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As online learning modes become more common, this can exacerbate educational inequalities for learners who do not have the ability to utilise these modes effectively. This has been seen in the COVID-19 crisis where there has been a shift to remote and distance learning modalities despite the limited ability for all learners to benefit equitably. In particular, digital literacy remains a fundamental barrier to benefitting from online and blended learning. This paper reports on a study that investigated the digital literacy needs and preferences of peri-urban, marginalised youth when utilising online and blended learning in South Africa and how online education platforms can be designed to better suit such groups. It is argued that for online courses to truly support marginalised groups, it needs to be ensured that these learners are digitally equipped and digitally literate in terms of accessing, utilising, and benefitting equitably from online learning. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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With the increasing internet accessibility in India and the challenges posed by the Covid-19 pandemic, the practice of virtual court hearing has been accelerated in India. The virtual Court acts as an effective means to conduct Court proceedings, debarring geographical barriers and uplifting Courtroom functioning's productivity. Along with the practical applicability of virtual court hearings in India comes the glitches or challenges posed by the virtual hearing of matters. Nonetheless, the necessity of physical hearing of matters cannot be ignored. In pursuance of this, arguments in favor of reverting towards physical hearings after the pandemic situation ends are being posed before the Indian Judiciary, which negates the applicability of virtual courtrooms. Thereby, this article aims to analyze the applicability, necessity and efficacy of virtual court hearings and the challenges posed by Virtual Court hearings in India.Copyright © 2020 Ubiquity Press. All rights reserved.
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Purpose of Study: Since the COVID pandemic began, there have been a dearth of opportunities for pre-medical students to work with practicing physicians. This is even truer in health care shortage areas such as California's impoverished San Joaquin Valley where the majority of its residents live below the poverty line and face a number of socioeconomic and educational hardships. Inequitable educational opportunities, lack of STEM identity, as well as lack of access to local mentors contribute to underrepresentation of individuals with diverse racial and ethnic backgrounds in STEM professions, including medicine. In partnership with the UCSF Fresno Department of Pediatrics we created a summer virtual Medical Education Apprentice Fellowship to help address some of these issues. Methods Used: This seven-week summer program was directed towards disadvantaged high school and undergraduate students living in the San Joaquin Valley. Four pediatric subspecialists, 4 medical students, 64 undergraduate students, and 4 high school students participated in the program. Participants were divided into specialty teams based on their interests, with each team (burn surgery, endocrinology, gastroenterology, or pulmonology) led by a medical student and faculty. Overall, this program had three primary components: (1) creating animated medical education videos for use in clinics, (2) hosting patient case study series, and (3) providing mentorship and professional development. Summary of Results: Forty-seven percent of students reported being the first in their family to pursue a STEM-related field. Prior to entering this program, only 50% of students felt strongly confident in their ability to be successful in a STEM-related field, and only 30% had a mentor that they fully trusted for guidance and resources. After completing the seven week program, 93% of students reported that they felt the program allowed them to explore medicine in innovative ways, 88% reported that they had made fruitful connections and now have a mentor and resources to guide them, and nearly 75% of students indicated a desire to address the social and health needs of the San Joaquin Valley as a healthcare professional. Conclusion(s): Our Medical Education Apprentice Fellowship provided disadvantaged students in the San Joaquin Valley with an opportunity to improve their digital literacy skills and medical knowledge while receiving mentorship from medical students and physicians. Grassroots programs such as this that form collaborative partnerships between students and health care professionals can be used to foster future healthcare leaders in order to address the health provider shortage in the San Joaquin Valley while providing underrepresented youth the chance to become healthcare champions.
