Digital Health Care Disparities

UNSTRUCTURED Vulnerable populations have been identified as having higher infection rates and poorer COVID-19 related outcomes, likely due to their inability to readily access primary care, follow public health directives and adhere to self-isolation guidelines. As a response to the COVID-19 pandemic, many health care services have adopted new digital solutions, relying on phone and internet connectivity. Yet, persons who are digitally inaccessible, such as those struggling with poverty or homelessness, are often unable to utilize these services. In response to this newly highlighted social disparity known as “digital health inequity”, emergency physicians at the University Health Network, Toronto, initiated a program called “PHONE CONNECT”. This novel approach attempts to improve patients’ access to health care, information and social services, as well as improve their ability to adhere to public health directives (social isolation and contact tracing). While similar programs addressing the same emerging issues have been recently described in the media, this is the first time phones are provided as a health care intervention in an emergency department. This innovative ED point-of-care intervention may have a significant impact on improving the health outcomes for vulnerable people during the COVID-19 pandemic, and even beyond it.

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Digital Home Health Care: Culture-Specific Observations in Saudi Arabia (Preprint)

10.2196/preprints.26002 ◽

2020 ◽

Author(s):

Abdulaziz A Alodhayani ◽

Marwah Mazen Hassounah ◽

Fatima R Qadri ◽

Noura A Abouammoh ◽

Zakiuddin Ahmed ◽

...

Keyword(s):

Health Care ◽

Saudi Arabia ◽

Home Health Care ◽

Health Program ◽

Digital Health ◽

Local Population ◽

Family Members ◽

Cultural Factors ◽

Home Health ◽

Design And Implementation

BACKGROUND There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to what aspects of the Saudi Arabian culture need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for chronically and terminally ill patients. OBJECTIVE This study aims to explore the specific cultural factors relating to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home (RAHAH); a connected health program in the Home Health Care Department at King Saud University Medical City, Riyadh, Saudi Arabia. METHODS A qualitative study design was adopted to conduct a focus group discussion (FGD) in July 2019 using a semi-structured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. RESULTS Two categories emerged from the FGD that influenced the experiences of digital health program intervention: (1) culture-related factors including language and communication, cultural views on using cameras during consultation, non-adherence to online consultations, and family role and commitment (2) caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with the patients and their family members may work as a barrier to proper communication through RAHAH. CONCLUSIONS We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving the direct family members with the healthcare providers.

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Author Correction: Deep transfer learning for reducing health care disparities arising from biomedical data inequality

Nature Communications ◽

10.1038/s41467-020-20480-x ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Yan Gao ◽

Yan Cui

Keyword(s):

Health Care ◽

Transfer Learning ◽

Health Care Disparities ◽

Biomedical Data

A Correction to this paper has been published: https://doi.org/10.1038/s41467-020-20480-x

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31.C. Workshop: Development and implementation of action plans on health literacy

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1396 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Public Health ◽

Health Care ◽

Health Literacy ◽

Health Information ◽

Digital Health ◽

Action Plan ◽

Knowledge Society ◽

Implementation Strategies ◽

Social Consequences ◽

Action Plans

Abstract Health literacy (HL) has become an important topic in many countries. As HL - meaning the ability to access, understand, appraise and apply health information (Sørensen et al. 2012) - is important to make sound health decisions, to promote health and to take an active part in managing health and illness in everyday life and navigating the health care system. In the modern digital knowledge society, HL is also indispensable for orienting oneself in the abundance of mostly digital health information, including incorrect and false information, for locating reliable information and for assessing the trustworthiness and quality of information. However, available studies show that HL is insufficient in many countries. Low HL has - as many studies show - negative social consequences ranging from unhealthy behaviour, higher risk for diseases, less self-care and deficits in coping with illness and chronicity, to over- and misuse (extensive use) of health care. The promotion of HL is therefore an important public health task. An increasing number of population studies and policy documents currently underline this. The WHO has therefore included HL into many of its strategies, like the declarations of Shanghai (2016) and Astana (2018), and has published several publications focusing on HL, like the Solid Facts (2013), the 57th Health Evidence Network Report (2018) or the Roadmap for Implementing Health Literacy Activities (2019). In many countries, strategies and national action plans to improve HL have been developed in response to the political call for action, e.g. in Scotland, Germany and recently also in Portugal. Other countries and regions are currently working on the development of a HL action plan, e.g. Belgium and the WHO European Region action plan on HL. The development and especially the implementation strategies of action plans in different countries and the experiences gained will be discussed comparatively in the workshop. Following an introduction (10'), two countries, which already have action plans will introduce their implementation strategy in one presentation each: Germany and Portugal (30'). This will be followed by two presentations of countries/regions in which action plans are currently being developed: Belgium and WHO Europe (30'). Afterwards the participants will have the opportunity to ask questions and discuss on the different strategies (20'). The workshop will help other initiatives to successfully develop and implement policy plans and strategies in different fields of public health. Key messages Strategies and national action plans to improve HL have been developed in different countries/regions. It is important to reflect on the chosen development and implementation strategies and to discuss their effects, successes and barriers.

