The Digital Divide: Amplifying health inequalities for people with severe mental ill health in the time of COVID-19.

Background People with severe mental ill health (SMI) experience a mortality gap of 15–20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. Methods We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. Outcomes 367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22–2.07; adjusted OR for Age 0.99, 95%CI 0.98–1.00). Interpretation COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

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Health risk behaviours among people with severe mental ill health during the COVID-19 pandemic: analysis of linked cohort data

10.1101/2021.03.29.21254527 ◽

2021 ◽

Author(s):

Emily Peckham ◽

Victoria Allgar ◽

Suzanne Crosland ◽

Paul Heron ◽

Gordon Johnston ◽

...

Keyword(s):

Health Risk ◽

Physical Health ◽

Health Inequalities ◽

Dietary Factors ◽

Drinking Patterns ◽

Risk Behaviours ◽

Younger Age ◽

Health Risk Behaviours ◽

Severe Mental Ill Health ◽

Data Linkages

Background People with severe mental ill health (SMI) experience a mortality gap of 15-20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. Methods We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. Outcomes 367 people provided health risk data. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health and younger age were significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22-2.07; adjusted OR for Age 0.99, 95%CI 0.98-1.00). Interpretation COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

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How has the COVID-19 pandemic impacted on smoking and nicotine dependence among people with severe mental ill health? Analysis of linked data from a UK Closing the Gap Cohort

10.1101/2021.02.10.21251467 ◽

2021 ◽

Author(s):

Emily Peckham ◽

Victoria Allgar ◽

Suzanne Crosland ◽

Paul Heron ◽

Gordon Johnston ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Nicotine Dependence ◽

Health Inequalities ◽

Linked Data ◽

Clinical Cohort ◽

Severe Mental Ill Health ◽

Smoking Patterns ◽

Closing The Gap

SummarySmoking rates are higher for people who use mental health services which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with SMI before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Whilst some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.

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What features of DHI design and deployment enable or hinder engagement with DHIs by demographic groups likely to be affected by the digital divide? Protocol for a systematic scoping review (Preprint)

10.2196/preprints.32538 ◽

2021 ◽

Author(s):

Catherine L. Jenkins ◽

Sumayyah Imran ◽

Aamina Mahmood ◽

Katherine Bradbury ◽

Elizabeth Murray ◽

...

Keyword(s):

Digital Divide ◽

Health Inequalities ◽

Scoping Review ◽

Digital Health ◽

Health Improvement ◽

Policy Makers ◽

Healthcare Facilities ◽

Demographic Groups ◽

Health Related ◽

Translation Services

UNSTRUCTURED Digital health interventions (DHIs) refer to interventions designed to support health-related knowledge transfer and deployed via digital technologies, such as mobile applications (apps) (Soobiah et al., 2020). DHIs are a double-edged sword: they have the potential to reduce health inequalities, for example by making treatments available remotely to rural populations underserved by healthcare facilities or by helping to overcome language barriers via in-app translation services. However, if not designed and deployed with care, DHIs also have the potential to increase health inequalities and exacerbate effects of the digital divide. Patient-level and public health measures delivered digitally therefore need to consider ways to mitigate the digital divide through DHI design, deployment and engagement mechanisms sensitive to the needs of digitally-excluded populations. This protocol outlines the procedure for a systematic scoping review focussing on features of DHI design and deployment that facilitate (or not) access to and engagement with DHIs by people from demographic groups likely to be affected by the digital divide. The results will have wider implications for researchers and policy makers using DHIs for health improvement peri-pandemic and post-pandemic and will inform best practices in the design and deployment of DHIs.

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Digital Divide: Marked Disparities in Computer and Broadband Internet Use and Associated Health Inequalities in the United States

International Journal of Translational Medical Research and Public Health ◽

10.21106/ijtmrph.148 ◽

2020 ◽

Vol 4 (1) ◽

pp. 64-79 ◽

Cited By ~ 1

Author(s):

Gopal K. Singh ◽

Mehrete Girmay ◽

Michelle Allender ◽

Ramey T Christine

Keyword(s):