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With the COVID-19 pandemic there was a swift and necessary adoption of telehealth for medical care, including medical nutrition therapy services. While the pandemic control measures have entered a new phase in Australia, the federal government has pledged to continue some Medical Nutrition Therapy (MNT) services as virtual consultations. It is important to ensure that service is equitable for all in the community and that the digital divide does not prevent access for disadvantaged groups. Older patients may be particularly at risk, and it is important to assess their ability to understand and accept virtual care. The aim of this scoping review was to identify available tools for assessing digital literacy in middle-aged and older adults and to determine their feasibility for patient use and their applicability to MNT services. The review followed the Joanna Briggs Institute guide for scoping reviews.(1) Five medical databases, reference lists of the identified studies and publications from main authors were searched to source peer-reviewed articles published in English from 2014 to February 2021. Studies for inclusion were those that used or tested a digital literacy tool in participants aged 45 years and above. Quantitative study designs conducted in clinical, community or population settings were considered Studies not meeting these criteria were deemed ineligible. The results were synthesised in tabular form and with a narrative review The generalisability of the included studies was assessed, and the applicability of the identified tools were evaluated using a four point-scale informed by the National Health Medical Research Council guide for developers of guidelines. Searches yielded 866 articles of which 30 studies (31 reports) inclusive of 11,620 participants, were used in the final analysis. Seven tools for assessment of digital literacy were identified, and the electronic health Literacy Scale (eHEALS) and modifications of this tool were most frequently used. Other tools included the Computer Proficiency Questionnaire and variations for mobile and wireless networks. Most studies found low digital health literacy among older adults. The eHEALS was found to be the most applicable for practitioners to use for assessing suitability of virtual care for their patients. This tool is inclusive of eight questions self-administered using a Likert scale (5-point) and covering the domains of traditional literacy, health and scientific literacy, information literacy as well as media and computer literacy. The findings highlight the importance of locating an appropriate digital literacy tool for older adults to better inform telehealth-delivered MNT practice. Future studies should explore effective interventions and educational programs for disadvantaged and under-served populations to help connect them with healthcare services online.
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Recent education-based challenges related to the COVID-19 pandemic, as well as a growing need to read and understand multiple internet-based sources in both academic and daily life, have highlighted the importance of better understanding how children read and learn both online and in traditional print-based environments. Previous research suggests that there may be some differences in the ways children approach and process internet-based and print-based literacy-focused tasks. Research has also demonstrated a strong link between student motivational factors, early home-based literacy experiences and reading comprehension, but it is unclear if these factors contribute equally to print-based and internet reading comprehension. The current study used data of 4451 students from the Canadian sample of the PIRLS 2016 study, an international literacy study designed to assess fourth grade students' print-based reading comprehension and internet literacy. Students' home and early literacy experiences and motivation were examined in relation to their print-based reading comprehension of informational text (PIRLS) and internet literacy scores (ePIRLS). Results showed a statistically significant positive relation between early home literacy and both print-based reading comprehension and internet literacy as well as between motivation and each reading outcome. Additionally, a mediation model demonstrated that print-based reading comprehension only partially mediates the relation between home literacy and internet literacy as well as the relation between motivation and internet literacy. This study highlights the importance of focusing on factors that influence children's internet literacy, above and beyond print-based reading comprehension. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Purpose: Knee osteoarthritis (KOA) is a chronic and irreversible degenerative joint disease that commonly causes pain and functional disability, which results in decreased mobility and quality of life. To minimize pain and disability, regular physical activity (PA) is strongly recommended. Despite the recommendation, patients often do not adhere to regular PA. Thus, it is necessary to understand the challenges of implementing physical activity by patients. Currently, the COVID-19 pandemic and protective measures have become a barrier for people with OAJ to practice PA regularly and to avoid sedentary behavior, which contributes to increased load and pain in the knees. Understanding these challenges would help to develop interventions to minimize that behavior and increase patient adherence. To explore the challenges of physical therapists and patients with KOA implementing regular physical activity during the COVID-19 pandemic. Method(s): Cross-sectional study with qualitative analysis. Thirty KOA patients were recruited for a semi-structured online interview. Interviews were recorded, transcribed and thematic analyzed. Result(s): Three themes arose: 1) the impact of the pandemic on KOA care (social isolation, mental health, lack of care routine);2) Facilitators of physical activity (lower pain, socialization, confrontation, financial resource, health);3) challenges of physical activity (available infrastructure, fear, lack of time and motivation, digital literacy, age, pain). Conclusion(s): Patients with KOA were impacted by the pandemic, experiencing facilitators and challenges of physical activity. Care may be improved by increasing the focus on the facilitators of physical activity and also, to help patients facing their challenges of physical activity.Copyright © 2023
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Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Method(s): First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, crosssectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were ed from the electronic health record (EHR). Result(s): Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%;n=889) was significantly lower compared to White patients (71%, n=2,142, p<0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p<0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively;p<0.001). Rates of self-reported access to videocapable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p>0.05). The most common selfidentified challenge to telehealth usage among both races was limited digital literacy. Conclusion(s): Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities.
