Due to COVID-19, the world has gone virtual— or so we say. We’ve left behind many populations in the shift from in-person to remote living while maintaining the assumption that everyone has the means to adapt to it.
While the rapid development of technology has allowed for most of the world to adapt to the pandemic to secure their resources and meet their needs, the lack of digital literacy and digital health literacy has widened the inequity that already exists in the provision of healthcare.
Technology and Healthcare
Technology has allowed us to meet many of our needs during the COVID-19 pandemic.
Technology usage during the pandemic has bridged various pre-existing gaps in healthcare; however, there are many barriers to technology and telehealth access and utilization that have widened many of those gaps for certain populations.
Gap #1: Access to People
Bridging the gap: Platforms such as Skype and FaceTime allow us to connect with the people that the pandemic forced us apart from. Platforms such as Microsoft Teams and Zoom have allowed us to “work from home” or “study from home” as we were forced to “shelter in place” or “stay at home.”
Widening the gap:
Many of us have been able to “work from home” or be at home during the pandemic, but that’s because we have had access to the resources needed to do so and were in positions that have allowed that.
On the other hand, those who were deemed as “essential workers,” such as grocery store employees, janitorial workers, and food service workers, were not given such options.
Outside of healthcare professions, many “essential worker” positions are filled by part-time employees and individuals who haven’t had access to the experience or education required by employers at offices and institutions. That being said, it’s often individuals who come from lower socioeconomic statuses who are deemed as “essential workers.”
In May of 2020, People of Color accounted for 43% of all essential workers in the USA, which helps us to understand one reason why the pandemic hit Black and Latinx communities so hard. As their peers were given the option to “work from home,” they were faced with the option to come to work despite the glaring health risks or lose their jobs.
Gap #2: Access to Healthcare
Bridging the gap:
Telehealth has allowed us to have appointments and check-ups while the doors to the doctor’s offices and hospitals closed. It’s made it safer for those who are “high-risk” to continue getting the services they need without risking going in person.
Widening the gap:
We cannot ignore the ways in which people’s identities affect their experience of the pandemic and their ability to access the resources they need. Among low-income individuals, there are, “lower rates of smartphone ownership (71%), home broadband access (59%), internet use (82%), and basic digital literacy (53%).”
One’s socioeconomic status can easily determine the type of resources available to them; and in this case, it can determine whether certain individuals can obtain the resources needed to survive in a global pandemic.
Despite video visits resulting in higher patient understanding and satisfaction than visits conducted over the phone, “at least 1 in every 4 Americans may not have digital literacy skills or access to Internet-enabled digital devices to engage in video visits.” Working in a helping profession, such as healthcare, requires trust and rapport building. And this is something that’s often done more easily and effectively in-person or face-to-face than it is done over the phone.
What this tells us is that alternatives are not substitutes. We cannot simply substitute in-person services with alternative services and assume that patients will interact with them in the same manner without also considering if the alternative services we’re providing are even accessible in the same magnitude.
Kaiser Permanente, a California-based health care provider, has seen growth in their telehealth use, with more than half of their patient interactions taking place through telehealth. This is significant because the switch from providing in-person to remote services happened fairly quickly with very little time for patients to adapt to the changes or even learn how to use the platforms.
There are 6.6 million Californians with limited English proficiency. So while patient portals and telehealth services don’t explicitly require patients to be proficient in English, its usability is definitely reduced the less English that a patient knows.
Within many healthcare portals and platforms, patients are first required to enroll in order to access its services. These portals are also where they are able to message their physicians and care team, schedule appointments, check test results and records, and request prescription refills, among other services.
Here are some accessibility questions to consider about individuals who lack proficiency in English or who lack digital literacy skills:
- Do they know how to email or message their provider?
- Do they know how to navigate their health care provider’s website and/or app?
- Do they know how to fill out forms online or schedule appointments virtually? Or how to find the phone number online to call and make an appointment?
These are basic services that patients were formerly able to complete in person, and the quick shift to moving all of these services online can be confusing and hard to navigate.
Gap #3: Access to Information
Bridging the gap:
Media outlets have provided us with instant access to the newest information pertaining to the pandemic, keeping the public informed about important news such as updated county guidelines, vaccine schedules, and information about new strains.
Widening the gap:
In January of this year, it was found that more than 8 in 10 Americans receive their news from digital devices, such as smartphones, computers, or tablets. That being said, the majority of pandemic-related news was being rolled out virtually with special attention given to these digital platforms that are less accessible to those who are unhoused and from lower socioeconomic statuses.
Let’s go a step further and analyze the language of the messaging around the pandemic:
“Work from home”
“Shelter in place”
“Stay at home”
These sayings that have made their rounds for the past year and a half all insinuate that the individual is safer at home. And because of this, there’s the notion that telehealth and other life choices in which the individual can be at home is the safest bet; and the information that’s been distributed to the public has been in alignment with this.
The majority of public messaging has been centered around how the individual can continue life at home. Specialized information and challenging voices that seek to make space for and acknowledge the individuals left behind— unhoused individuals, individuals experiencing domestic violence, and individuals without the luxury of working from home— are mainly found online.
They’re in articles and blogs like this one. And how can individuals who don’t utilize these forms of media access such information?
The rhetoric around what’s considered to be safe practices during the pandemic illustrates which populations are targeted for the use of services and which are being left behind.
If you could not afford to have WiFi,
If English was hard for you to understand and speak in,
If you didn’t have a laptop or personal device,
If you weren’t familiar with the technology that exists today,
If you didn’t have a private space,
If you didn’t have a secure place to live,
How would you be doing right now and through the duration of the pandemic?
How would you go about getting the resources you need to survive this pandemic— socially, financially, physically, and mentally?
What would you want to be changed about the way services are provided so that they’re as accessible to you as possible?