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A Roadmap to Inform Development, Validation and Approval of Digital Mobility Outcomes: The Mobilise-D Approach

Digital Biomarkers ◽

10.1159/000512513 ◽

2020 ◽

Vol 4 (1) ◽

pp. 13-27 ◽

Cited By ~ 1

Author(s):

Lynn Rochester ◽

Claudia Mazzà ◽

Arne Mueller ◽

Brian Caulfield ◽

Marie McCarthy ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Health Care Professionals ◽

Digital Health ◽

Disease Status ◽

Proximal Femoral Fracture ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Physical Mobility ◽

High Level

Health care has had to adapt rapidly to COVID-19, and this in turn has highlighted a pressing need for tools to facilitate remote visits and monitoring. Digital health technology, including body-worn devices, offers a solution using digital outcomes to measure and monitor disease status and provide outcomes meaningful to both patients and health care professionals. Remote monitoring of physical mobility is a prime example, because mobility is among the most advanced modalities that can be assessed digitally and remotely. Loss of mobility is also an important feature of many health conditions, providing a read-out of health as well as a target for intervention. Real-world, continuous digital measures of mobility (digital mobility outcomes or DMOs) provide an opportunity for novel insights into health care conditions complementing existing mobility measures. Accepted and approved DMOs are not yet widely available. The need for large collaborative efforts to tackle the critical steps to adoption is widely recognised. Mobilise-D is an example. It is a multidisciplinary consortium of 34 institutions from academia and industry funded through the European Innovative Medicines Initiative 2 Joint Undertaking. Members of Mobilise-D are collaborating to address the critical steps for DMOs to be adopted in clinical trials and ultimately health care. To achieve this, the consortium has developed a roadmap to inform the development, validation and approval of DMOs in Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease and recovery from proximal femoral fracture. Here we aim to describe the proposed approach and provide a high-level view of the ongoing and planned work of the Mobilise-D consortium. Ultimately, Mobilise-D aims to stimulate widespread adoption of DMOs through the provision of device agnostic software, standards and robust validation in order to bring digital outcomes from concept to use in clinical trials and health care.

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PARE0008 MOBILE APPLICATION “MOJRA” FOR MONITORING PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3922 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1290.1-1290 ◽

Cited By ~ 1

Author(s):

N. Teodorovic ◽

S. Djordjevic ◽

L. Vranic

Keyword(s):

Rheumatoid Arthritis ◽

Health Care ◽

Best Practice ◽

Mobile Apps ◽

Digital Health ◽

Work Capacity ◽

Learning Center ◽

Approval Procedure ◽

The Republic

Background:In Serbia, regular examinations with a rheumatologist are scheduled on average every 3 to 4 months. With this in mind, there is a real possibility that many patient data during this period may not be presented to the doctor during the examination, either because the patient forgets them or because they may focus on other issues and may not highlight key factsObjectives:To overcome this problem, the Association of Patients with Rheumatic Diseases of Serbia-ORS in cooperation with an IT firm developed the application “MojRA”, which was presented at the annual rheumatology congress of Serbia held in September 2019. The application “MojRA” is intended for patients suffering from rheumatoid arthritis - RA. The application enables efficient storage and systematization of data, allows doctors to monitor the condition of their patients between two examinations and have a medical history. “MojRA” is available for now from smartphones running the android operating system on the google play store. The privacy of patient information is guaranteed.Methods:Patients with RA will be able to record and store information about important moments during treatment in a simple and transparent way. At each subsequent visit they will be able to describe what happened to their illness in the meantime. The application can create different types of reports and views.At the same time, the doctor can use the app to inform the patient about her/his condition in real time, which will contribute to better and more meaningful communication. All this would improve the quality of health care, preserving work capacity and improving the quality of life.Results:In order to simplify biotherapy committee approval procedure for patients of RA, the “Charger” has been developed in association with ORS and URes. The “Charger” will connect data collected by MojRa to the registry of RA patients, making the whole approval procedure more efficient and transparent.Testing of the second version of this application is underway, meetings are held between the patients using the application and the IT company that created it.Plans are to expand the app to other types of arthritis in the near future, too, and will soon be completed for devices running Apple operating systems.Conclusion:In addition to being of great benefit to patients and doctors, it can in the future be of immeasurable importance for the savings in the overall health care system of the Republic of Serbia.References:[1]Mobile Apps for Rheumatoid Arthritis: Opportunities and Challenges, Mollard E, Michaud K, Rheum Dis Clin, May 2019, Volume 45, Issue 2, Pages 197–209[2]Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality, Rebecca Grainger, Hutt Hospital, JMIR Publications, Advancing Digital Health Research, Feb 27, 2017.[3]ACR Mobile Apps,https://www.rheumatology.org/Learning-Center/Apps,American College of Reumatology.Disclosure of Interests:None declared