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The article describes the importance of digital literacy for teachers in educational institutions in Peru, as well as the development of their communication skills in synchronous classes with their students in times of the Covid-19 pan-demic. The theoretical review was carried out in scientific articles of the last ten years indexed in bibliographic databases such as Dialnet, SciELO, Redalyc, Academic and Proquest under the PRISMA systematic review methodology. Eighteen articles were evaluated and selected from a total of 52 pub-lished between 2012 and 2022. The results show that it is of the utmost importance that teachers develop their digital and communicative skills. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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Regarding academic paradigms of the teaching process, educational administration, including governance, the COVID-19 outbreak has impacted the government education institutions. Educators' conflict self-efficacy as well as job dedication are crucial for investigation in light of this approaching paradigm change. The studies demonstrated that conflict self-efficacy substantially impacted public focuses on teachers' job involvement as during COVID-19 outbreak. Educators' job dedication is positively predicted by their ability to handle ambiguity throughout this period. In addition, the information revealed a high level of conflict self-efficacy in concepts of intervention, prevention, accomplishment, and confusion governance, as well as a significant impact on work dedication among instructors of devotion to the classroom, dedication to pupils, responsibility to educators, as well as dedication to the job role. The study's outcomes also revealed a relationship between crisis self-efficacy and teachers' job dedication during the epidemic. This research establishes a theoretical foundation for a more comprehensive assessment of teacher digital competence (TDC). Furthermore, it discusses the term digital literacy and skill and how it affects teachers' emotional state. It also states the emerging trends in the field of digital education in the time of COVID outbreak. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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The goal of this research is to determine the impact of the covid-19 outbreak on Peruvian higher education. Surveys were issued to 349 instructors at various institutions to obtain information. As a result of the study's findings, it appears that COVID-19 has a detrimental influence on higher education, running interruptions to teaching and learning, less access to educational and research resources, job losses and increased student debt. However, virtual education has been impeded by limited internet connectivity, a scarcity of computer equipment, and a lack of digital literacy. The study underlines the importance of adopting distance education technology in order to mitigate the consequences of COVID-19 and potential future pandemics on university education. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Parallel to the covid-19 pandemic, the World Health Organization warns of an infodemic of fake news related to the disease. This integrative review investigates the dimension of this phenomenon and how science found ways to confront it. A bibliographic search was conducted on the Scopus/Elsevier and Medline/PubMed databases, retrieving 23 articles. Literature analysis found that fake news provide false social support and mobilize feelings which make them more acceptable than the truth. Hence, social media and the internet emerge as platforms to spread false information. Research suggests that government and media institutions can use communication channels and monitoring and infoveillance technologies as allies to alert, elucidate, and remove misleading content. We find the need of investments in scientific and digital literacy actions so people may assess the quality of the information they receive. Finally, this study proposes the adoption of creative strategies to foster reasoning skills together with scientific information translated into an accessible language, preferably approved by health and institutional authorities. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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Background: Real world research has long required adaptability and flexibility to respond to the challenges and changing contexts in which we operate. But, how can we adapt when a global pandemic interrupts usual strategies and contingency planning? Aim/Objectives: The aim of this critical review was to examine strategies that effectively support the delivery of successful research projects in primary care during the pandemic. Method(s): Using a pragmatic case review approach, we examined three projects undertaken by our team during the first two years of the covid-19 pandemic. Content analysis of project documentation and progress reports was undertaken, examining