United States ◽

Health Insurance ◽

Digital Divide ◽

Health Inequalities ◽

Computer Use ◽

Internet Use ◽

The United States ◽

Community Level ◽

Broadband Internet ◽

Racial Ethnic

Background: Despite the considerable increase in computer and internet use over the past two decades, few studies have examined socioeconomic, demographic, and health characteristics associated with computer and internet use in the United States. Community-level differences in computer and internet use and associated disparities in health and mor tality indicators have not been analyzed. This study examines these associations at the individual and community level using national census, health, and mortality data. Methods: We analyzed data from the 2017 American Community Survey (ACS) Micro-data Sample, the 2013-2017 ACS Summary File, 2013-2017 National Vital Statistics System, and 2019 County Health Rankings and Roadmaps. Health and socioeconomic characteristics associated with broadband internet and computer use among adults aged ≥18 were modeled by logistic regression (N=2,385,595). Results: In 2017, 89.7% of Asian/Pacific Islanders (APIs) had broadband internet service, compared with 66.0% of American Indians/Alaska Natives (AIANs), 77.2% of Blacks/African-Americans, 78.8% of Hispanics, and 83.5% of non-Hispanic Whites. APIs (97.4%) were more likely than other racial/ethnic groups to own or use a computer (including smartphones), while AIANs (80.3%) were less likely. Socioeconomic gradients in internet and computer use were marked. Those below the poverty level and with less than a high school education reported 18 and 15 percentage points lower rates of internet and computer use respectively. Compared to metropolitan areas, nonmetropolitan areas had lower internet access (80.3% vs. 69.7%) and computer use (88.4% vs. 80.5%). Rural areas and small urban towns had the lowest level of internet and computer use. Risks of disabilities and lack of health insurance were greater among persons with lower broadband internet and computer access. Communities with low internet and computer use had seven years shorter life expectancy than communities with high use and were at increased risks of mortality from various chronic conditions, poor health, mental distress, hospitalization, smoking, obesity, and physical inactivity. Conclusions and Implications for Translation: Significant socioeconomic and racial/ethnic disparities in internet and computer use and associated health inequalities exist in the US. Closing the social divide in internet and computer use can positively impact individual empowerment, educational attainment, economic growth, community development, access to health care and health-related information, and health promotions efforts. Key words: • Digital divide • broadband internet • computer use • disability • health insurance • causespecific mortality • morbidity • health behaviors Copyright © 2020 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

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Measuring the digital divide among people with Severe Mental Ill Health using the Essential Digital Skills framework

10.1101/2021.08.18.21262204 ◽

2021 ◽

Author(s):

Spanakis Panagiotis ◽

Wadman Ruth ◽

Walker Lauren ◽

Heron Paul ◽

Mathers Alice ◽

...

Keyword(s):

Digital Divide ◽

Health Sector ◽

Internet Access ◽

Professional Life ◽

Work Skills ◽

Problem Solving Skills ◽

Digital Skills ◽

Severe Mental Ill Health ◽

Digital Exclusion ◽

First Time

AbstractAimsAmidst the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk for digital exclusion. This risk might not abide by the end of the pandemic. This paper seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion.Methods249 adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time the EDS is benchmarked in people with SMI.Results42.2% had no Foundation Skills and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home.ConclusionA significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support, to ensure people retain access to key services and develop digital skills and confidence. To our knowledge this is the first time this has been described using the Essential Digital Skills (EDS) framework. Services, including the NHS, need to be aware and mitigate the risks.

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Telemedizin für Ältere – Chancen mehren, kritische Punkte angehen!

Therapeutische Umschau ◽

10.1024/0040-5930/a000721 ◽

2015 ◽

Vol 72 (9) ◽

pp. 577-579

Author(s):

Ulrich Otto ◽

Silvan Tarnutzer ◽

Marlene Brettenhofer

Keyword(s):

Digital Divide

Zusammenfassung. Der Nutzen von Telemedizinanwendungen für Ältere ist daran zu messen, inwieweit sie erhöhte Potenziale für eine selbstständige Lebensführung bei guter Lebensqualität ermöglichen können. Idealerweise ist dieser Nutzen am „Gesundheitsstandort Privathaushalt“ abrufbar, eingebettet in einem bedarfs- und bedürfnisgerechten Gesundheitssystem, in welchem sämtliche medizinischen und pflegerischen Prozesse integrativ miteinander vernetzt sind. Ergänzt werden muss dieses System durch verstärkte Koproduktion mit den PatientInnen selbst und deren Angehörigen. Um sich diesen Zielen zu nähern, braucht es ein Umdenken und die Bereitschaft aller AkteurInnen zu tiefgehenden Veränderungen. Medizinische Institutionen müssen sich als lernende Organisationen stärker an den PatientInnen und deren individuellen Bedarfen sowie an intersektoraler und interdisziplinärer Kooperation orientieren. In der Gesundheitspolitik ist es nötig, Verteilungs- und Gerechtigkeitsaspekte stärker zu gewichten. Dabei gilt es besonders, bildungsferneren Schichten und in ländlichen Regionen den Zugang zur Nutzung von Technologien zu erleichtern, um digital divide-Phänomene zu vermeiden. Der Einsatz neuer Gesundheitstechnologien muss deshalb durch flankierende Vorbereitungen und Begleitung durch schnell erreichbare AnsprechpartnerInnen beim Einsatz unterstützt werden. Hinzu kommen Anforderungen an Finanzierungsmodelle und erweiterte Krankenkassenleistungen.

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