggest supporting policy changes around healthcare costs, focusing on digital navigators, and expanding research on uptake and engagement cross-culturally. Generally, the goal is to make interventions cost-effective, user-friendly regardless of technology skill level, and accessible. To facilitate equality in research the authors suggest global use of online study registration platforms, including end users early in the intervention design process, diverse recruitment strategies including cross-cultural and language comparisons, and open access to results. Here, the ultimate aim is to increase diversity in research networks, promoting intersectional research and data sharing. Webpages maintaining summaries of recent research in digital health and healthcare-related areas are promoted as a critical method of preventing research waste and promoting collaborations. Without proper consideration of the above discussion points the authors reiterate that digital health research and interventions may widen rather than bridge existing health inequalities.


Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State

Baim-Lance A, Angulo M, Chiasson MA, Lekas HM, Villarreal J, Cantos A, Kerr C, Nagaraja A, Yin MT, Gordon P. Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State. BMC Health Serv Res 22, 609 (2022).

This study used mixed methods to investigate access, use and quality of HIV and other telehealth services for older people living with HIV (PLWH) during the initial wave of the COVID-19 pandemic. Participants over 50 years of age and receiving HIV care in an urban academic medical center in New York City or in a rural federally qualified health center were enrolled (total N=80). The study administered a survey of closed and open-ended questions (in English or Spanish) in-person or via telephone. The survey assessed physical and mental health history and current health status, COVID-19 history, management of HIV and comorbidities during COVID-19, social support during COVID-19, and socio-demographics. Results found that telehealth access and use were impacted by several factors, including access to devices, connectivity, technology literacy, and privacy concerns. Seventy-four percent of participants had at least one telehealth visit for an HIV or specialty visit. Most (70%) participants who had at least one telehealth visit perceived it as worse than in-person. Specifically, participants felt the telehealth appointments were less interpersonal, prone to technical issues, and resulted in poorer outcomes (i.e., lack of receiving referrals and follow up care management). Reported barriers to telehealth included limited access to and reliability of technology, low technology literacy, and discomfort sharing with providers virtually. These findings inform the need for development of digital health interventions that are acceptable and feasible for older PLWH.


Workshop on implementation science and digital therapeutics for behavioral health

Lord S, Campbell A, Brunette M, et al. (2021). Workshop on implementation science and digital therapeutics for behavioral health. JMIR Mental Health. 8(1): e17662. doi: 10.2196/17662

This paper describes proceedings of a day-long workshop, “Implementation Science and Digital Therapeutics” hosted by The Center for Technology and Behavioral Health (CTBH). Read More


Digital exclusion among mental health service users: Qualitative investigation

Greer B, Robotham D, Simblett S, Curtis H, Griffiths H, Wykes T. (2019). Digital exclusion among mental health service users: Qualitative investigation. Journal of Medical Internet Research. 21(1): e11696. doi: 10.2196/11696

Researchers interviewed 20 patients at a mental health clinic who were unable to use the internet (i.e. digitally excluded). Participants completed an assessment of technology access and confidence and participated in an interview exploring familiarity with the internet, barriers to internet use, and facilitators to initiating internet use. Read More


Where is the Balance? Pushing Back Against Consumer Health Tech

Article Excerpt: Smartphones have become critical tools for managing and understanding one’s health, and the dependence on such technology is increasing. Some doctors and researchers have begun to notice this trend and the potential dangers it represents, even to the point of classifying it as an addiction. It is undeniable that some individuals’ total dependence on digital devices shares many of the same characteristics with substance abuse, and this alarming trend is increasingly common in young people. So the question becomes: How do we find the balance between the healthy usage and total reliance?

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Article Source: G Style Magazine


Social health inequalities and eHealth: A literature with qualitative synthesis of theoretical and empirical studies.

Latulippe K, Hamel C, Giroux D. (2017). Social health inequalities and eHealth: A literature review with qualitative synthesis of theoretical and empirical studies. Journal of Medical Internet Research. 19(4): e136. doi: 10.2196/jmir.6731

Researchers analyzed 73 articles that address social health inequalities (SHI) in digital health. Read More