timelines and impacts of events on research strategy. Robust debrief sessions were held with project staff, examining project-specific risks, strengths and weaknesses of strategies attempted/used, and project outcomes. Finding(s): Common issues for the three projects related to timely and effective consultation with participants when face-to-face contact was either impossible or severely restricted. Challenges included: delivering interventions through repeated lockdowns;recruiting patients in clinical practice;relocating classroom environment to online;and mitigating ethical risks to participants during video recording. Strategies successfully applied included moving co-design in-person sessions to a zoom environment mid-project;open and timely consultation and genuine collaborative practice with participants, stakeholders, staff and governing bodies;utilisation of networks;and the availability of online communication and research tools. Factors facilitating success included strong relationships established with research participants;agile and skilled research team;digital literacy of participants;and a shared belief in the importance of the projects. Implications: Use of technology for research has increased substantially since the beginning of the pandemic, enhancing the responsiveness of researchers to changing circumstances. However, the effectiveness of technology to support research in a rapidly changing and unstable environment is dependent on the ability of researchers to communicate effectively with research participants, stakeholders and team members.
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Background: Chronic lymphocytic leukemia (CLL) and myelodysplastic syndromes (MDS) are two of the most frequent hematological malignancies. CLL and MDS are also considerably heterogeneous in terms of clinical course and response to treatment, ranging from relatively indolent to extremely aggressive. Thus, open issues abound regarding the impact of CLL and MDS and their treatment on patients' quality of life (QoL). Patient-reported outcomes (PROs) have been identified as an emerging paradigm, aiming to capture the patient's perspective onselfassessed health status. Obviously, these data are critical with regards to the evaluation of the treatment effects and the patients' QoL, while also enabling the positioning of the patient as a key stakeholder within the healthcare decision making process. Novel methodologies and eHealth approaches can be valuable for the adoption of the PRO paradigm in real-world settings as they can promote richer, less obtrusive and preemptive communication which could facilitate early recognition of potential symptoms of disease or treatment adverse effects (e.g., adverse drug reactions, lack of physical activity, worsening of QoL etc.). Aims: In this , we present the lessons learned thus far from the implementation of the MyPal project, a Horizon 2020 Research & Innovation Action aiming to foster palliative care for patients with CLL and MDS by leveraging the ePRO paradigm. Methods: MyPal aspires to empower patients and their caregivers to more accurately capture their symptoms/conditions, communicate them in a seamless and effective way to their healthcare providers (HCPs);and, ultimately, to foster action through advanced methods of identification of important deviations relevant to the patient's state and QoL. To this end, MyPal developed a technical platform including a mobile app for patients with CLL and MDS, collecting information via standardized questionnaires and other information sources (e.g., wearable sensors), also enabling spontaneous symptoms reporting, educational material provision, motivational messages, discussion guides, notifications etc. A data intensive web-based dashboard platform is also provided for healthcare professionals, providing real-time analytics, enabling a better view of collected PROs and other relevant information on patients' health status. Currently, a randomised clinical study is being conducted in 4 European countries to evaluate the proposed intervention and its potential impact on patients' QoL. Results: Based on this experience, a number of key issues have emerged: (a) while patients are generally positive about the use of eHealth, they are still reluctant about engaging in eHealth clinical studies;(b) digital literacy levels differ across different age groups as well as among different cultural contexts;(c) the COVID-19 pandemic seriously hindered patient recruitment due to the widely adopted recommendations for patients to avoid visits to hospitals unless absolutely necessary but (d) the COVID-19 pandemic also highlighted the potential benefits for HCPs of using eHealth tools in order to deliver patient care in a more decentralized and patient-centric fashion. Summary/Conclusion: In conclusion, MyPal is likely to provide important new evidence about how digital health systems can be used to improve QoL and facilitate better communication between patients with hematological malignancies and HCPs.