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A Scoping Review of Behavior Change Interventions to Decrease Health Care Disparities for Patients With Disabilities in a Primary Care Setting: Can Social Marketing Play a Role?

Social Marketing Quarterly ◽

10.1177/1524500421992135 ◽

2021 ◽

Vol 27 (1) ◽

pp. 48-63

Author(s):

Angela Makris ◽

Mahmooda Khaliq ◽

Elizabeth Perkins

Keyword(s):

Primary Care ◽

Health Care ◽

Behavior Change ◽

Social Marketing ◽

Health Care Disparities ◽

Social Model ◽

Care Providers ◽

Social Model Of Disability ◽

Behavior Change Interventions ◽

The Social

Background: One in four Americans have a disability but remain an overlooked minority population at risk for health care disparities. Adults with disabilities can be high users of primary care but often face unmet needs and poor-quality care. Providers lack training, knowledge and have biased practices and behaviors toward people with disabilities (PWD); which ultimately undermines their quality of care. Focus of the Article: The aim is to identify behavior change interventions for decreasing health care disparities for people with disabilities in a healthcare setting, determine whether those interventions used key features of social marketing and identify gaps in research and practice. Research Question: To what extent has the social marketing framework been used to improve health care for PWD by influencing the behavior of health care providers in a primary health care setting? Program Design/Approach: Scoping Review. Importance to the Social Marketing Field: Social marketing has a long and robust history in health education and public health promotion, yet limited work has been done in the disabilities sector. The social marketing framework encompasses the appropriate features to aligned with the core principles of the social model of disability, which espouses that the barriers for PWD lie within society and not within the individual. Incorporating elements of the social model of disability into the social marketing framework could foster a better understanding of the separation of impairment and disability in the healthcare sector and open a new area of research for the field. Results: Four articles were found that target primary care providers. Overall, the studies aimed to increase knowledge, mostly for clinically practices and processes, not clinical behavior change. None were designed to capture if initial knowledge gains led to changes in behavior toward PWD. Recommendations: The lack of published research provides an opportunity to investigate both the applicability and efficacy of social marketing in reducing health care disparities for PWD in a primary care setting. Integrating the social model of disability into the social marketing framework may be an avenue to inform future interventions aimed to increase health equity and inclusiveness through behavior change interventions at a systems level.

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An Overview of Cancer Health Disparities: New Approaches and Insights and Why They Matter

Carcinogenesis ◽

10.1093/carcin/bgaa121 ◽

2020 ◽

Author(s):

Tsion Zewdu Minas ◽

Maeve Kiely ◽

Anuoluwapo Ajao ◽

Stefan Ambs

Keyword(s):

Health Care ◽

Health Disparities ◽

Social Stress ◽

Access To Health Care ◽

Health Care Disparities ◽

Underserved Populations ◽

Tumor Biology ◽

Cultural Barriers ◽

Cancer Therapies ◽

Cancer Health Disparities

Abstract Cancer health disparities remain stubbornly entrenched in the US health care system. The Affordable Care Act was legislation to target these disparities in health outcomes. Expanded access to health care, reduction in tobacco use, uptake of other preventive measures and cancer screening, and improved cancer therapies greatly reduced cancer mortality among women and men and underserved communities in this country. Yet, disparities in cancer outcomes remain. Underserved populations continue to experience an excessive cancer burden. This burden is largely explained by health care disparities, lifestyle factors, cultural barriers, and disparate exposures to carcinogens and pathogens, as exemplified by the COVID-19 epidemic. However, research also shows that comorbidities, social stress, ancestral and immunobiological factors, and the microbiome, may contribute to health disparities in cancer risk and survival. Recent studies revealed that comorbid conditions can induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. In this review, we will discuss unanswered questions and new opportunities in cancer health disparity research related to comorbid chronic diseases, stress signaling, the immune response, and the microbiome, and what contribution these factors may have as causes of cancer health disparities.

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