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Background: Synchronous video visits (“telehealth”) were rapidly adopted to facilitate provision of cancer care during the COVID-19 pandemic, with little time to comprehensively assess patient and provider needs. Attitudes toward telehealth use during active treatment (vs. survivorship care) were largely unknown, as were perceptions of, experiences with, and needed support for telehealth use among older adults with cancer. Older adults in particular may face increased vulnerability to inequities in access to care due to limited digital literacy. Methods: We conducted surveys and semi-structured interviews with providers, staff, and older patients (age ≥60) from a comprehensive cancer center. Data collection occurred between Dec 2020 - Nov 2021. Results: We completed a total of 106 provider/staff surveys, 128 patient surveys, 20 provider/staff interviews, and 15 patient interviews. A majority of surveyed providers/staff felt that telehealth should “definitely be offered” during treatment-phase encounters (55.9% treatment follow-up;69.1% results communication;70.2% discussing treatment side effects). Similarly, most patients indicated they would be willing to have video visits with a member of their care team for: discussing treatment side-effects (73.5%), results communication (69.6%), and treatment follow-up (65.7%). Patients reported experiencing challenges with joining video visits (29%) and understanding the telehealth process (28%). Similarly, less than a third (30.8%) of providers/ staff agreed or strongly agreed that the institution did a good job of preparing patients for their first telehealth encounter. Patients felt the institution should do more to communicate the advantages of telehealth to older adults in handouts and videos, which included: engaging multiple family members in critical appointments (e.g., treatment decisions, end-of-life), seeing their doctor when they were too sick to travel, and reducing potential exposure to infectious disease at the clinic. Participants suggested several strategies to assist patients with limited digital literacy: offering video tutorials of the connection process, creating “fake appointments” to practice online connections, and hiring a digital navigator to assist with technical difficulties and setup of the online portal. Despite challenges, a majority of surveyed patients (65.7%) and providers/staff (76.9%) intend to continue using telehealth after the COVID-19 pandemic passes. Conclusions: Use of telehealth for cancer care was received positively by older patients and providers/staff. Taking targeted steps to enhance implementation could reduce barriers to care, including among older adults and other populations with limited digital literacy, thereby promoting greater equity of access to telehealth benefits beyond the pandemic.
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Objectives: Indonesia is entering an aging society with an older people population reaching 26.82 million people or 9.92% of the total population in 2020 and it is predicted that around one-fifth of Indonesia's population in 2045 will be older people. The senior citizen is the covid-19 most at risk due to comorbidities and low digital literacy. In Indonesia, the liver is one of the highest comorbid factors in increasing the risk of death by 13.5 times and increasing to 16.8 times in the elderly due to COVID-19. This condition increases the aging market in Indonesia but low digital literacy will affect the lower QoL. Materials and Methods: Using data from the 2014 Indonesia Family Life Survey (IFLS), this study aims to analyze mental health problems and mobile phone ownership in older adults (60) with Liver disease. Results: The analysis shows that the proportion of older people with liver disease reaches 4,07% and 59,18% are male. 57,5% of them experienced mental health problems and the percentage is higher in men. However, the percentage of elderly with liver disease experiencing mental health problems will decrease by 6,78% when they have a cellphone. The elderly SES in Indonesia has a fairly diverse distribution between provinces and 55,8% of them are still working. Nearly half of older people's education attainment is elementary school, which reaches 46.05 percent. In general, the elderly with higher digital literacy prefer to seek treatment at a formal health facility than traditional practitioners such as shamans. They tend to seek outpatient care treatment at a community health center or Puskesmas (44,11%), specialist (29,41%), and private hospital (11,76%). Conclusion: Increasing digital aging encourages elderly health literacy, as well as decreases mental health problems. Mainstreaming the digital aging issue can help various information and services needed by the elderly to be healthier, independent, and with dignity.
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BACKGROUND: The COVID-19 pandemic highlighted both the continued impact of long-standing systemic oppression on disparate health outcomes as well as the growing importance of healthcare provided through digital means. For example, an explosion in the use of telehealth for remote care noted significant disparities in use by minority groups. There is a growing recognition of the crucial importance of determinants in the digital environment and their impact on health outcomes. These digital determinants of health (DDoH) function independently as barriers to and facilitators of health as well as interact with social determinants of health (SDoH) to impact outcomes. A framework for digital health equity, detailing key DDoHs, is needed to support the work of developers in industry, health systems operations and academia. METHODS: The framework for digital health equity is an adaptation of the NIMHD Research Framework, which is the culmination of decades of work in the field of health disparities. The NIMHD framework is organized into several domains, including biological, behavioral, physical/built environment, sociocultural environment, and the health care system. Because of its particular importance at this time -we incorporate a digital environment domain with key DDoHs. RESULTS: Determinants at the individual level include digital literacy, readiness, interest, and self-efficacy. Readiness describes necessary technological equipment availability. Interest is used here to describe an individual's desire and willingness to use and trust in digital tools. Determinants at the interpersonal level include bias, interdependence, and relationship disruption. We use the term bias to describe the impact perceptions about an individual's digital literacy, readiness and interest have on clinician willingness to enroll and engage individuals with digital healthcare tools. Relationship disruption describes the complex cultural transformation encouraged by digital technologies. For disparity populations this has the potential to impact well documented relational determinants including medical mistrust and poor-quality communication. Determinants at the community level include cellular wireless and broadband access, quality and affordability as well as health system infrastructure. Determinants at the societal level include the impact of policy, data and design standards, algorithmic bias as well as social norms and ideologies in technical industry. Key examples of facilitators of positive health outcomes are provided at all levels. CONCLUSIONS: By adapting the leading health disparities research framework for digital health equity, we hope developers will benefit from decades of progress in the field of health disparities as well as see their work in the larger context of SDoHs so that we might work together towards meaningful progress in using digital means to achieve health equity for all.
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BACKGROUND: The Veterans Health Administration (VHA) has supported access to care for rural veterans, especially through widespread telemedicine adoption. The COVID-19 pandemic highlighted the importance of telemedicine due to in-person visit restrictions. However, video telemedicine requires adequate broadband access (defined as download/upload speeds of 25/ 3 Mbps). The “digital divide”, or the gulf between those who do and do not have ready access to computers and the internet, is influenced by income, rurality, and digital literacy. In the veteran population, 15% do not have home internet access and 30% live in rural areas, contributing to the digital divide. Population-based estimates of 25/3 Mbps broadband access have limited reliability and validity for research and public policy. The objective of this study was to compare two datasets measuring broadband access to calculate county-level broadband penetration rates (i.e., percentage of county population with internet at >25/3 speeds) in a veteran population. METHODS: We calculated county-level penetration rates using two publicly available datasets (2019-2020): Federal Communications Commission (FCC) fixed broadband speeds as reported by internet providers;and Microsoft US Broadband Usage (Microsoft) as estimated by package size and download time of Microsoft products. These data were linked to VHA patient data including residential rurality using rural-urban commuting area (RUCA) codes. Penetration rates were compared between and within data sources, stratified by RUCA codes classified into rural and urban categories. RESULTS: In 2020 according to FCC data, median county-level penetration rate was higher at 85% compared to 37% using Microsoft data. Within data sources, penetration rates generally increased over time (FCC: Mean Difference=3.2%;p<0.001) and (Microsoft: Mean Difference= 11.0%;p<0.001) from 2019 to 2020. Only 15.2% of veterans living in counties with the best FCC penetration rates were from a rural region whereas 98.5% of veterans in the worst FCC counties were classified as rural (Table). CONCLUSIONS: FCC data report higher penetration rates, overall, compared to Microsoft data, potentially overestimating broadband access. Regardless of data source, rural veterans live in counties with lower (worse) penetration rates compared to urban counterparts. Broadband access may disproportionately affect rural veterans and their ability to use video telemedicine. Future work should link broadband penetration rates to differences in telemedicine use.
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BACKGROUND: The COVID-19 pandemic forced many primary care visits from in-person to remote via telemedicine, including phone and video visits. Health systems face challenges ensuring telemedicine access for patients with limited English proficiency (LEP) who are disproportionately seen in safetynet health settings. METHODS: We examined safety-net health settings delivering primary care via telemedicine during the pandemic and participating in a quality improvement collaborative across California (n=43 sites, n=11 interview sites). All sites reported the number and modality of primary care visits (in-person, phone, video), patient demographics, payer mix, and language needs. For qualitative data, we purposively sampled to capture sites representing geographic diversity, a range of telemedicine maturity, and with large populations of patients best served in non-English languages. We then conducted semistructured interviews focused on barriers and facilitators to use and uptake of telemedicine among patients, providers, and staff. Interviews were audio recorded, transcribed, and analyzed with a focus on language-specific considerations, using a mixed inductive/deductive approach informed by the Consolidated Framework for Implementation Research. RESULTS: The sites cared for racially and ethnically diverse patients with nearly 75% on Medicaid. Over half of patients (52%) across sites were better served in a language other than English (median: 50%, range 39-83%). All sites experienced an immense increase in the number of telemedicine visits conducted in the six months after March 2020 compared with the six months prior (range: 258-8,273,200%). As of February 2021, most sites provided a minority of telemedicine visits over video compared with phone (median: 5% video, range 0-69%). Interview data showed that most sites mapped telephone visits workflows onto pre-existing infrastructure and resources. Telemedicine vendors provided limited language options and sites faced challenges integrating interpretation services into video visits. Interview respondents were concerned that patients with LEP faced intersecting challenges related to technology access and limited digital literacy, exacerbating language-related barriers to telemedicine. Sites relied on language concordant staff and additional technical support to overcome barriers and facilitate access for LEP patients. CONCLUSIONS: While telemedicine has potential to increase access to primary care, care settings must prioritize language concordance among patients, providers, and staff, and telemedicine platform developers must adapt existing tools to improve their accessibility for patients with LEP.
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As the COVID-19 pandemic continues globally, educators are facing the reality that hybrid learning is here to stay. In practical based subjects like the molecular life sciences this presents challenges, but also opportunities. The forced move to remote online delivery during the pandemic provided opportunities to reinvigorate and critique our teaching like never before. As we move forward, we are being tasked with deciding what aspects of our courses are essential to be delivered face-to-face and what can best be delivered online, and how do we ensure students have equitable learning opportunities. In the sciences we offer practical experiences as places for skill development and linking of theory with application, but also for social connection. Participation in these authentic activities provide opportunities for students to establish a scientific identity and a sense of belonging to the scientific community. What our students have shown us over the last 2 years is that engagement and social connection online is even more essential for their success, alongside the provision of authentic experiences that are meaningful and well-structured. Through the exploration of a case study from a research-intensive university in Australia, I will share insights from the delivery of a large first year molecular biology course (>850 students), a second year biochemistry course (>450 students), and a researchintensive third year capstone course (24 students), which were delivered completely online or in a hybrid model in 2020-2022. Students very clearly state that online learning is not preferred, however the flexibility with online learning can develop many key employability skills, particularly in regards to communication, teamwork, creativity and digital literacy. During this presentation, I welcome discussion on experiences of educators and shared insights in paving a new way forward in the hybrid delivery model of traditionally intense face-to-face courses.